1 Start 2 Complete

Learner Demographics *

Physician

Nurse

Other

Overall Series Rating *

	Excellent	Satisfactory	Poor
Overall, how would you rate this series?	Overall, how would you rate this series? - Excellent	Overall, how would you rate this series? - Satisfactory	Overall, how would you rate this series? - Poor

Extent to which identified Series objectives were met: I am better able to ... *

	Outstanding	Good	Satisfactory	Fair	Poor
Identify mechanisms of the complications that a pediatric patient might have experienced.	Identify mechanisms of the complications that a pediatric patient might have experienced. - Outstanding	Identify mechanisms of the complications that a pediatric patient might have experienced. - Good	Identify mechanisms of the complications that a pediatric patient might have experienced. - Satisfactory	Identify mechanisms of the complications that a pediatric patient might have experienced. - Fair	Identify mechanisms of the complications that a pediatric patient might have experienced. - Poor
Determine methods to decrease complication rates in pediatric patients.	Determine methods to decrease complication rates in pediatric patients. - Outstanding	Determine methods to decrease complication rates in pediatric patients. - Good	Determine methods to decrease complication rates in pediatric patients. - Satisfactory	Determine methods to decrease complication rates in pediatric patients. - Fair	Determine methods to decrease complication rates in pediatric patients. - Poor
Assess system-based problems relating to pediatric complications.	Assess system-based problems relating to pediatric complications. - Outstanding	Assess system-based problems relating to pediatric complications. - Good	Assess system-based problems relating to pediatric complications. - Satisfactory	Assess system-based problems relating to pediatric complications. - Fair	Assess system-based problems relating to pediatric complications. - Poor
Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics).	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Outstanding	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Good	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Satisfactory	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Fair	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Poor

Do you believe the subject matter presented/discussed was: *

	Yes	No
Objective	Objective - Yes	Objective - No
Fair & Balanced	Fair & Balanced - Yes	Fair & Balanced - No
Free of Commercial Bias	Free of Commercial Bias - Yes	Free of Commercial Bias - No

Have you made changes to your practice as a result of this series?

Yes

No

Please describe:

Do you have any recommendations for the moderator(s)/facilitator(s) of this series?

Yes

No

Please describe:

The Series included educational components that addressed cultural linguistic competency and implicit bias

Yes

No

N/A (If a research or non-direct patient care series)

Outside of this activity, what additional topics would you like addressed in other educational opportunities?

Leave this field blank