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A Guide to Mainpro Accreditation - The College of Family Physicians ...

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APPENDIX 5: Sample Evaluation Form<br />

Title:<br />

CME PROGRAM EVALUATION<br />

Date:<br />

Location:<br />

EDUCATIONAL OBJECTIVES<br />

<strong>The</strong> program met the stated objectives:<br />

Strongly<br />

Strongly<br />

Neutral<br />

Agree<br />

Disagree<br />

1. 5 4 3 2 1<br />

2. 5 4 3 2 1<br />

3. 5 4 3 2 1<br />

4. 5 4 3 2 1<br />

PROGRAM CONTENT and DELIVERY<br />

Strongly<br />

Strongly<br />

Neutral<br />

Agree<br />

Disagree<br />

<strong>The</strong> program content was relevant <strong>to</strong> family medicine. 5 4 3 2 1<br />

<strong>The</strong> program met my expectations. 5 4 3 2 1<br />

<strong>The</strong> program was well organized. 5 4 3 2 1<br />

Disclosure <strong>of</strong> potential conflicts <strong>of</strong> interest was clearly communicated. 5 4 3 2 1<br />

Faculty members were effective in delivering/facilitating the program. 5 4 3 2 1<br />

<strong>The</strong>re were adequate opportunities <strong>to</strong> interact with my peers. 5 4 3 2 1<br />

<strong>The</strong>re were adequate opportunities <strong>to</strong> interact with program faculty. 5 4 3 2 1<br />

<strong>The</strong> information I learned will be used in my future practice. 5 4 3 2 1<br />

Did you perceive any degree <strong>of</strong> commercial bias in any part <strong>of</strong> the program Yes<br />

No<br />

*If ‘Yes’, please describe:<br />

What was the most effective part <strong>of</strong> the program Why<br />

What was the least effective part <strong>of</strong> this program Why<br />

Describe two ways in which you will change your practice as a result <strong>of</strong> attending this program:<br />

1.<br />

2.<br />

Please list any <strong>to</strong>pics you would like <strong>to</strong> see addressed in future programs:<br />

General Comments:<br />

Thank you for completing the program evaluation. Please return form <strong>to</strong> the program organizer.<br />

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