LEARNER RECORDS: EVALUATION You must complete the program evaluation and applicable activity evaluation(s) in order to earn AMA PRA Category 1 Credits TM , MOC points, or participation in MIPS. For each of the objectives determine if the activity increased your: A Competence B Performance C Outcome D No Change
COURSE 1 - CHILD ABUSE RECOGNITION AND REPORTING IN PENNSYLVANIA:
A B C D
1. Adhere to the requirements and reporting procedures for mandatory reporting of child abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Identify, assess, and document signs and symptoms of suspected child abuse. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Please identify a specific change, if any, you will make in your practice related to child abuse recognition and reporting.
4. What do you see as a barrier to making these changes?
COURSE 2 - ALTERNATIVES TO OPIOIDS FOR PAIN MANAGEMENT:
A B C D
5. Utilize a function-based paradigm for creating treatment plans for chronic pain conditions and follow guideline-recommended steps for initiating treatments for acute and chronic pain conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Appropriately prescribe the full range of non-opioid analgesic options for managing acute and chronic non-cancer pain. . . . . . . . . . . 7. Please identify a specific change, if any, you will make in your practice related to alternatives to opioids for pain management.
8. What do you see as a barrier to making these changes?
COURSE 3 - ASSESSMENT AND PREVENTION OF SUICIDE:
A B C D
9. Identify risk factors and utilize appropriate screening tools for patients at risk of suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Use appropriate strategies for the assessment and treatment of patients at risk of suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Please identify a specific change, if any, you will make in your practice related to assessment and prevention of suicide.
12. What do you see as a barrier to making these changes?
COURSE 4 - GUIDANCE ON PROFESSIONAL BOUNDARIES AND SEXUAL MISCONDUCT:
A B C D
13. Utilize best practices during intimate examinations, including use of chaperones and respectful communication with patient. . . . . . . 14. Recognize and report suspected sexual misconduct or assault. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. Please identify a specific change, if any, you will make in your practice related to professional boundaries and sexual misconduct.
16. What do you see as a barrier to making these changes?
COURSE 5 - INTIMATE PARTNER VIOLENCE: COMPASSIONATE CARE, EFFECTIVE ASSESSMENT:
A B C D
17. Identify the barriers that prevent effective and compassionate care of potential survivors of IPV between patient and physicians. . . . . . 18. Utilize patient interviewing techniques in situations where IPV is suspected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Please identify a specific change, if any, you will make in your practice related to intimate partner violence.
20. What do you see as a barrier to making these changes?
COURSE 6 - MEDICAL ERRORS AND THE UNITED STATES HEALTHCARE SYSTEM:
A B C D
21. Conduct appropriate root cause analysis of medical errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. Utilize strategies for the prevention and reduction of medical errors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23. Please identify a specific change, if any, you will make in your practice related to medical errors.
24. What do you see as a barrier to making these changes?
COURSE 7 - SUBSTANCE USE DISORDERS: A DEA REQUIREMENT:
A B C D
25. Discuss substance use disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26. Describe the roles of the U.S. Drug Enforcement Agency (DEA), Food and Drug Administration (FDA), and Department of Health and Human Services (HHS) in scheduling controlled substances and enforcing controlled substance laws and regulations. . . . . . . . . . 27. Understand the different DEA Controlled Substance Schedules and prescribing regulations associated with the different DEA Controlled Substance Schedules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28. Review medical marijuana legislation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29. Describe essential considerations when prescribing controlled substances, including regulatory exceptions and clinical concerns. 30. Describe controlled substance prescribing practices.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31. Understand the treatment options for patients suffering from substance use disorder (SUD).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32. Please identify a specific change, if any, you will make in your practice related to substance abuse disorders.
33. What do you see as a barrier to making these changes?
OVERALL PROGRAM:
Yes No If no, please explain:
34. The program was balanced, objective & scientifically valid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35. Do you feel the program was scientifically sound & free of commercial bias or influence? .
37. Based on your educational needs, please provide us with suggestions for future program topics & formats. 36. How can this program be improved? 38. For which activities would you like to use your participation as a clinical practice improvement activity (CPIA) for MIPS? Course 1 Course 2 Course 3 Course 4 Course 5 Course 6
Course 7
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