EVALUATION & FEEDBACK FORM
Kindly complete the questionnaire and help us to evaluate the usefulness of this program
Name
*
First Name
Last Name
Email
*
example@example.com
Please indicate your affiliation:
*
Staff Physician
Fellow
Resident
Nurse Practitioner
Respiratory Therapist
Allied Health
Sonographer
Other
1. Evaluation for Hemodynamics club at WCPM 2019
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Of little or no use to me
Of some use to me
Useful
Very useful with minor shortcomings
Extremely useful
10.30 – 11.00 Physiologic approach to hemodynamics (MG Abdul Wahab)
11.00 – 11.30 Interactive discussion of case scenarios (physiology) (MG Abdul Wahab)
11.30 – 12.00 Basics of echocardiography and ultrasound (Hanifi Soylu)
13.30 – 14.00 Near infrared spectroscopy in hemodynamic assessment (Hanifi Soylu)
14.00 – 14.30 Interactive discussion of case scenarios (NIRS) (Hanifi Soylu)
14.30 – 15.00 Integrated hemodynamic assessment (Hanifi Soylu)
15.30 – 16.00 Neonatal targeted echocardiography (MG Abdul Wahab)
16.00 – 16.30 Lung USG in hemodynamic assessment (MG Abdul Wahab)
16.30 – 17.00 Interactive Case Discussion (MG Abdul Wahab)
2. Did you perceive any degree of bias in any part of the program?
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YES
NO
If YES, please explain
3. Please rate your overall impressions of the whole program
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YES
NO
Did you find this course interesting?
Did this program meet your expectations?
Was there adequate provision for questions and discussion?
Was the program organized to your satisfaction?
Did you learn something new from this program?
Did you learn something you would use in your practice?
4. As a result of this activity I plan to incorporate the following changes into my practice:
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6. What changes would you suggest to improve the format of today’s program?
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7. Additional comments and feedbacks
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