Continuing Education Proposal Packet
	
| Activity title: | Health Risks Associated with 9/11 and the WTC Disaster: Lessons Learned | 
| Activity #: | WB2812 | Proposed start/release date: (MM/DD/YYYY) | 3/1/2019 | 
| Please take a moment to give us your feedback and write your comments in the boxes provided. | ||||||||||||||||||||||||||||
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					 Content and Learning Materials | ||||||||||||||||||||||||||||
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					 | Strongly Agree | Agree | Neither / Undecided | Disagree | Strongly Disagree | N/A | |||||||||||||||||||||
|  | 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. | Comments: | ||||||||||||||||||||||||||
|  | What suggestions do you have to improve this educational activity? | Comments: | ||||||||||||||||||||||||||
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					 Presentation | ||||||||||||||||||||||||||||
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					 | Strongly Agree | Agree | Neither / Undecided | Disagree | Strongly Disagree | N/A | |||||||||||||||||||||
|  | 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. |  |  |  |  |  |  | |||||||||||||||||||||
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					 Learning Environment | ||||||||||||||||||||||||||||
|  | The learning environment was conducive to learning. |  |  |  |  |  |  | |||||||||||||||||||||
|  | Do you believe this activity was influenced by commercial interests? | Yes | No | |||||||||||||||||||||||||
|  | If yes, please explain. | Comments: | ||||||||||||||||||||||||||
|  | Did you experience technical difficulties with this activity? | Yes | No | |||||||||||||||||||||||||
|  | If yes, please explain. | Comments: | ||||||||||||||||||||||||||
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					 Knowledge, Competence, and Practice | 
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					 | Strongly Agree | Agree | Neither / Undecided | Disagree | Strongly Disagree | N/A | 
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|  | This activity effectively met my educational needs. |  |  |  |  |  |  | 
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|  | I will be able to apply the knowledge gained from this activity to increase or maintain my competence. |  |  |  |  |  |  | 
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|  | I will be able to apply the knowledge gained from this activity to my practice. |  |  |  |  |  |  | 
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|  | I will be able to apply the knowledge/skills gained from this activity to develop strategies/provide interventions. |  |  |  |  |  |  | 
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|  | I will be able to apply the knowledge gained from this activity to improve performance. |  |  |  |  |  |  | 
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|  | I will be able to apply the knowledge gained from this activity to improve performance of the team. |  |  |  |  |  |  | 
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|  | What change or impact do you anticipate? | 
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|  | Do you anticipate barriers applying this knowledge? | Yes No | 
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|  | If yes, please explain 
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					 Learning Objectives | 
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					 | Strongly Agree | Agree | Neither / Undecided | Disagree | Strongly Disagree | N/A | 
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|  | I can identify immediate, short- and long-term health risks posed by exposure to disaster and/or terrorist attacks to responders and survivors |  |  |  |  |  |  | 
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|  | I can identify comorbidities most common in survivors and responders to the 9/11 World Trade Center, Pentagon, and Shanksville, Pennsylvania sites |  |  |  |  |  |  | 
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|  | I can assess the healthcare status and needs of the survivors and responders from the 9/11 attacks |  |  |  |  |  |  | 
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|  | Please share your comments regarding the learning objectives. | Comments: | 
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					 Access | 
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					 | Strongly Agree | Agree | Neither / Undecided | Disagree | Strongly Disagree | N/A | 
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|  | The CDC’s Training and Continuing Education Online (TCEO) system is easy to use. [Only use if using TCEO] |  |  |  |  |  |  | 
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|  | The availability of CE credit/contact hours influenced my decision to participate in this activity. |  |  |  |  |  |  | 
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					 Activity Specific | 
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| 30. | As a result of my participation in this activity, I intend to... (Select all that apply) | 
 
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| 31. | As a result of this training, how will you change your clinical practices? (Select all that apply) | 
 
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| 32. | "Please indicate any barriers that may prevent you from making changes in practice. (Select all that apply) | 
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| 33. | Have you visited World Trade Center Health Program training webpage of CE activities? | Yes | No | |||||||||||||||||||||||||
| 34. | In your practice, are you aware of any patients exposed to environmental contaminants on 9/11 or in the months following? | Yes | No | |||||||||||||||||||||||||
| 35. | What is your practice location? (Select one) | 
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| 36. | Were you practicing in the New York metropolitan area; Washington, DC; or Pennsylvania on September 11, 2001? | Yes | No | |||||||||||||||||||||||||
| 37. | Have you ever: (Select all that apply) | 
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| 38. | Please share any questions, additional comments, or suggestions for future trainings. | Comments: | ||||||||||||||||||||||||||
	
| File Type | application/msword | 
| File Modified | 0000-00-00 | 
| File Created | 0000-00-00 |