Spring Education Meeting 2025 Evaluation

Participant Contact Information

Name *

Credentials

Such as MD, RN, etc.; if not applicable, leave blank.

Practice or Organization *

Email Address *

Your CME certificate will be sent to this address.

Phone Number *

Address *

City *

State *

Zip *

If seeking MOC Part 2 credit, please enter your ABP diplomate number:

If seeking MOC Part 2 credit, please enter your date of birth (MM/DD/YY):

End Year for Current MOC Cycle:

Specialty

Primary Care (Pediatrics)

Primary Care (Family Medicine)

Medical Subspecialty

Nursing or Allied Health

Community Health Worker

Home Visitor

Resident

Social Worker

Other

Activity Evaluation

Please select the reason (or reasons) that you chose to access this activity:

MOC Part II Credit

CME Credit (or Other Continuing Education Credit)

Educational Content/Topic

Speaker

OtherOther

What is one new piece of information from this education session that you feel is the most impactful to your practice?

As a result of this activity, do you plan to make changes in practice? *

Yes

Based on what you learned in this session, which of the following changes will you make to your practice?

Educate appropriate staff

Use new resources for patient visits

Expand knowledge of topic through research

Make changes to practice work flow (Please provide example if possible)Make changes to practice work flow (Please provide example if possible)

OtherOther

Assess your level of commitment to making the modification to your practice stated above: *

Very committed

Committed

Somewhat committed

Not very committed

Do not expect to change practice

As you look ahead, what CME topic is your highest learning priority?

Please rate the following statements based on your opinion following this education session.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

N/A

The content matched my current or potential scope of practice

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

N/A

The speaker was knowledgeable and able to effectively teach the content

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

N/A

I was satisfied with this learning activity

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

N/A

This activity was free of bias and promotes the values of belonging, respect and fairness. *

Yes

No (if no, please comment)No (if no, please comment)

This activity was free of commercial bias. *

Yes

No (if no, please comment)No (if no, please comment)

Faculty disclosures were made. *

Yes

No (if no, please comment)No (if no, please comment)

How can the Ohio AAP Assist in meeting your education needs?

At the conclusion of this activity are you able to:

Apply strategies for effectively communicating with legislators, including crafting persuasive, data driven messages and engaging in meaningful conversations with actionable outcomes. *

Yes

Determine the most appropriate action plan for your level of skill, interest and capacity to make in an impact in advocacy. *

Yes

# of CME Hours:

Legislative Meetings

Did you meet with any legislative staff and/or legislators during the meeting? *

Yes

Who did your group meet with today (legislative staff and/or legislators)? *

What was the level of engagement and interest shown by the legislators/staff? *

Highly engaged

Engaged

Neutral

Disengaged

Highly disengaged

Did you receive any positive comments or responses to the information that was given today? *

Yes

Please describe any positive comments or responses to the information that was given today.

Did you receive any negative comments or responses to the information that was given today? *

Yes

Please describe any negative comments or responses to the information that was given today.

Did any legislators have any questions that you could not answer that may require Ohio AAP to follow up? *

Yes

Please describe any questions legislators had that may require Ohio AAP to follow up.

Would you like to become involved in future advocacy efforts with the Ohio AAP? *

Yes

PLEASE ANSWER THESE ADDITIONAL REFLECTIVE STATEMENTS FOR MOC PART II CREDIT:

How did you participation in this activity impact your comfort and confidence when engaging in advocacy?

What changes do you plan to implement in your practice or advocacy activities over the next 90 days?

Signature

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