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
Integrate best practices pertaining to goals of care discussions and care delivery to patients.	Integrate best practices pertaining to goals of care discussions and care delivery to patients. - Outstanding	Integrate best practices pertaining to goals of care discussions and care delivery to patients. - Good	Integrate best practices pertaining to goals of care discussions and care delivery to patients. - Satisfactory	Integrate best practices pertaining to goals of care discussions and care delivery to patients. - Fair	Integrate best practices pertaining to goals of care discussions and care delivery to patients. - Poor
Identify resources to support goal concordant care.	Identify resources to support goal concordant care. - Outstanding	Identify resources to support goal concordant care. - Good	Identify resources to support goal concordant care. - Satisfactory	Identify resources to support goal concordant care. - Fair	Identify resources to support goal concordant care. - Poor
Discuss goals of care with their patients earlier on in their care and throughout.	Discuss goals of care with their patients earlier on in their care and throughout. - Outstanding	Discuss goals of care with their patients earlier on in their care and throughout. - Good	Discuss goals of care with their patients earlier on in their care and throughout. - Satisfactory	Discuss goals of care with their patients earlier on in their care and throughout. - Fair	Discuss goals of care with their patients earlier on in their care and throughout. - 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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