Evaluation of this Program (ACPA 2023 CME Conference) Question Title * 1. Was the information presented in this activity biased and/or compromised by commercial support? Yes No If Yes, please explain. Question Title * 2. Did this activity meet its stated learning objectives? Check ALL that were met. Identify the unmet need and disease burden associated with pain conditions. Illustrate the pathophysiology of multiple pain conditions. Review the diagnostic criteria of several pain conditions. Analyze and document pain condition relationships during disease attacks using a phase model. Recognize patients that qualify for therapy to expand management capabilities. Explain how pain conditions become chronic and how to prevent progression. Use a communication guide in practice to explain pain conditions to improve patient outcomes. Question Title * 3. How do you rate Dr. Stanos's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 4. How do you rate Dr. Webster's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 5. How do you rate Dr. Zimmerman's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 6. How do you rate Dr. Duvall's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 7. How do you rate Dr. Sandoval's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 8. How do you rate Dr. Gupta's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 9. How do you rate Dr. Twillman's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 10. How do you rate Dr. Kobak's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 11. How do you rate Dr. Gokani's delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 12. Did this activity provide new information to you? Yes No Question Title * 13. Was the educational approach used in this activity conducive to your learning experience? Yes No Question Title * 14. Was the information presented applicable to your clinical practice? Yes No Question Title * 15. Will the information presented help you to improve your patients’ outcomes? Yes No Question Title * 16. This activity increased my knowledge, competence, and/or will improve my performance in my practice Yes No Question Title * 17. Of the patients you will see in the next week, about how many will benefit from the information you learned by participating in this activity? 1-10 11-25 26-50 >50 Question Title * 18. Based upon your participation in this activity, do you intend to change your practice behavior? Yes, I plan to implement changes in my practice based on the information presented No, I need more information before I will make any changes to my practice behavior Not applicable – My current practice has been reinforced by the information presented Question Title * 19. If you plan to change your practice behavior, what type of change(s) do you plan to implement? Check all that apply. Differentiate and diagnose pain conditions. Treat and manage pain conditions. Utilize pain management techniques on a case-by-case basis Recognize patients that qualify for therapy to expand management capabilities. Question Title * 20. Are there any barriers that would keep you from implementing the practice paradigms discussed in this activity? Lack of evidence-based guidelines Lack of applicability of guidelines to my current practice and/or patients Lack of time Organizational/Institutional Insurance/Financial Patient Adherence/Compliance Treatment related adverse events No perceived barriers Other (please specify) Question Title * 21. Please give us your overall comments regarding this activity. Question Title * 22. Claim Credit I certify that I have participated in the number of hours (0.25 increments, up to 6.25 hours chosen below) of this educational activity and request a CME certificate indicating that number of credits. I will claim only the total number of hours for which I participated. [Please print legibly.] Question Title * 23. Number hours you participated in this activity (0.25 increments, up to 6.25 hours). 6.25 6.0 5.75 5.5 5.25 5 4.75 4.5 4.25 4.0 3.75 3.5 3.25 3.0 2.75 2.5 2.25 2.0 1.75 1.5 1.25 1.0 0.75 0.5 0.25 Question Title * 24. Please Fill out the form below for your CME/CE Certificate First and Last Name Title (MD, DO, NP, PA, RN, etc.) Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 25. What is your specialty (Ex. Family Practice, Neurology, etc) Question Title * 26. How many years have you been in practice? < 10 10-20 21-30 > 30 Question Title * 27. How many days a week do you see patients? 0-1 2-3 4-5 6-7 Question Title * 28. How many patients do you typically see per day? 0-10 11-20 21-30 31-40 > 40 Question Title * 29. What is your practice like? Solo or small group (1-5 providers) Large group (> 5 providers) Government Owned Facility/Clinic Retired/Not Seeing Patients Other (please specify) Done