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
Demonstrate the important aspects of clinical and non-clinical hospice and palliative medicine.	Demonstrate the important aspects of clinical and non-clinical hospice and palliative medicine. - Outstanding	Demonstrate the important aspects of clinical and non-clinical hospice and palliative medicine. - Good	Demonstrate the important aspects of clinical and non-clinical hospice and palliative medicine. - Satisfactory	Demonstrate the important aspects of clinical and non-clinical hospice and palliative medicine. - Fair	Demonstrate the important aspects of clinical and non-clinical hospice and palliative medicine. - Poor
Assess patients for palliative and end of life symptoms and apply their knowledge in a clinical setting.	Assess patients for palliative and end of life symptoms and apply their knowledge in a clinical setting. - Outstanding	Assess patients for palliative and end of life symptoms and apply their knowledge in a clinical setting. - Good	Assess patients for palliative and end of life symptoms and apply their knowledge in a clinical setting. - Satisfactory	Assess patients for palliative and end of life symptoms and apply their knowledge in a clinical setting. - Fair	Assess patients for palliative and end of life symptoms and apply their knowledge in a clinical setting. - Poor
Be prepared to take the Hospice and Palliative Medicine Board Exams and Hospice Medical Director Certification Board Exam.	Be prepared to take the Hospice and Palliative Medicine Board Exams and Hospice Medical Director Certification Board Exam. - Outstanding	Be prepared to take the Hospice and Palliative Medicine Board Exams and Hospice Medical Director Certification Board Exam. - Good	Be prepared to take the Hospice and Palliative Medicine Board Exams and Hospice Medical Director Certification Board Exam. - Satisfactory	Be prepared to take the Hospice and Palliative Medicine Board Exams and Hospice Medical Director Certification Board Exam. - Fair	Be prepared to take the Hospice and Palliative Medicine Board Exams and Hospice Medical Director Certification Board Exam. - 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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