CME Activity Evaluation Form

CME Evaluation Form

CME Evaluation Form

Participant Contact Information

Please enter your name as you prefer for it to appear on your CME certificate.
Such as MD, RN, etc.; if not applicable, leave blank.
Your CME certificate will be sent to this address.
Specialty

Activity Evaluation

How did you participate in an educational activity?
Which activity are you claiming credit for?
Which activity are you claiming credit for?
At the end of the activity how strongly do you believe the education you received will impact your practice?
Assess your level of commitment to making the modification to your practice stated above:
Please select the reason (or reasons) that you chose to access this activity:

On a scale of 1 - 5, please rate the following statements.

( 1 = Strongly Disagree, 3 = Neutral, 5 = Strongly Agree)
There was bias related to diversity, equity or inclusion in this presentation.
This activity was free of commercial bias.
Faculty disclosures were made.
In order to assist us in measuring the outcomes of this educational activity, would you be willing to participate in a brief post-activity questionnaire?

At the conclusion of this activity, are you able to:

Highlight updates made to GINA asthma guidelines in 2022.

Please answer these additional assessment questions:

What does GINA stand for?
TRUE or FALSE: Patients with apparently mild asthma are NOT at risk of serious adverse events
Which of the following are changes or clarifications in GINA 2022?

At the conclusion of this activity are you able to:

Outline approaches to asthma management in the community and in the hospital
Identify action steps we all can take for (and with) patients and communities in the pursuit of health equity and justice
Consider population health approaches that elevate action on social, economic, and environmental determinants of health (SDH)

PLEASE ANSWER THESE ADDITIONAL ASSESSMENT QUESTIONS:

A 5-year-old boy is admitted to the hospital. He is having difficulty breathing and cannot seem to catch his breath. You hear wheezes on your physical examination, and you make the decision to treat him for an acute asthma exacerbation with inhaled bronchodilators, inhaled corticosteroids, and systemic corticosteroids. Prior to discharge from the hospital, what do you make sure to ask about and intervene upon (if appropriate)?
The use of maps in health care could support a better understanding of place-based social determinants of health for populations, and if incorporated more directly into patient-centered care, it could also:
Population health is defined as:

At the conclusion of this activity are you able to:

Identify common presentations of anxiety in pre-teen children
Describe the workup for anxiety in pre-teen children
List treatment approaches for anxiety in pre-teen children

PLEASE ANSWER THESE ADDITIONAL ASSESSMENT QUESTIONS:

Which of the following is the most common mental health problem in pre-adolescent youth?
Which of the following is felt to be influencing increases in loneliness and friendlessness in youth since the 2010’s?
Which of the following is characterized by persistent and excessive worry about losing major attachment figures or about possible harm such as illness, injury, disasters, or death?
Which of the following screening tools can be most helpful in determining if a child is experiencing significant anxiety?
Which of the following treatment approaches for anxiety is preferred as front line?

At the conclusion of this activity are you able to:

Apply new skills in discussions to address vaccine hesitancy with healthcare workers
Utilize proper techniques demonstrated in PPE use in primary care, including training, fit, and supply limitations
Recommend opportunities for primary care and school-based health providers to collaborate on infection control
I have increased knowledge regarding healthcare infection prevention and control (IPC).​

Additional Evaluation Questions:

Would you recommend this activity to others?

Please answer these additional assessment questions:

True or False: The HIPAA Privacy Rule allows a health care provider to disclose protected health information (PHI) about a student to a school nurse.
Preventative care for international travel includes:
True or False: Measles requires droplet precautions.

At the conclusion of this activity are you able to:

Identify common presentations of anxiety in pre-teen children
Describe the workup for anxiety in pre-teen children
List treatment approaches for anxiety in pre-teen children

PLEASE ANSWER THESE ADDITIONAL ASSESSMENT QUESTIONS:

Which of the following is the most common mental health problem in pre-adolescent youth?
Which of the following is felt to be influencing increases in loneliness and friendlessness in youth since the 2010’s?
Which of the following is characterized by persistent and excessive worry about losing major attachment figures or about possible harm such as illness, injury, disasters, or death?
Which of the following screening tools can be most helpful in determining if a child is experiencing significant anxiety?
Which of the following treatment approaches for anxiety is preferred as front line?

