1 Start 2 Complete

Learner Demographics *

Physician

Speech-Language Pathologist

Nurse

Other

Please specify: *

Future activities on this subject matter are necessary/important to my practice? *

Yes

No

What do you think about the length of the entire consortium? *

Too long

Too short

Just right

Other

Describe:

Do you feel an appropriate amount of topics have been addressed? There are...

Too many topics

Too few topics

Just the right amount

What other topics would you like to learn more about?

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

	Outstanding	Good	Satisfactory	Fair	Poor
Distinguish between appropriate surgical, medical, and radiation therapy options for specific tumor types and disease stages.	Distinguish between appropriate surgical, medical, and radiation therapy options for specific tumor types and disease stages. - Outstanding	Distinguish between appropriate surgical, medical, and radiation therapy options for specific tumor types and disease stages. - Good	Distinguish between appropriate surgical, medical, and radiation therapy options for specific tumor types and disease stages. - Satisfactory	Distinguish between appropriate surgical, medical, and radiation therapy options for specific tumor types and disease stages. - Fair	Distinguish between appropriate surgical, medical, and radiation therapy options for specific tumor types and disease stages. - Poor
Discuss approaches for improving collaboration among surgical oncology, medical oncology, radiation oncology, radiology, pathology, and supportive-care teams.	Discuss approaches for improving collaboration among surgical oncology, medical oncology, radiation oncology, radiology, pathology, and supportive-care teams. - Outstanding	Discuss approaches for improving collaboration among surgical oncology, medical oncology, radiation oncology, radiology, pathology, and supportive-care teams. - Good	Discuss approaches for improving collaboration among surgical oncology, medical oncology, radiation oncology, radiology, pathology, and supportive-care teams. - Satisfactory	Discuss approaches for improving collaboration among surgical oncology, medical oncology, radiation oncology, radiology, pathology, and supportive-care teams. - Fair	Discuss approaches for improving collaboration among surgical oncology, medical oncology, radiation oncology, radiology, pathology, and supportive-care teams. - Poor
Examine early supportive-care strategies, including speech-language pathology, nutrition, dental oncology, and rehabilitation involvement.	Examine early supportive-care strategies, including speech-language pathology, nutrition, dental oncology, and rehabilitation involvement. - Outstanding	Examine early supportive-care strategies, including speech-language pathology, nutrition, dental oncology, and rehabilitation involvement. - Good	Examine early supportive-care strategies, including speech-language pathology, nutrition, dental oncology, and rehabilitation involvement. - Satisfactory	Examine early supportive-care strategies, including speech-language pathology, nutrition, dental oncology, and rehabilitation involvement. - Fair	Examine early supportive-care strategies, including speech-language pathology, nutrition, dental oncology, and rehabilitation involvement. - 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

What percentage of information presented during the activity was new to you? *

0-20%

21-40%

41-60%

61-80%

81-100%

The information presented:

	Yes	No
Was timely and will influence how I practice	Was timely and will influence how I practice - Yes	Was timely and will influence how I practice - No
Will assist me in improving patient care	Will assist me in improving patient care - Yes	Will assist me in improving patient care - No
Fulfilled my educational needs	Fulfilled my educational needs - Yes	Fulfilled my educational needs - No

The information presented (check all that apply): *

Reinforced my current practice/treatment habits

Will improve my practice/patient outcomes

Provided new ideas or information I expect to use

Enhanced my current knowledge base

Does not directly apply to my practice

Will the information presented cause you to make any changes in your practice? *

Yes

No

Please describe any change(s) you plan to make in your practice as a result of this activity: *

How committed are you to making these changes? *

5 is very committed, 1 is not at all committed

5

4

3

2

1

Are there any existing barriers/factors that may prevent you from implementing a change in practice? *

Yes

No

Please describe: *

Please identify a topic which you found most impressive

Please identify a topic which you found was not addressed as well as you would have hoped for

Was any bias toward a commercial interest noted in the information provided (products/services unduly favored or promoted)?

Yes

No

Please identify products/service, faculty and or presentation(s) that were biased:

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

Yes

No

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

Comments:

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