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 most current research findings which apply to specific patient care issues and clinical needs.	Identify most current research findings which apply to specific patient care issues and clinical needs. - Outstanding	Identify most current research findings which apply to specific patient care issues and clinical needs. - Good	Identify most current research findings which apply to specific patient care issues and clinical needs. - Satisfactory	Identify most current research findings which apply to specific patient care issues and clinical needs. - Fair	Identify most current research findings which apply to specific patient care issues and clinical needs. - Poor
Assess and communicate individual patient and family needs.	Assess and communicate individual patient and family needs. - Outstanding	Assess and communicate individual patient and family needs. - Good	Assess and communicate individual patient and family needs. - Satisfactory	Assess and communicate individual patient and family needs. - Fair	Assess and communicate individual patient and family needs. - Poor
Demonstrate understanding and provide the highest standards of evidence-based care.	Demonstrate understanding and provide the highest standards of evidence-based care. - Outstanding	Demonstrate understanding and provide the highest standards of evidence-based care. - Good	Demonstrate understanding and provide the highest standards of evidence-based care. - Satisfactory	Demonstrate understanding and provide the highest standards of evidence-based care. - Fair	Demonstrate understanding and provide the highest standards of evidence-based care. - 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