At the conclusion of this activity are you able to:

Identify key components of high quality asthma care
Acknowledge challenges to providing this care
Describe strategies that can be used in the office to overcome these challenges and make care more consistent
Recognize the important roles schools, and especially school nurses, can play in optimizing asthma care

PLEASE ANSWER THESE ADDITIONAL ASSESSMENT QUESTIONS:

Which of the following are key components of high-quality asthma care?
According to the 2020 NHLBI/NAEPP update, which type of therapy is the preferred treatment for a 10-year-old whose asthma that is not controlled by low-dose inhaled corticosteroids (ICS)?
Which of the following is true regarding the role school nurses play in student care?

At the conclusion of this activity are you able to:

Describe the top three micronutrient deficiencies for children living in Ohio
Apply clinical best practices in addressing micronutrient deficiencies.
Educate families on how to supplement meals to include more nutrients.

PLEASE ANSWER THESE ADDITIONAL ASSESSMENT QUESTIONS:

Please select the three main micronutrient deficiencies in children in Ohio. Select all that apply.
Which of the following is a good source of iron?
True or False: A diet can be supplemented with fortified foods or vitamins.
Which of the following may be considered as risk factors for low calcium levels?

At the conclusion of this activity are you able to:

Identify young patients (2-6 years of age) presenting with behavioral challenges who require further evaluation.
Differentiate among the presentations of ADHD, anxiety, learning disabilities and oppositional defiant disorder in children aged two to six years.
List parenting techniques that can be employed to help manage common behavioral challenges in children aged two to six years.

PLEASE ANSWER THESE ADDITIONAL ASSESSMENT QUESTIONS:

Executive function deficits include all of the following except:
Boys and girls present ADHD differences how:
Collaborative and proactive solutions therapeutic model includes all of the following except:
Which of the following is not an ADHD Screening tool:
Individualized Education Programs and 504 plans are:

At the conclusion of this activity are you able to:

Apply clinical and coverage resources to prescribe guideline-recommended medications and avoid insurance barriers
Resolve prior authorization barriers associated with SMART
Describe best practices for improving asthma medication ratio (AMR)

Please answer these additional assessment questions:

An inhaler needs to contain which long acting beta-2 agonist (LABA) if using as a single maintenance and reliever therapy (SMART)?
Asthma medication ratio is calculated using the following equation?
Which of the following statement is true regarding dry powder inhalers (DPIs)?
Which session(s) did you participate in?

The Pediatrician's Role in Lead Prevention

At the conclusion of this activity are you able to:
Increase understanding of the legal requirements for lead screening in Ohio
Improve discussions with caregivers on lead poisoning prevention, elevated blood lead levels, testing, and treatment
Utilize new skills to assess patients for appropriate screening for elevated blood lead levels

ADHD in Younger Ages

At the conclusion of this activity are you able to:
Differentiate among the presentations of ADHD, anxiety, learning disabilities and oppositional defiant disorder in children aged two to six years
List parenting techniques that can be employed to help manage common behavioral challenges in children aged two to six years

At the conclusion of this activity are you able to:

Plan to implement two actionable steps that can help prevent the progression of Type 2 diabetes with patients
Appropriately refer patients to endocrinology when screening suggests further evaluation and management is medically indicated

Please answer these additional assessment questions:

Which of the following defines Stage 2 type 1 diabetes?
What does C-peptide determine as part of lab work?
A 10-year-old male presents for his well visit with his mother. Mom has a medical history of type 1 diabetes and expresses concerns about her son’s risk for developing type 1 diabetes. Which of the following would be the best course of action?
Which of the following is not considered a risk factor for youth onset t2d?
Which of the following statements about youth onset t2d (compared to adult onset t2d) is incorrect?

