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Continuing Medical Education Evaluation & Credit Claims
Which activity did you attend?
STEMI M&M
Stroke M&M
Trauma M&M
Tumor Boards Case Conference
7/18/23 Provider CME Stand Alone Conference
Date of activity
-
Month
-
Day
Year
Date
Do you want to evaluate and claim credit for another activity?
Yes
No
Which activity did you attend?
Anesthesia RSS
Cardiovascular - Adult Congenital Heart Disease Case Conference
Cardiovascular CICU Case Conference
Cardiovascular Educational Dinners
Cardiovascular Grand Rounds
Cardiovascular - Lee's Summit East Lunch & Learn
Cardiovascular MMI M&M
Cardiovascular Morning Report Case Conference
Cardiovascular Surgery Critical Care Case Reviews
Carotid M&M
Echocardiography Physician Monthly Meeting Journal Club
Epilepsy Surgical Case Conference
General and Craniofunctional M&M
GI RSS
Maternal-Fetal Case Conference
Medicine Grand Rounds
Medicine Journal Club
Multidisciplinary Cancer - Brain
Multidisciplinary Cancer - Breast
Multidisciplinary Cancer - GI
Multidisciplinary Cancer - GYN
Multidisciplinary Cancer - Thoracic
Multidisciplinary Cancer Head and Neck
Multi-specialty Vascular Conference Case Conference
Neonatal ICU PR M&M
Neonatal Journal Club
Neuroscience Grand Rounds
Neuroscience M&M
Neurosurgery M&M
Neurovascular Case Conference
Ortho Case Conference
Ortho Grand Rounds
Spine Case Conference
Spine IPU Journal Club
Spine M&M
STEMI Peer Review M&M
Structural Heart Case Conference
Surgery Grand Rounds
Surgery M&M
Trauma Grand Round
Trauma M&M
Trauma Peer Review M&M
Date of activity
-
Month
-
Day
Year
Date
Do you want to evaluate and claim credit for another activity?
Yes
No
Which activity did you attend?
Anesthesia RSS
Cardiovascular - Adult Congenital Heart Disease Case Conference
Cardiovascular CICU Case Conference
Cardiovascular Educational Dinners
Cardiovascular Grand Rounds
Cardiovascular - Lee's Summit East Lunch & Learn
Cardiovascular MMI M&M
Cardiovascular Morning Report Case Conference
Cardiovascular Surgery Critical Care Case Reviews
Carotid M&M
Echocardiography Physician Monthly Meeting Journal Club
Epilepsy Surgical Case Conference
General and Craniofunctional M&M
GI RSS
Maternal-Fetal Case Conference
Medicine Grand Rounds
Medicine Journal Club
Multidisciplinary Cancer - Brain
Multidisciplinary Cancer - Breast
Multidisciplinary Cancer - GI
Multidisciplinary Cancer - GYN
Multidisciplinary Cancer - Thoracic
Multidisciplinary Cancer Head and Neck
Multi-specialty Vascular Conference Case Conference
Neonatal ICU PR M&M
Neonatal Journal Club
Neuroscience Grand Rounds
Neuroscience M&M
Neurosurgery M&M
Neurovascular Case Conference
Ortho Case Conference
Ortho Grand Rounds
Spine Case Conference
Spine IPU Journal Club
Spine M&M
STEMI Peer Review M&M
Structural Heart Case Conference
Surgery Grand Rounds
Surgery M&M
Trauma Grand Round
Trauma M&M
Trauma Peer Review M&M
Date of activity
-
Month
-
Day
Year
Date
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What changes do you plan to make in your practice as a result of participating in this activity?
*
Rate your confidence in applying your new learning into practice:
*
1
2
3
4
5
Not confident
Confident
1 is Not confident, 5 is Confident
What barriers to implementing changes do you experience in your practice? Check all that apply.
Cost constraints
Insurance/Reimbursement issues
Lack of time with patients
Overwhelming amount of information
Lack of administrative or management support, workflow issues
Lack of authority to implement changes
Gaps in my knowledge and training
Lack of support staff
Gaps in support staff knowledge and training
I do not anticipate any barriers to implementing changes
Other
Did you detect any ACCME defined commercial interest bias in this activity?
*
Yes, commercial interest bias
No
If yes, to the above question please describe
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What areas of your practice could be enhanced or improved with additional education?
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The speaker(s) were effective at presenting the content
The information presented is relevant to my clinical practice
This activity will improve my ability to care for patients
This activity will improve patient outcomes
This activity increased my competence of the subject matter
The educational format was appropriate for the setting, objectives, and desired results of this activity
What are your credentials
*
MD/DO
Other
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Physicians
MD/DO
Number of Continuing Medical Education credits you are claiming:
Name
First Name
Last Name
Credentials (as you want them to appear on your certificate)
Email address for CME tracking
example@example.com
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Non-Physician
Certificate of Completion
Name
First Name
Last Name
Credentials (as you want them to appear on your certificate):
Email
example@example.com
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Submit
Should be Empty: