1 Start 2 Complete The goal of the evaluation is to demonstrate the desired outcome of the activity. Example 1: Do attendees feel they have the skills to speak up if they encounter a patient concern in the operating room? Example 2: Can the learner effectively articulate how to mobilize resources during an unexpected patient event? All evaluations must be completed post activity and summarized by the Course Director, administrator or planning committee. This activity met the stated objectives: * Strongly Disagree Disagree Neutral Agree Strongly Agree This activity will have an impact on how I practice: * Strongly Disagree Disagree Neutral Agree Strongly Agree Based on what you have learned from this activity, what 3 changes will you make to your practice? * 1. 2. 3. The content of this activity is relevant to my practice in the Operating Room: * Strongly Disagree Disagree Neutral Agree Strongly Agree The information provided increased my skills regarding patient safety: * Strongly Disagree Disagree Neutral Agree Strongly Agree The activity was realistic enough for me to engage in: * Strongly Disagree Disagree Neutral Agree Strongly Agree If not, how could it be improved? * Other than time and money, what barriers might impact these changes? * Please list 3 ways this educational activity can help address risks in your practice. * 1. 2. 3. Based on your answers above, please identify (at least) 3 ways you plan to use the information and strategies you learned today to help address risk specifically in your practice. * 1. 2. 3. Are there other topics for a future discussion that might be useful in your practice? * Do you attest that you completed the asynchronous, pre-live activity, work? * Yes No Other comments: Thank you for your time and participation. As the final part of this activity, we will contact you in 6 months to follow up on your responses to item 10 above. Leave this field blank