At the conclusion of this activity are you able to:

Plan to implement two actionable steps that can help prevent the progression of Type 2 diabetes with patients
Appropriately refer patients to endocrinology when screening suggests further evaluation and management is medically indicated

Please answer these additional assessment questions:

Which of the following defines Stage 2 type 1 diabetes?
What does C-peptide determine as part of lab work?
A 10-year-old male presents for his well visit with his mother. Mom has a medical history of type 1 diabetes and expresses concerns about her son’s risk for developing type 1 diabetes. Which of the following would be the best course of action?
Which of the following is not considered a risk factor for youth onset t2d?
Which of the following statements about youth onset t2d (compared to adult onset t2d) is incorrect?

At the conclusion of this activity are you able to:

Communicate effectively with the Ohio Department of Health regarding abnormal test results
Order appropriate testing for congenital CMV infection following an abnormal newborn hearing screen
Respond effectively to abnormal thyroid screening
Manage and follow a patient with an abnormal newborn screening for Duchenne muscular dystrophy

Please answer these additional assessment questions:

Which of the following is true about the Ohio Revised Code regarding newborn screening?
Which of the following is true when screening for critical congenital heart disease?
The following is true regarding Ohio’s new screening on Duchenne Muscular Dystrophy (DMD):
Which of the following is true about congenital cytomegalovirus (CMV) infection?
The following is an example of a criterion used by the Ohio Department of Health to determine if a test should be added to the newborn blood spot test:

At the conclusion of this activity are you able to:

Utilize new skills in providing guidance to caregivers on mental health challenges resulting from adolescent social media use

Please answer these additional assessment questions:

Which of the following are considered benefits of social media use:
Which of the following are recommended to help caregivers support healthy social media?
Cyberbullying is when a victim is:
True or False: Online bullying and harassment can be easier to commit than other acts of bullying because the bully doesn't have to confront their target in person.
Which is true regarding cyberbullying victimization:

At the conclusion of this activity are you able to:

Communicate effectively with the Ohio Department of Health regarding abnormal test results
Order appropriate testing for congenital CMV infection following an abnormal newborn hearing screen
Respond effectively to abnormal thyroid screening
Manage and follow a patient with an abnormal newborn screening for Duchenne muscular dystrophy

Please answer these additional assessment questions:

Which of the following is true about the Ohio Revised Code regarding newborn screening?
Which of the following is true when screening for critical congenital heart disease?
The following is true regarding Ohio’s new screening on Duchenne Muscular Dystrophy (DMD):
Which of the following is true about congenital cytomegalovirus (CMV) infection?
The following is an example of a criterion used by the Ohio Department of Health to determine if a test should be added to the newborn blood spot test:

At the conclusion of this activity are you able to:

Review best practices and intervention strategies for practice improvement
Collaborate with practice coach to develop plans to improve identified gaps in lead screening, testing, and treatment

At the conclusion of this activity, are you able to:

Promote positive oral health routines, starting during prenatal period.
Understand and implement fluoride varnish procedures.
Recognize the opportunity to integrate and promote relational health during routine pediatric visits and anticipatory guidance.

Please answer these additional assessment questions:

Two-Generation (2Gen) approaches build family well-being by intentionally and simultaneously working with children and the adults in their lives together.
What is NOT a way oral infection can occur?
Which of the following is NOT a role of the primary care health professional?

At the conclusion of this activity, are you able to:

Know proven models of early literacy promotion.
Be able to advise parents about good sleep hygiene and help with sleep related concerns.
Recognize the opportunity to integrate and promote relational health during routine pediatric visits and anticipatory guidance.

Please answer these additional assessment questions:

About 1/3 parents have below basic health literacy.
Which is NOT a 5 R of early education?
Which of the following is appropriate sleep guidance for toddler?

At the conclusion of this activity, are you able to:

Explain the impact of early literacy on kindergarten readiness and lifelong learning.
Discuss the resources available for Ohio's families from Reach Out and Read, and the Imagination Library.

PLEASE COMPLETE THESE QUESTIONS IF SEEKING MOC PART II CREDIT OR IF YOU ARE CLAIMING ENDURING CREDIT (DID NOT PARTICIPATE IN THE LIVE TRAINING):

How do we achieve reading comprehension?
A published population study showed that participants in a combined Reach Out and Read and Imagination Library program showed significant improvement in:

At the conclusion of this activity, are you able to:

Explain the disaster cycle and a pediatrician’s role in a disaster, preparing the pediatrician’s office and staff for a disaster.
Discuss resources on preparing families and patients for a disaster with families.
Prepare families with CYSHCN (Children and Youth with Special Healthcare Needs) for a disaster through anticipatory guidance and resources.

At the conclusion of this activity, are you able to:

Explain “Race”/Racism and Implicit and Explicit Bias in the context of education activity development.
Demonstrate how racism occurs in medical settings.
Create an Anti-Racism strategy/lens for evaluating and presenting education in your practice.

At the conclusion of this activity, are you able to:

Describe suicide statistics.
Identify and be able to use REACH skills.
Apply knowledge gained in communication with patients and families regarding safe storage options and the importance of barrier methods.

Please complete these questions if seeking MOC Part II credit:

What is the current leading cause of death in children and adolescents in the US?
Which of the following are REACH skills?
34% of people ages 15+ years had contact with a healthcare provider in the week before their death.

At the conclusion of this activity, are you able to:

Understand the demographics of adolescent births in the United States.
Discuss risk factors and complications of adolescent pregnancies.
Management of perinatal depression and anxiety.

At the conclusion of this activity, are you able to:

Understand the new clinical practice guidelines.
Offer treatment for obesity early and immediately.
Explain gaps and future research needs.

At the conclusion of this activity, are you able to:

Identify how much sleep children and teens need.
Recognize common sleep problems.
Recommend a sleep schedule and additional resources. 
Prior to the webinar, how familiar were you with providing anticipatory guidance on sleep and how it affects nutrition and activity for children?
As a result of participating in this learning activity, do you intend to make changes in your practice to incorporate new methods to address the importance of sleep with patients?
How much sleep do teens (age 13-18) need?
True or False: Sleep helps our brains learn new things, pay attention, and remember things.
Which of the following is NOT a common sleep problem?

At the conclusion of this activity, are you able to:

Describe how the homeless crisis response system is organized, how people access assistance, what different programs do, and who they serve.
Discuss the guiding principles of our systems and best practices in serving people experiencing homelessness.
Anticipate how homelessness impacts youth and young adults.

At the conclusion of this activity, are you able to:

Define the importance of early feeding practices, environmental factors and importance of early relationships in the adoption of healthy active living behaviors.
Identify the key protective and risk factors that are associated with early obesity prevention.
Recognize the role that you can play in supporting the adoption of health active living behaviors.
Describe actionable strategies to discuss with parents to support families in establishing healthy active living behaviors.

PLEASE COMPLETE THESE QUESTIONS IF SEEKING MOC PART II CREDIT OR IF YOU ARE CLAIMING ENDURING CREDIT (DID NOT PARTICIPATE IN THE LIVE TRAINING):

Which of the following statements about Responsive feeding is TRUE?
Children with obesity are how many more times likely have obesity as an adult?
Which of the following actions by healthcare providers made it easier for parents to hear and act on healthy messages?

At the conclusion of this activity, are you able to:

Perform an oral health assessment including recognition of signs of early childhood caries (ECC).
Explain the ABC’s of safe sleep for infants, advise parents about good sleep hygiene and help with sleep related concerns.
Recognize the opportunity to integrate and promote relational health during routine pediatric visits and anticipatory guidance.

