Sutter Medical

Center, Sacramento

A Sutter Health Affiliate

EVALUATION SUMMARY REPORT – Regularly Scheduled Series

Period July 1-June 30, ______

Activity Title:______Course#______

1. Overall Educational Impact

a. Knowledge
Poor
1 / Fair
2 / Good
3 / Very Good
4 / Excellent
5 / Average Score
5 / # Responses
b. Competence
Poor
1 / Fair
2 / Good
3 / Very Good
4 / Excellent
5 / Average Score / # Responses
c. Performance
Poor
1 / Fair
2 / Good
3 / Very Good
4 / Excellent
5 / Average Score / # Responses
d. Patient Care Outcomes
Poor
1 / Fair
2 / Good
3 / Very Good
4 / Excellent
5 / Average Score / # Responses

2. Effectiveness in meeting the identified professional practice gap

Poor
1 / Fair
2 / Good
3 / Very Good
4 / Excellent
5 / Average Score / # Responses

3. Overall activity ratings

a. / Overall quality of activity
Poor
1 / Fair
2 / Good
3 / Very Good
4 / Excellent
5 / Average Score / Responses
b. / Selection of topics
Poor / Fair / Good / Very Good / Excellent / Average Score / Responses
c. / Overall quality of faculty
Poor / Fair / Good / Very Good / Excellent / Average Score / Responses
d. / Questions and Discussion
Poor / Fair / Good / Very Good / Excellent / Average Score / Responses
e. / Relevance to practice
Poor / Fair / Good / Very Good / Excellent / Average Score / Responses
f. / Educational content
Poor / Fair / Good / Very Good / Excellent / Average Score / Responses

4. Commitment to change.

Not at All / Unlikely / Somewhat Likely / Highly Likely / Definitely / Average Score / Responses

Number of MD’s______

Nurses_____ Residents_____ Other_____

5. List professional practice change responses:

6. List identified “Barriers to Change”

# of
Responses / Percentage
of total
Cost:
Lack of time to assess/counsel patients:
Lack of administrative support/resources:
Patient compliance issues:
Lack of consensus or professional guidelines:
Other (describe)
Total responses:

7. Overall Non-bias Rating:

YES:
NO:

8. Overall effectiveness in meeting cultural and linguistic competency requirements:

YES:
NO:

9. List suggested topics and formats:

10. List provided email addresses for follow-up:

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