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Dept of Geriatric Medicine's Grand Rounds Evaluation Form
Please complete this evaluation in order to receive CME credits.
Return to the Grand Rounds Page:
https://geriatrics.jabsom.hawaii.edu/grand-rounds/
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Email
*
Your email
Requesting Continuing Education Credits?
The Hawaii Consortium Hawaii Consortium for Continuing Medical Education designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™
Certificate of Attendance
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Full Name
*
Your answer
Degree
*
Your answer
License Number
Your answer
Speaker
*
Your answer
Date
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MM
/
DD
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YYYY
Session Title
Your answer
Objectives/Content
On a scale from 1 = low to 5 = high, please rate the following
This session met its stated objectives
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Strongly Disagree
1
2
3
4
5
Strongly Agree
This session's content has application to my practice and/or work.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
This session helped expand my knowledge or skills in geriatric care.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
This training will help me empower my patients
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Strongly Disagree
1
2
3
4
5
Strongly Agree
Because of this session, I can see ways to improve my practice. (If so, please explain below).
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Strongly Disagree
1
2
3
4
5
Strongly Agree
Please describe change:
Your answer
Presenter
On a scale from 1 = low to 5 = high, please rate the following
The presenter demonstrated mastery of topic.
*
Strongly Disagree
1
2
3
4
5
Strongly Agree
The presenter offered content in an understandable and useful manner.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
The presenter used appropriate and relevant examples and key linkages to areas of geriatrics and gerontology.
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Strongly Disagree
1
2
3
4
5
Strongly Agree
I would recommend this presenter to others.
*
Strongly Disagree
1
2
3
4
5
Strongly Agree
Overall
On a scale from 1 = low to 5 = high, please rate the following
Overall quality of the session.
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Poor
1
2
3
4
5
Excellent
My knowledge or this topic prior to this session:
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Poor
1
2
3
4
5
Excellent
My knowledge of this topic after the session.
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Poor
1
2
3
4
5
Excellent
Misc.
Did you detect any commercial bias?
*
Yes
No
What was your main "take home" message from this training? How would you apply this knowledge?
Your answer
What additional topics and/or speakers should be included in the future?
Your answer
Thank you for participating in this evaluation!
If you have questions or issues with this form, please contact
nakasone@hawaii.edu
A copy of your responses will be emailed to the address you provided.
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