PLEASE COMPLETE THESE QUESTIONS IF SEEKING MOC PART II CREDIT OR IF YOU ARE CLAIMING ENDURING CREDIT (DID NOT PARTICIPATE IN THE LIVE TRAINING):

Which of the following is the most important reason that pediatric clinicians should assess the oral hygiene of the mother of a newborn?
Which of the following is true?
Early childhood literacy promotion may improve both kindergarten readiness and relational health. What two programs in Ohio have evidence of effectiveness and are easy to implement in community practice?

At the conclusion of this activity, are you able to:

Implicit bias in healthcare-the data.
How to address bias in healthcare interactions and decision-making.

Please answer these additional assessment questions:

TRUE OR FALSE Bias is neutral feelings toward an individual or group.
Biases can affect which of the following without our conscious knowledge?

At the conclusion of this activity, are you able to:

Understand the best practices for social media use.
Develop common marketing strategies for practice.

Please answer these additional assessment questions:

Which is NOT a capability of telehealth?
Which is a way to adapt to the new normal of healthcare delivery?
TRUE or FALSE: There are not many ethical considerations surrounding social media use among pediatricians.

At the conclusion of this activity, are you able to:

Identify when to use specific screening tools with families.

Please answer these additional assessment questions:

TRUE or FALSE: Developmental screening is a process of recognizing children who might be at risk for developmental delays.
Which is considered a social determinant of health?
TRUE or FALSE: PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.

At the conclusion of this activity, are you able to:

Identify the reasons that teens vape and address these reasons with families.
Diagnose and manage the side effects of vaping.

Please answer these additional assessment questions:

TRUE or FALSE: Chronic e-cigarette users can spend up to $5,082.50 per year whereas smoking a pack of cigarettes a day can cost between $2,087.80 and $5,091.75
Which is not a vaping ingredient?
TRUE or FALSE: Cigarette use is healthier than vaping.

At the conclusion of this activity, are you able to:

Identify contraindications to breastfeeding and resources for decision support.
Encourage breastfeeding mothers to use only human milk
Promote appropriate educational resources.

Please answer these additional assessment questions:

TRUE or FALSE: In 2000, 43% of Peds program directors believed the level of breastfeeding education in their resident programs were inadequate or in need of improvement.
Which is not a contraindication to breastfeeding?
Which is not a common reason parents choose to formula feed?

At the conclusion of this activity, are you able to:

Examine and implement techniques to effectively and efficiently elicit and document the key components of a Well Child Care (WCC)

Please answer these additional assessment questions:

TRUE or FALSE: Bright Futures Mission Statement is to promote and improve the health, education, and well-being of infants, children, adolescents, families, and communities.
What is NOT a component of a well child visit?
TRUE or FALSE Universal fasting lipid profile should be obtained at all 15yo WCC.

At the conclusion of this activity, are you able to:

Describe common presentations of depression and anxiety in youth.

Please answer these additional assessment questions:

Which is NOT a symptom of anxiety disorder in youth?
True or False: AAP guidelines DO NOT recommend universal screening for depression.
True or False: Medication management is safe and effective for pediatric depression and anxiety with SSRIs as the first line medications.

At the conclusion of this activity, are you able to:

Implement the 5 strategies to enhance communication with families.

Please answer these additional assessment questions:

What kids are higher risk and should get vaccinated ASAP?
The definition of disease is: Able to detect organism in your body
Which is not one of the 5 strategies to enhance communication with families?

At the conclusion of this activity, are you able to:

Define pediatric medical traumatic stress and be able to identify children and families at risk for maladaptive response.
Define relational health and describe how it helps to elucidate “the solution.”

Please answer these additional assessment questions:

TRUE or FALSE: A stressor disrupts homeostasis.
Trauma stress reactions include:
Which is not a “lense” to operationalize relational health?

At the conclusion of this activity, are you able to:

Discuss strategies for incorporating developmental monitoring and screening into well child visit.

Please answer these additional assessment questions:

TRUE or FALSE: The CDC estimates 1 in 6 children have a developmental disability but less than half are identified before they start school.
Children from minoritized backgrounds are at-risk for late diagnosis due to:
Which is not an AAP surveillance and screening recommendation?

