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Evaluation of this Program (ACPA 2023 CME Conference)
1.
Was the information presented in this activity biased and/or compromised by commercial support?
Yes
No
If Yes, please explain.
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.
3.
How do you rate Dr. Stanos's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
4.
How do you rate Dr. Webster's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
5.
How do you rate Dr. Zimmerman's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
6.
How do you rate Dr. Duvall's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
7.
How do you rate Dr. Sandoval's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
8.
How do you rate Dr. Gupta's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
9.
How do you rate Dr. Twillman's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
10.
How do you rate Dr. Kobak's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
11.
How do you rate Dr. Gokani's delivery of this education?
Excellent
Very Good
Average
Needs Improvement
12.
Did this activity provide new information to you?
Yes
No
13.
Was the educational approach used in this activity conducive to your learning experience?
Yes
No
14.
Was the information presented applicable to your clinical practice?
Yes
No
15.
Will the information presented help you to improve your patients’ outcomes?
Yes
No
16.
This activity increased my knowledge, competence, and/or will improve my performance in my practice
Yes
No
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
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
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.
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)
21.
Please give us your overall comments regarding this activity.
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.]
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
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
25.
What is your specialty (Ex. Family Practice, Neurology, etc)
26.
How many years have you been in practice?
< 10
10-20
21-30
> 30
27.
How many days a week do you see patients?
0-1
2-3
4-5
6-7
28.
How many patients do you typically see per day?
0-10
11-20
21-30
31-40
> 40
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)