POSTGRADUATE INSTITUTE FOR MEDICINE
"New Therapies for Anemia Management in CKD
An Interactive Symposium on the Full Spectrum of Kidney Disease"
Post-Test Answer Sheet and Evaluation Form
Course number 01813ES13


To obtain a statement of participation, you must complete the post-test by recording the best answer to each question in the answer key on the evaluation form, complete the evaluation form, and mail or fax the evaluation form with answer key to the Postgraduate Institute for Medicine. The Post-Test / Evaluation Form must be submitted by December 31, 2002. Mail/fax to:

Postgraduate Institute of Medicine
304 Inverness Way South, Suite 265
Englewod, CO 80112
(303)790-4876 - FAX

Certificates will be mailed within 4-6 weeks after receipt to those who successfully complete the Post-Test/Evaluation form. There is no registration fee to participate in this activity.

Name (please print) __________________________________________________________________
Degree
__________________________________________________________________
Specialty
__________________________________________________________________

Mailing Address for Certificate:

Street
__________________________________________________________________
City/State/Zip Code

__________________________________________________________________
Signature
__________________________________________________________________
Date
__________________________________________________________________
Phone #
__________________________________________________________________
Fax #
__________________________________________________________________
E-mail: __________________________________________________________________

I certify my actual time spent to complete this educational activity to be ___ hour(s)
[not to exceed 2 hours]

________________________________________
Signature




Post-Test ANSWER SHEET
Mark the answer that is correct for each PostTest question below: First click on the Post-Test Questions link and print out the questions for your reference.

. A. B. C. D. E.
1. o o o o  
2. o o o o o
3. o o o o  
4. o o o o  
5. o o o o  
6. o o      
. A. B. C. D. E.
7. o o      
8. o o o o o
9. o o o o o
10. o o      
11. o o o o o
12. o o o    

Please answer the following questions by circling the appropriate rating:

5 = Outstanding

4 = Good

3 = Satisfactory

2 = Fair

1 = Poor


Extent to Which Program Activities Met the Identified Objectives

Upon completion of this activity, participants should be able to:


Discuss the prevalence of chronic kidney disease (CKD) and anemia of CK54321
Discuss the problem of underdiagnosis and undertreatment of anemia54321
Explain the relationship between effective management of chronic kidney disease and clinical outcomes54321
Describe new data related to pre-dialysis patients54321
Identify the economic impact of anemia management 54321
Describe the link between CKD, anemia, and heart disease54321

Effectiveness of the Individual Faculty Members

Speakers

Knowledge of Subject Matter

Appropriateness of Teaching Strategies

Brian Pereira, MD

5    4    3    2    1

5    4    3    2    1

Allan Collins, MD

5    4    3    2    1

5    4    3    2    1

Adeera Levin, MD

5    4    3    2    1

5    4    3    2    1

Francesco Locatelli, MD

5    4    3    2    1

5    4    3    2    1


Is there anything you would like to communicate directly to the speakers?


____________________________________________________________________________________

____________________________________________________________________________________

Overall Effectiveness of the Activity

Objectives were related to overall purpose/goal(s) of activity54321
Related to my practice needs54321
Will influence how I practice54321
Will help me improve patient care54321
Stimulated my intellectual curiosity54321
There was sufficient time for questions and answers54321
Handout materials were useful54321
Overall, the activity met my expectations54321
Avoided commercial bias or influence54321

Will the information presented cause you to make any changes in your practice?


____Yes____No

If Yes, please describe any change(s) you plan to make in your practice as a result of this activity.

____________________________________________________________________________________

____________________________________________________________________________________

How committed are you to making these changes?
    

5 (Very committed)   4    3    2    1 (Not at all committed)

Additional comments about this activity?
 

____________________________________________________________________________________

____________________________________________________________________________________

Do you feel future activities on this subject matter are necessary and/or important to your practice?

____Yes ____No

Please list any other topics that would be of interest to you for future educational activities:

____________________________________________________________________________________

____________________________________________________________________________________