Boston, MA 02118
P: 617.638.4605
www.bu.edu/cme
Evaluation Template
Activity Title: / Activity Date:
Speaker/ Presenter 1: / Speaker/ Presenter 2:
1. How would you rate this educational activity overall? (5 = excellent, 1 = poor, please circle one)
5 4 3 2 1
2. Did you feel that there was commercial bias[1] (regarding pharmaceuticals, medical device companies, or other medical products) in this activity?
Yes If yes, please explain:
No
3. How will what you learned in this session impact your practice, your patient care, and the system in which you work? What will you change or do differently?
4. What barriers, besides time and/or money, do you anticipate encountering as you make changes in your practice?
5. Do you feel each of the following objectives was met?
· Insert Objective 1 / Yes No Partially N/A· Insert Objective 2 / Yes No Partially N/A
· Insert Objective 3 (Please add additional spaces for additional objectives) / Yes No Partially N/A
6. Do you feel that the information presented was based on the best available evidence?
Yes If no, please explain:
No
7. Which of the following competency areas do you feel have been improved as a result of this activity? (Mark all that apply)
Patient Care / Professionalism / Practice Based LearningMedical Knowledge / System Base Practice / Communication Skills
8. Please suggest topics for future activities.
General Comments:
Boston University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Boston University School of Medicine designates this live activity for a maximum of <Insert # Here> AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
***IF APPLICABLE:
This program meets the criteria of the Massachusetts Board of Registration in Medicine for risk management study.
This program meets the criteria of the Massachusetts Board of Registration in Medicine for <Insert # Here> hours of opioid education.
This program meets the criteria of the Massachusetts Board of Registration in Medicine for <Insert # Here> hours of end of life care education
[1] Defined as: information presented in a manner that attempts to sway participants’ opinions in favor of a particular commercial product for the express purpose of furthering a commercial entity’s business, meaning a deliberate intent to mislead. (The Journal of Continuing Education in the Health Professions, Volume 26, pp. 161-167).