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?
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.
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:

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:

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?

Participating in the 2023 Spring Education Meeting improved your knowledge of the following:

HPV Benefits and Safety
Strategies to Address Parental Refusal of HPV
Bridging Communication between School Health Clinics and Primary Care.
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?
Would you like to claim MOC (Maintenance of Certification) Part II Credit from the ABP (American Board of Pediatrics)?
Additional questions are required to claim MOC Part II credit

MOC Part II Credit Questions

What is the most common HPV-related cancer?
Meningitis B vaccine (Bexsero [MenV-4C]) may offer protection against which sexually transmitted infections?
True/False HPV is always given as a 3 part series, at zero, 2, and 6 months
Which are effective strategies to help increase HPV vaccination rates:
True or False: School health programs provide only vaccines and medications to students at school.
True or False: Community health workers and school nurses are strongly connected to the neighborhoods, know the community well, and have cultural similarities to families.
What are the benefits of school health?

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?

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

Understand the basic premise of eating disorders and how to apply it to a visit.
Implement strategies on how to approach nutrition support
Discuss when to referral and provide additional resources
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:

Understand the new clinical practice guidelines.
Offer treatment for obesity early and immediately.
Explain gaps and future research needs.
Prior to the webinar, how familiar were you with the updated clinical practice guidelines?
After attending the webinar, how comfortable are you with implementing the clinical practice guidelines into your practice?
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:

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.
Prior to the webinar, how familiar were you with providing anticipatory guidance on youth homelessness?
After attending the webinar, how comfortable are you with providing anticipatory guidance on youth homelessness
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?