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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.
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.
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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 CK | 5 | 4 | 3 | 2 | 1 |
| Discuss the problem of underdiagnosis and undertreatment of anemia | 5 | 4 | 3 | 2 | 1 |
| Explain the relationship between effective management of chronic kidney disease and clinical outcomes | 5 | 4 | 3 | 2 | 1 |
| Describe new data related to pre-dialysis patients | 5 | 4 | 3 | 2 | 1 |
| Identify the economic impact of anemia management | 5 | 4 | 3 | 2 | 1 |
| Describe the link between CKD, anemia, and heart disease | 5 | 4 | 3 | 2 | 1 |
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?
____________________________________________________________________________________
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Overall Effectiveness of the Activity
| Objectives were related to overall purpose/goal(s) of activity | 5 | 4 | 3 | 2 | 1 |
| Related to my practice needs | 5 | 4 | 3 | 2 | 1 |
| Will influence how I practice | 5 | 4 | 3 | 2 | 1 |
| Will help me improve patient care | 5 | 4 | 3 | 2 | 1 |
| Stimulated my intellectual curiosity | 5 | 4 | 3 | 2 | 1 |
| There was sufficient time for questions and answers | 5 | 4 | 3 | 2 | 1 |
| Handout materials were useful | 5 | 4 | 3 | 2 | 1 |
| Overall, the activity met my expectations | 5 | 4 | 3 | 2 | 1 |
| Avoided commercial bias or influence | 5 | 4 | 3 | 2 | 1 |
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.
____________________________________________________________________________________
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How committed are you to making these changes?
5 (Very committed) 4 3 2 1 (Not at all committed)
Additional comments about this activity?
____________________________________________________________________________________
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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:
____________________________________________________________________________________
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