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

Which activity are you claiming credit for?
As a result of participating in this learning activity, do you intend to make changes in your practice?
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)

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

Highlight updates made to GINA asthma guidelines in 2022.
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:

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

Identify sources of lead and risks of lead exposure to children in Ohio.
Discuss quality improvement and EHR approaches to improving lead screening and addressing high lead levels.
Review available resources for communicating with patients and families about lead.
As a result of participating in this learning activity, do you intend to make changes in your practice to incorporate new methods to address nutrition and activity with patients?

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

Explain vaccine safety, efficacy and risk/benefits to hesitant patients.
Review best practices and strategies for increasing HPV vaccination rates.
Collaborate with school health clinics on joint vaccine and communication efforts.

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.
As a result of participating in this learning activity, do you intend to make changes in your practice to incorporate new methods to address nutrition and activity with patients?

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.
Which languages are most represented in your practice? (Check 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? (Check all that apply)
Which of the following best represents how you think of yourself?