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eval

CME Attendance and Program Evaluation

This web form has a twofold purpose, not only does it provide The Osler Institute with important feedback that assists us in acquiring and keeping only the finest faculty, it is also utilized to confirm your attendance and the number of hours you have attended for CME purposes(as required by the ACCME).

Name as you wish it to appear on your CME Certificate

Email address (for delivery of your CME certificate)

Please choose your specialty*

Choose one of the following answers

Anesthesiology
Child / Adolescent Psychiatry
Cytology
Family Medicine
Neurology
Obstetrics / Gynecology
Ophthalmology
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiation Oncology
Radiology
Surgery (Critical Care)
Surgery (General)
Surgery (Orthopaedic)
Surgery (plastic surgery)
Surgery (Plastic)
Surgery (Thoracic)
Surgery (Vascular )
Vascular-Neurology
Other:

For live on-site reviews

How would you rate the hotel which held your review?

For online reviews

How would you rate the online system used to participate in the course?

Choose one of the following answers

Excellent
Good
Fair
Below Average

Enter the Month / Year you attended our course and the city in which the course was held


Date
Location

General Course Evaluation

	Yes	No
Financial disclosure information was provided (For live review course it will be on the Home page of your ESyllabus - online reviews will include this in the tabs near the bottom of the online review page)
The learning environment enhanced the learning experience
This format is an effective method of exam preparation
Osler staff were helpful and informative
Overall, the course was worthwhile and a valuable board prep tool

Course Timing: How would you prefer this course to be scheduled in reference to the examination?

Choose one of the following answers

Immediately prior
1-2 weeks prior
3-4 weeks prior
5-6 weeks prior
Other:

Please select the answer that best agrees with the amount of time that should be spent in review when compared to the current schedue.

Choose one of the following answers

Much less
less
just right
longer
much longer
Other:

Why are you taking this review?

Choose one of the following answers

Certification
Recertification
CME-Credits
Other:

How did you learn about The Osler Institute?

Choose one of the following answers

Direct Mail Piece
Osler website
Social Media, Facebook, Linked In etc
Referral by friend / colleague
Email advertising
Online Search
Other:

Please indicate your agreement with the following statements

	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
The course was free of commercial bias
The audio-visual aids were used effectively
The information provided was evidence based
The course learning objectives were met
Sufficient time was provided for Q&A
Faculty communicated effectively
Notes and/or case selections were appropriate

Please include any general comments that would help us improve the quality of our review.

Please list any faculty who you thought were exceptionally outstanding (one per line please)

Enter the number of CME Hours attended or "ALL"

As a result of participating in this course, please state 1-2 changes in your practice of medicine you intend to implement? Please save comments on course improvements for a later question (Required)

Please confirm you want to clear your response?