In order to successfully complete this activity, you are required to read or listen to the entire web-based presentation, legibly complete this Post-Test / Evaluation Form, and achieve a minimum passing grade of at least 70% on the Post-Test. The Post-Test / Evaluation Form must be submitted by December 31, 2002. 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.
TUFTS UNIVERSITY SCHOOL OF MEDICINE
"Redefining Chronic Renal Insufficiency:
A Panel Discussion on the Emerging Role of Anemia"
Post-Test / Evaluation Form
Name (please print) __________________________________________________
Degree____________ Position/Title __________________
Mailing Address for Certificate:
Street _______________________________________________________________
City/State/Zip Code ___________________________________________________
Signature __________________________________ Date ____________
Phone # ___________________________
Fax # ________________________
E-mail: ______________________________________________
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. 1. o o o o 2. o o o o 3. o o o o 4. o o o o 5. o o
. A. B. C. D. 6. o o 7. o o 8. o o 9. o o o o 10. o o o o
Evaluation of Objectives
Please rank how well the program objectives were met in the following topic areas.
Participants should be able to: High ----- ----- ----- Low Discuss prevalence, severity, and management of anemia in CRI 5 4 3 2 1 Recognize the link between management of CRI and clinical outcomes 5 4 3 2 1 Understand the clinical rationale for early referral and treatment of anemia in CRI patients 5 4 3 2 1 Recognize the Renal Anemia Management Period (RAMP), a new and novel approach to identifying and treating CRI-related anemia in patients 5 4 3 2 1 Understand the need for partnering with general practitioners and family physicians to increase patient identification and referral 5 4 3 2 1
Evaluation of Speakers and Panel High ----- ----- ----- Low Dr. Brian Pereira . Content relevant to my practice 5 4 3 2 1 Was able to communicate relevant knowledge of subject 5 4 3 2 1 Dr. Adeera Levin . Content relevant to my practice 5 4 3 2 1 Was able to communicate relevant knowledge of subject 5 4 3 2 1 Dr. David Churchill . Content relevant to my practice 5 4 3 2 1 Was able to communicate relevant knowledge of subject 5 4 3 2 1 Dr. Roger London . Content relevant to my practice 5 4 3 2 1 Was able to communicate relevant knowledge of subject 5 4 3 2 1 Dr. Steven Fishbane . Content relevant to my practice 5 4 3 2 1 Was able to communicate relevant knowledge of subject 5 4 3 2 1 Dr. Allen Nissenson . Content relevant to my practice 5 4 3 2 1 Was able to communicate relevant knowledge of subject 5 4 3 2 1
Overall Seminar Evaluation High ----- ----- ----- Low Potential impact on my practice 5 4 3 2 1 It will help me improve my professional effectiveness 5 4 3 2 1 Overall the seminar met my expectations 5 4 3 2 1 Avoided commercial bias or influence 5 4 3 2 1
Any additional comments about this activity?
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Any suggestions for future self study programs on this or other subjects?
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Please fax this completed Post-Test/Evaluation Form to 617-636-0472, or mail to: Tufts University School of Medicine; Office of Continuing Education; 136 Harrison Avenue; Boston, Massachusetts 02111.