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pdfContinuing Education Proposal Packet
Live Educational Activity and Enduring Materials
Course Evaluation
Activity title: After the 9/11 Terrorist Attacks: The World Trade Center Health Program and Disaster Response
WD2811
Activity #:
Proposed start/release date: 3/1/2017
Please take a moment to give us your feedback and write your comments in the boxes provided.
Content and Learning Materials
1.
2.
3.
4.
5.
6.
The content and learning materials addressed a
need or a gap in my knowledge or skills.
The difficulty level was appropriate.
The length and pace of the activity was
appropriate.
Feedback (Q&A, knowledge checks) I received
during the activity was helpful.
Please share your comments about the content
and learning materials.
What suggestions do you have to improve this
educational activity?
Strongly
Agree
Agree
Neither /
Undecided
Disagree
Strongly
Disagree
N/A
Comments:
Comments:
Presentation
7.
8.
9.
The content expert(s) demonstrated expertise in
the subject matter.
The delivery method used (conference, journal
article, webcast, e-learning, etc.) was appropriate
for the subject matter and helped me learn the
content.
The instructional strategies (lecture, case
scenarios, figures, tables, media, etc.) helped me
learn the content.
Learning Environment
10. The learning environment was conducive to
learning.
11. Do you believe this activity was influenced by
commercial interests?
12. If yes, please explain.
13.
Did you experience technical difficulties with this
activity?
14.
If yes, please explain.
Strongly
Agree
Agree
Neither /
Undecided
Disagree
Strongly
Disagree
N/A
Yes
No
Comments:
Yes
No
Comments:
Knowledge, Competence, and Practice
15.
This activity effectively met my educational
needs.
5-WB2811-Evaluation (3).doc
Strongly
Agree
Agree
Neither /
Undecided
Disagree
Strongly
Disagree
N/A
Page 1 of 4
Version: 2/28/2017
Continuing Education Proposal Packet
Live Educational Activity and Enduring Materials
Course Evaluation
16.
17.
18.
19.
20.
21.
22.
I will be able to apply the knowledge gained from
this activity to increase or maintain my
competence.
I will be able to apply the knowledge gained from
this activity to my practice.
I will be able to apply the knowledge/skills
gained from this activity to develop
strategies/provide interventions.
I will be able to apply the knowledge gained from
this activity to improve performance.
What change or impact do you anticipate?
Do you anticipate barriers applying this
knowledge?
If yes, please explain
Yes
No
Comments:
Learning Objectives
23.
24.
25.
26.
27.
28.
I can identify patients who are eligible for care
under the WTC Health Program
I can identify exposure-related health risks
associated with environmental exposures from the
WTC site
I can describe the lessons learned from the 9/11
disaster response
I can identify patients who are eligible for care
under the WTC Health Program
The content was relevant to the learning
objectives.
Please share your comments regarding the
learning objectives.
Strongly
Agree
Agree
Neither /
Undecided
Disagree
Strongly
Disagree
N/A
Comments:
Access
29.
30.
The CDC’s Training and Continuing Education
Online (TCEO) system is easy to use.
[Only use if using TCEO]
The availability of CE credit/contact hours
influenced my decision to participate in this
activity.
5-WB2811-Evaluation (3).doc
Strongly
Agree
Agree
Neither /
Undecided
Disagree
Strongly
Disagree
N/A
Page 2 of 4
Version: 2/28/2017
Continuing Education Proposal Packet
Live Educational Activity and Enduring Materials
Course Evaluation
Activity Specific
31.
32.
33.
As a result of my participation in this activity, I
intend to... (Select all that apply)
As a result of this training, how will you change
your clinical practices? (Select all that apply)
Please indicate any barriers that may prevent you
from making changes in practice. (Select all that
apply)
5-WB2811-Evaluation (3).doc
Page 3 of 4
Review which cancers and screenings the World
Trade Center Health Program (WTCHP) covers
for patients who were at the sites of the 9/11
terrorist attacks at the World Trade Center
(WTC), the Pentagon, and Shanksville,
Pennsylvania
Ask all patients whether they may have been
exposed to WTC contaminants on 9/11 or in the
months following
Recommend that all patients who may have been
exposed at any of the three 9/11 sites enroll in
the WTCHP to receive monitoring or initial
screening, and if they have a covered condition,
to determine whether their condition is 9/11related
Inform exposed patients of the September 11th
Victim Compensation Fund
Make other change(s)
Continue my existing practices, which this
program confirmed
None of the above
Increased knowledge/awareness
Screening/ monitoring
Treatment/ care plan
Referral/Continuity-of-care
Communication with patients/clients
Communication with other providers and
caregivers
Other ____________________________
I do not anticipate changing any aspect of my
clinical practice as a result of this training
I do not have time in a typical office visit to
query patients about their potential exposure on
9/11
I do not have time in a typical office visit to
counsel patients about the WTCHP and available
screenings and treatment
I do not have patient education resources to help
patients with questions about the WTCHP
The WTCHP process for patients to have their
cancer certified is cumbersome
Patients are not forthcoming about their WTC
experiences and exposures
It is difficult to navigate the WTCHP website
Other barrier(s)
I do not anticipate any barriers to making
desired changes in practice
Version: 2/28/2017
Continuing Education Proposal Packet
Live Educational Activity and Enduring Materials
Course Evaluation
34.
Have you visited World Trade Center Health
Program training webpage of CE activities?
Yes
No
35.
In your practice, are you aware of any patients
exposed to environmental contaminants on 9/11
or in the months following?
Yes
No
36.
What is your practice location? (Select one)
37.
Were you practicing in the New York
metropolitan area; Washington, DC; or
Pennsylvania on September 11, 2001?
Manhattan
New York City other than Manhattan
New York State
New Jersey
Washington DC
Pennsylvania
Other
Yes
38.
Have you ever: (Select all that apply)
39.
Please share any questions, additional comments,
or suggestions for future trainings.
5-WB2811-Evaluation (3).doc
No
Had a patient enrolled in the WTCHP
Referred a patient to enroll in the WTCHP
Had a patient with cancer certified by the
WTCHP
None of the above
Comments:
Page 4 of 4
Version: 2/28/2017
| File Type | application/pdf |
| File Title | Thank you for participating in the Program |
| Author | Frank J. Papotto |
| File Modified | 2017-02-28 |
| File Created | 2017-02-28 |