At the conclusion of this activity, are you able to:

Utilize new skills to assess patients for appropriate screening for elevated blood lead levels.

Please answer these additional assessment questions:

Which of the following are symptoms of lead poisoning?
What is the most common way children in Ohio are exposed to lead?
What are the two factors at which Ohio law mandates a child be tested for lead poisoning?

At the conclusion of this activity, are you able to:

Identify which clinical features in the well child visit raise concerns for postpartum depression.
Implement methods to increase screening and appropriate billing for postpartum depression in well child visits.

Please answer these additional assessment questions:

Approximately what percentage of women experience postpartum depression?
Maternal perinatal depression is associated with the following adverse outcomes in children?
Which of the following outcomes are associated with screening or treatment of depression in women during the first 3 months following childbirth?
When can I use CPT code 96161 to bill for caregiver screening for depression in Ohio?

At the conclusion of this activity, are you able to:

Identify patient-preferred language and disliked language related to weight and BMI.
Assess patient readiness for initiation of conversations about weight and BMI by first asking permission to address the topic.

Please answer these additional assessment questions:

When discussing concerns about weight with an adolescent patient, which term is most preferred?
Which of the following is a reason parents are reluctant to discuss elevated weight or BMI during their child’s office visit?
Which of the following describes an unconscious negative attitude towards a particular social group?

At the conclusion of this activity, are you able to:

Utilize new skills to share CDC recommendations for elevated blood lead level (EBL) screening with others in practice.
Implement best practices when EBL levels are identified following screening.

Please answer these additional assessment questions:

What is the current BLRV (blood lead reference value) for children in Ohio?
What are the two ways a child can be tested for lead poisoning?
At what age are eligible children required per Ohio law to be tested for lead?

At the conclusion of this activity are you able to:

Implement appropriate new skills for the allied health professional in maternal depression screening and treatment
Apply case study examples to help identify families in need of screening or resources

Please answer these additional assessment questions:

Approximately what percentage of women experience postpartum depression?
Maternal perinatal depression is associated with the following adverse outcomes in children?
Which of the following outcomes are associated with screening or treatment of depression in women during the first 3 months following childbirth?

At the conclusion of this activity are you able to:

Explain the health effects of elevated blood lead levels in children.
Identify environmental sources of lead exposure and risk factors for lead poisoning in children.
Describe interventions by local health departments following the identification of lead poisoning.
Apply mandated lead testing requirements for children.

At the conclusion of this activity are you able to:

Define adherence and self-management utilizing an evidence-based pediatric self-management model
Describe the prevalence and implications of pediatric adherence
Identify psychosocial factors and social drivers impacting adherence and self-management
Describe clinical exemplars for pediatric adherence and self-management

PLEASE ANSWER THESE ADDITIONAL ASSESSMENT QUESTIONS:

Which options best reflect the dynamic nature of adherence behaviors?
Which statement best reflects typical adherence patterns over time?
Which option reflects a clinical strategy targeting the community domain?

Pediatrician and Practice Demographics

As a component of our commitment to Diversity Equity and Inclusion (DEI), the Ohio AAP is capturing data that will help us understand our current landscape and improve our education, programs and advocacy for our members and the children they serve. The Ohio AAP has based these questions on standards set by the National AAP; answering these questions is optional and your answers will not by shared or impact your participation in any activities.
Will you answer the demographic questions?

About your practice

Please describe the community in which your primary practice/position is located. Select all that apply.
Which languages are most represented in your practice? Select all that apply.
What racial or cultural group(s) describe your patient population? Select all that apply.
How many physicians are in your practice?
Which best describes your primary employment setting, that is, the setting where you spend most of your time.
Which best describes your primary employment setting, that is, the setting where you spend most of your time.
Which types of providers are included in your practice? Select all that apply.

About yourself

How long have you been practicing medicine?
What is your age?
What is your gender?
With what racial or cultural group(s) do you identify? Select all that apply.
Which languages are you capable of speaking fluently? Select all that apply.
Which of the following best represents how you think of yourself?