NNCC/MCN Learning Collaborative

EVALUATION - Module 1: Patient and Family Engagement Through Care Teams

PLEASE NOTE: ALL CERTIFICATES WILL BE SENT ELECTRONICALLY. IF YOU WOULD LIKE TO RECEIVE A HARD-COPY OF YOUR CERTIFICATE, BE SURE TO PROVIDE YOUR COMPLETE MAILING ADDRESS IN THE APPROPRIATE QUESTIONS BELOW. --------------------------------------------------------------------------------- Learning Objectives: 1. Describe the importance of interdisciplinary care teams in the provision of patient-centered care. 2. Understand roles and responsibilities of different members of the care team (including the patient). 3. Describe strategies to optimize interdisciplinary communication among teams.

1. Did the training meet all of the learning objectives listed above?*

Please utilize the 4 - 1 scale below: 4 - The learning objectives were fully met. 3 - The learning objectives were mostly met. 2 - The learning objectives were somewhat met. 1 - The learning objectives were not met.

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2. The scholarship and expertise of Emily Kane, MPA?*

Please utilize the 4 - 1 rating scale below to answer questions 2 and 3: 4 - Excellent 3 - Good 2 - Fair 1 - Poor

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3. The scholarship and expertise of Casey Alrich, MPH?

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4. Your overall satisfaction with the webinar?*

Please utilize the 4 - 1 rating scale below: 4 - Completely satisfied 3 - Mostly satisfied 2 - Somewhat satisfied 1 - Dissatisfied

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5. The webinar presented new areas of knowledge and/or new ideas/methods to implement?*

Please utilize the 4 - 1 rating scale below: 4 - Completely agree 3 - Mostly agree 2 - Somewhat agree 1 - Disagree

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6. The webinar contained information at a level commensurate with my training and experience?*

Please utilize the 4 - 1 rating scale below: 4 - Completely agree 3 - Mostly agree 2 - Somewhat agree 1 - Disagree

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7. How helpful was the information you learned today in enhancing the performance and operations of your health center?*

Please utilize the 4 - 1 rating scale below: 4 - Completely helpful 3 - Mostly helpful 2 - Somewhat helpful 1 - Not helpful N/A - Not applicable

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8. If applicable, how do you plan to use the information learned in your daily work?*

9. Was the content balanced and free of commercial bias?*

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10. Did the speaker(s) fully disclose any conflict of interest and discussion of off-label usage of medications and/or medical devices?*

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11. Do you have any training, technical assistance, or resource needs? If so, please specify below.

12. What is the biggest challenge for your clinic in providing quality care to patients?

13. Name (as it should appear on your certificate)*

14. Credentials

15. Certificate Type*

NOTE: TEXAS CHW CERTIFICATES ARE NOT AVAILABLE FOR THIS TRAINING.

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16. Would you like to receive a hard-copy of your certificate?*

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17. Name of the organization you represent*

18. Type of Organization*

Please utilize the key below to identify the type of organization you represent: 1 - PCA 2 - Health Center 3 - HCCN 4 - Self Reported Other 5 - I don't know / none of the above

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19. What is your occupational title?*

20. Address*

21. City*

22. State*

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23. Zip Code

24. Email Address*

25. Phone Number*

26. Type of number provided*

Please utilize the following key: 1 - Cell phone / Mobile phone 2 - Home phone 3 - Work phone

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