Medical Program Evaluation

Tourette Syndrome Association Medical Program Evaluation

“

Form Approved

OMB No. 0920-XXXX

Exp. Date XX/XX/20XX

Tourette Syndrome – Diagnosis and Management”

Speaker, University

Date

Location

Learning Objectives:

1. Cite the criteria used to diagnose Tourette Syndrome

2. Describe conditions co-occurring with TS

3. State theories about etiology

4. Describe the range of management strategies

1. Please indicate your PROFESSION & SPECIALTY:

Physician___________ PA__________ Nurse _________ NP___________ Ph.D.___________ Psychologist__________

(specialty) (specialty) (specialty) (specialty) (specialty) (specialty)

Social Worker_________ Counselor _________ Occupational Therapist__________ Other_____________

(specialty) (specialty) (specialty) (describe)

2. Do you have experience in managing patients with TS or tic disorders? Yes____ No____

If yes, how many? 1-5 ___ 6-10 ___ more than 10 ___

3. Please rate your knowledge about identification and management of TS before and after participating in this program

Knowledge BEFORE today’s program None Some A lot			Self-rating of your knowledge related to:	Knowledge AFTER today’s program None Some A lot
1	2	3	Diagnosis/Recognition	1	2	3
1	2	3	Co-occurring Issues	1	2	3
1	2	3	Treatment Options	1	2	3
1	2	3	Patient/family Education	1	2	3

4. How much of this content was new to you? Almost all____ 75%____ 50%____ 25%____ Almost none____

Please rate each of the following statements

	Strongly disagree	Disagree	Agree	Strongly agree	N/A
5. My skills in diagnosing/recognizing TS will be improved as a result of this program	1	2	3	4
6. My skills in managing patients who have TS will be improved as a result of this program	1	2	3	4
7. I can state theories on etiology	1	2	3	4
8. If given an opportunity, I can apply the knowledge gained as a result of this program	1	2	3	4
9. I intend to use my knowledge to identify and diagnose patients with TS	1	2	3	4
10. I intend to educate patients and families in my practice about TS	1	2	3	4
11. The presenter communicated the content effectively	1	2	3	4

Please describe any expected changes to your skills, strategy and/or practice:

Suggestions to improve this program:

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