Enduring material evaluation template

Quality of Instruction *

Please evaluate this course according to the following scale: (1 = poor; 2 = fair; 3 = good; 4 = excellent)

	Poor	Fair	Good	Excellent
Impact of Learning Objectives	Impact of Learning Objectives - Poor	Impact of Learning Objectives - Fair	Impact of Learning Objectives - Good	Impact of Learning Objectives - Excellent
Quality of The Content	Quality of The Content - Poor	Quality of The Content - Fair	Quality of The Content - Good	Quality of The Content - Excellent
Quality of Presentation	Quality of Presentation - Poor	Quality of Presentation - Fair	Quality of Presentation - Good	Quality of Presentation - Excellent
Scientific Integrity	Scientific Integrity - Poor	Scientific Integrity - Fair	Scientific Integrity - Good	Scientific Integrity - Excellent
Held My Interest	Held My Interest - Poor	Held My Interest - Fair	Held My Interest - Good	Held My Interest - Excellent
Increased my confidence in managing clinical or professional issues	Increased my confidence in managing clinical or professional issues - Poor	Increased my confidence in managing clinical or professional issues - Fair	Increased my confidence in managing clinical or professional issues - Good	Increased my confidence in managing clinical or professional issues - Excellent
Relevant to My Practice	Relevant to My Practice - Poor	Relevant to My Practice - Fair	Relevant to My Practice - Good	Relevant to My Practice - Excellent
Appropriate Level of Difficulty	Appropriate Level of Difficulty - Poor	Appropriate Level of Difficulty - Fair	Appropriate Level of Difficulty - Good	Appropriate Level of Difficulty - Excellent
Easy to Navigate	Easy to Navigate - Poor	Easy to Navigate - Fair	Easy to Navigate - Good	Easy to Navigate - Excellent
Worth My Time	Worth My Time - Poor	Worth My Time - Fair	Worth My Time - Good	Worth My Time - Excellent
Overall Course Rating	Overall Course Rating - Poor	Overall Course Rating - Fair	Overall Course Rating - Good	Overall Course Rating - Excellent
My Recommendation to Colleagues	My Recommendation to Colleagues - Poor	My Recommendation to Colleagues - Fair	My Recommendation to Colleagues - Good	My Recommendation to Colleagues - Excellent

Commercial Bias *

	Yes	No
Course Was Free of Bias	Course Was Free of Bias - Yes	Course Was Free of Bias - No

Do you intend to make any changes to your practice as a result of this activity? *

Yes

No

Practice Changes *

Select the single best answer.

I will change the management and/or treatment of my patients

I will create/revise protocols, policies, and/or procedures

I will seek additional information on this topic.

Other...

Practice Changes Other...

No Changes *

This activity validated my current practice; no changes will be made.

I will do nothing differently. System barriers prevent me from changing my practice.

Not applicable to my current practice or position.

Other...

No Changes Other...

Course suggestions

Please list any topics where you see a need for more education.

Improvement suggestions

Please describe any ways we might improve this educational activity.

Evaluate and treat confidence level *

Has your confidence level in the following areas increased as a result of your participation in this activity?

	No	Somewhat	Yes
Code correctly for your services	Code correctly for your services - No	Code correctly for your services - Somewhat	Code correctly for your services - Yes
Choose the correct ICD-10 diagnosis	Choose the correct ICD-10 diagnosis - No	Choose the correct ICD-10 diagnosis - Somewhat	Choose the correct ICD-10 diagnosis - Yes

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