You can always press Enter⏎ to continue

Now create your own Jotform - It's free!Create your own Jotform

Welcome

Hi there, please fill out and submit this form.

21Questions

1
Name* This field is required.
First and Last Name
Credentials
2
Email* This field is required.
example@example.com
3
Date of Lecture* This field is required.
Date
Year
Month
Day
4
This series has increased, improved, or positively impacted my: (select all that apply)* This field is required.
Knowledge
Competence
Performance
Patient Outcomes
5
Do you feel the series is scientifically sound and free of commercial bias?* This field is required.
YESNO
6
If No, please explain:
7
Were the speakers/presenters knowledgeable regarding the content of their presentation?* This field is required.Kyle Hammond, MD
YESNO
8
If No, please explain:
9
Were the speakers/presenters relevant regarding the content of their presentation?* This field is required.Kyle Hammond, MD
YESNO
10
If No, please explain:
11
Were the speakers/presenters effective regarding the content of their presentation?* This field is required.Kyle Hammond, MD
YESNO
12
If No, please explain:
13
Were the speakers/presenters knowledgeable regarding the content of their presentation?* This field is required.Cleo Stafford, MD
YESNO
14
If No, please explain:
15
Were the speakers/presenters relevant regarding the content of their presentation?* This field is required.Cleo Stafford, MD
YESNO
16
If No, please explain:
17
Were the speakers/presenters effective regarding the content of their presentation?* This field is required.Cleo Stafford, MD
YESNO
18
If No, please explain:
19
Were the speakers/presenters knowledgeable regarding the content of their presentation?* This field is required.Frazier Keitt, DO
YESNO
20
If No, please explain:
21
Were the speakers/presenters relevant regarding the content of their presentation?* This field is required.Frazier Keitt, DO
YESNO
22
If No, please explain:
23
Were the speakers/presenters effective regarding the content of their presentation?* This field is required.Frazier Keitt, DO
YESNO
24
If No, please explain:
25
Do you feel that the following learning objectives were met?* This field is required.To understand the rehabilitation updates and methods for throwing shoulder
Yes
No
Partially
26
Do you feel that the following learning objectives were met?* This field is required.To understand pathologies associated with the throwing shoulder
Yes
No
Partially
27
Do you feel that the following learning objectives were met?* This field is required.To understand the nonsurgical treatments for throwing shoulder
Yes
No
Partially
28
Do you feel that the following learning objectives were met?* This field is required.To identify various peripheral neuropathies of the upper extremity
Yes
No
Partially
29
Do you feel that the following learning objectives were met?* This field is required.To understand the role that ultrasound can play in the diagnosis and treatment of upper extremity peripheral neuropathies.
Yes
No
Partially
30
Do you feel that the following learning objectives were met?* This field is required.Discuss the tone of speech and rhetoric necessary for equitable conversation moving forward
Yes
No
Partially
31
If No, please explain:
Yes
No
Partially
32
If you answered NO to any of these, please explain:
Huge
Large
Normal
Small
Ok
Ok
33
Please indicate which of the following ACGME core competencies have been addressed by this series (select all that apply):* This field is required.
Patient care
Practice-based learning & improvement
Interpersonal and communication skills
Systems-based practice
Medical knowledge
Professionalism
34
Please rate the barriers you perceive in implementing these changes.* This field is required.
None/Minimal
Sizable
Insurmountable
Reimbursement/Insurance issues
Cost effectiveness
Time management
Patient compliance issues
Administrative support
Lack of experience
Reimbursement/Insurance issues
Cost effectiveness
Time management
Patient compliance issues
Administrative support
Lack of experience
None/Minimal
Sizable
Insurmountable
None/Minimal
Sizable
Insurmountable
None/Minimal
Sizable
Insurmountable
None/Minimal
Sizable
Insurmountable
None/Minimal
Sizable
Insurmountable
None/Minimal
Sizable
Insurmountable
1 of 6
35
How will you address these barriers to implement changes in knowledge and/or behavior?
Huge
Large
Normal
Small
Ok
Ok
36
How might the format of this series be improved in order to be most appropriate for the content presented? (select all that apply)* This field is required.
Format is appropriate; no changes needed
Include more case-based presentations
Increase interactivity with attendees
Add a hands-on instructional component
Allow more time for Q&A
37
Other comments:
Huge
Large
Normal
Small
Ok
Ok
Should be Empty:

Question Label

1 of 37See AllGo Back

Save & Continue Later

Your form is saved successfully!

If you want to continue answering your form later, please enter the email address you would like to send the link to:

Please enter a valid email address.

Something went wrong while saving your answers. Please try again.

Email has been sent successfully.

Save your progress

OR

Already have an account? LOGIN

Skip Create an Account

Save your progress

Name

Email Address

Password

I agree to theTerms of ServiceandPrivacy Policy

Your form submission has been saved as a draft.

If you want to continue answering your form later, please enter the email address you would like to send the link to:

Save your progress

OR

Username or email

Password

Forgot Password?

Your form submission has been saved as a draft.

We’ve sent you an email with a link to complete your submission.