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
Improve ability to identify complex patient situations.	Improve ability to identify complex patient situations. - Outstanding	Improve ability to identify complex patient situations. - Good	Improve ability to identify complex patient situations. - Satisfactory	Improve ability to identify complex patient situations. - Fair	Improve ability to identify complex patient situations. - Poor
Integrate multidisciplinary input into each physician’s patient care.	Integrate multidisciplinary input into each physician’s patient care. - Outstanding	Integrate multidisciplinary input into each physician’s patient care. - Good	Integrate multidisciplinary input into each physician’s patient care. - Satisfactory	Integrate multidisciplinary input into each physician’s patient care. - Fair	Integrate multidisciplinary input into each physician’s patient care. - Poor
Examine radiologic findings associated with complex presentations. This includes but is not limited to assessment of chest wall invasion, determination of metastatic sites, and correlation of radiologic to pathologic findings.	Examine radiologic findings associated with complex presentations. This includes but is not limited to assessment of chest wall invasion, determination of metastatic sites, and correlation of radiologic to pathologic findings. - Outstanding	Examine radiologic findings associated with complex presentations. This includes but is not limited to assessment of chest wall invasion, determination of metastatic sites, and correlation of radiologic to pathologic findings. - Good	Examine radiologic findings associated with complex presentations. This includes but is not limited to assessment of chest wall invasion, determination of metastatic sites, and correlation of radiologic to pathologic findings. - Satisfactory	Examine radiologic findings associated with complex presentations. This includes but is not limited to assessment of chest wall invasion, determination of metastatic sites, and correlation of radiologic to pathologic findings. - Fair	Examine radiologic findings associated with complex presentations. This includes but is not limited to assessment of chest wall invasion, determination of metastatic sites, and correlation of radiologic to pathologic findings. - 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?

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