Promoting Physician Wellness - June 27, 2019

Please score your agreement with or assessment of the following questions and statements by rating on a scale of 1 to 5, with 5 representing the highest level of satisfaction or agreement. *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree NA=Not applicable to my practice

	5	4	3	2	NA
The information and/or skills learned will enhance my professional competence or ability.	The information and/or skills learned will enhance my professional competence or ability. - 5	The information and/or skills learned will enhance my professional competence or ability. - 4	The information and/or skills learned will enhance my professional competence or ability. - 3	The information and/or skills learned will enhance my professional competence or ability. - 2	The information and/or skills learned will enhance my professional competence or ability. - NA
This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients.	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 5	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 4	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 3	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 2	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - NA

As a result of participating in this course, to what extent do you agree that you will be better able to accomplish these objectives *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree 0=Not applicable to my practice

	5	4	3	2	1	0
Identify the ACGME duty hour regulations	Identify the ACGME duty hour regulations - 5	Identify the ACGME duty hour regulations - 4	Identify the ACGME duty hour regulations - 3	Identify the ACGME duty hour regulations - 2	Identify the ACGME duty hour regulations - 1	Identify the ACGME duty hour regulations - 0
Recognize the signs of fatigue, sleep deprivation and other conditions that contribute to physician impairment	Recognize the signs of fatigue, sleep deprivation and other conditions that contribute to physician impairment - 5	Recognize the signs of fatigue, sleep deprivation and other conditions that contribute to physician impairment - 4	Recognize the signs of fatigue, sleep deprivation and other conditions that contribute to physician impairment - 3	Recognize the signs of fatigue, sleep deprivation and other conditions that contribute to physician impairment - 2	Recognize the signs of fatigue, sleep deprivation and other conditions that contribute to physician impairment - 1	Recognize the signs of fatigue, sleep deprivation and other conditions that contribute to physician impairment - 0
Identify the effect of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance	Identify the effect of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance - 5	Identify the effect of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance - 4	Identify the effect of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance - 3	Identify the effect of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance - 2	Identify the effect of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance - 1	Identify the effect of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance - 0
Engage in strategies to prevent and reduce the impact of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance.	Engage in strategies to prevent and reduce the impact of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance. - 5	Engage in strategies to prevent and reduce the impact of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance. - 4	Engage in strategies to prevent and reduce the impact of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance. - 3	Engage in strategies to prevent and reduce the impact of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance. - 2	Engage in strategies to prevent and reduce the impact of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance. - 1	Engage in strategies to prevent and reduce the impact of fatigue, sleep deprivation, and other conditions on physician’s functioning and performance. - 0

Rate the following *

Scoring Key: 5=Excellent 4=Very Good 3=Good 2=Fair 1=Poor NA=Not Applicable

	5	4	3	2	1	NA
Course content.	Course content. - 5	Course content. - 4	Course content. - 3	Course content. - 2	Course content. - 1	Course content. - NA
Susan Chalfin, Ph.D.	Susan Chalfin, Ph.D. - 5	Susan Chalfin, Ph.D. - 4	Susan Chalfin, Ph.D. - 3	Susan Chalfin, Ph.D. - 2	Susan Chalfin, Ph.D. - 1	Susan Chalfin, Ph.D. - NA

Was this course fair, balanced and without commercial bias? *

Yes

No

If you checked "No,” please explain why: *

How many patients will you see in your practice who will likely be impacted by what you learned at this activity? *

1-5

6-10

Over 10

Not applicable to my practice

What do you intend to do differently in the treatment of your patients as a result of what you learned? What new strategies will you apply in your practice of patient care? *

If you do not plan to implement any new strategies learned, please list any barriers or obstacles that might keep you from doing so. *

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Promoting Physician Wellness - June 27, 2019