TCEO Follow-up Evaluation

CDC Course Evaluation
Live and Enduring Educational Activity

Form Approved
OMB No. 0920 – 0017
Expiration Date: 06/30/2019

WB3888 – CDC Follow-up Course Evaluation
It has been 3 weeks since you completed (course name will appear here). Please take a few minutes to answer this 6 question
follow-up survey. Your feedback will help CDC understand the impact of educational activities.
Questions:
1. Did you use what you learned from this course in your work?
☐ Yes
☐ No
☐ Not applicable, I did not learn anything new from this course
2. What did you use from this course? (if it applies)

The public reporting burden of this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is
not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to - CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta,
Georgia 30333 ATTN: PRA (0920-0017).

CDC Course Evaluation
Live and Enduring Educational Activity

3. As a result of this course, I have: (select all that apply)
☐ not improved
☐ maintained my competence
☐ increased my competence
☐ improved my performance
☐ provided clinical interventions in practice
☐ developed strategies I use in practice
☐ other (please specify)
☐ not applicable, I did not learn from this course
☐ not applicable, I did not use anything from this course
4. How did you benefit your team as a result of what you learned? (select all that apply)
☐ I provided better communication across my interprofessional team(s)
☐ I shared information with colleagues to improve patient education
☐ I identified changes needed in practice
☐ I increased participation in shared decision making across my interprofessional team(s)
☐ Other (Please Specify)
☐ Not applicable, I did not learn from the course and/or will not benefit my team
5. What factors kept you from using what you learned from this course in your work? (select all that apply)
☐ None, I have used this content in my work
☐ I did not have the resources I needed
☐ I was not provided opportunities to use this course
☐ I did not have time to use what I learned
☐ My supervisor did not support me in using what I learned
☐ My colleagues did not support me in using what I learned
☐ The course content was not relevant to my current work
☐ Other (please specify)
?