Evaluation (Completion of this form is mandatory)
MDAZ1827
Last Name________________________________________ First Name_________________________________ MI____________ State________________________ License #_______________________________________ Expiration Date_________________
To receive continuing education credit, completion of this Evaluation is mandatory. Please answer all of the following questions and provide your signature at the bottom of this page.
Please read the following questions and choose the most appropriate answer for each course completed. # Question MDAZ03CS Responsible Prescribing of Controlled Substances 3 CE Hours MDAZ15CP Chronic Pain Syndromes:
Current Concepts and Treatment Strategies 15 CE Hours
Was the course content new or review?
1
New Review
New Review
2 How many self-assessment questions did you answer correctly? 3 How much time did you spend on this activity, including the questions?
_______ Hours
_______ Hours
Would you recommend this course to your peers?
4 5
Yes No
Yes No
Did the course content support the stated course objective?
Yes No
Yes No
6 Did the course content demonstrate the author’s knowledge of the subject?
Yes No
Yes No
Was the course content free of bias?
7
Yes No
Yes No
8 Before completing the course, did you identify the necessity for education on the topic to improve your professional practice?
Yes No
Yes No
9 Have you achieved all of the stated learning objectives of this course?
Yes No
Yes No
10 Has what you think or feel about this topic changed?
Yes No
Yes No
11 Were self-assessment questions with evaluation an effective teaching strategy?
Yes No
Yes No
12 Did evidence-based practice recommendations assist in determining the validity or relevance of the information? 13 Are you more confident in your ability to provide patient care after completing this course?
N/A
N/A
Yes No
Yes No
14 Do you plan to make changes in your practice as a result of this course content?
Yes No
Yes No
Additional Comments / Criticisms / Concerns _ _______________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ I have read the course(s) and completed the Evaluation(s) in full. Signature _ ____________________________________________________________________________________________________________ Signature required to receive continuing education credit
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