ASE 2019 Pre-Meeting Clerkship Courses CME Evaluation Step 1 of 2 50% Name* First Last Email* Are you a member of the American College of Surgeons?* Yes No ACS Membership IDCredits will not post to your ACS MyCME webpage if ID not provided. Are you a Practicing Physician?* Yes No, I am not a physician or not currently practicing Your Name*As you wish it to appear on your CME certificate Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Total Hours of Attendance Claimed*Please enter a number from 0.25 to 8.25.AMA PRA Category 1 Creditsâ„¢ The American College of Surgeons designates this live activity for a maximum of 8.25 AMA PRA Category 1 Creditsâ„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity. *NOTE: 15 MINUTES OF SESSION ATTENDANCE = 0.25 AMA PRA CATEGORY 1 CREDITSâ„¢ Overall, how would you rate this educational activity?* Excellent Very good Good Fair Poor Program topics and content met the stated objectives.* Strongly Agree Agreee Neutral Disagree Strongly Disagree Content was relevant to my educational needs.* Strongly Agree Agreee Neutral Disagree Strongly Disagree Educational format was conducive to learning.* Strongly Agree Agreee Neutral Disagree Strongly Disagree This activity has improved my competence.* Strongly Agree Agreee Neutral Disagree Strongly Disagree This activity will improve my performance.* Strongly Agree Agreee Neutral Disagree Strongly Disagree This activity will enhance my communication skills.* Strongly Agree Agreee Neutral Disagree Strongly Disagree This activity will improve patient outcomes.* Strongly Agree Agreee Neutral Disagree Strongly Disagree This activity will improve processes of care and/or healthcare system performance.* Strongly Agree Agreee Neutral Disagree Strongly Disagree Program was free of commercial bias.* Strongly Agree Agreee Neutral Disagree Strongly Disagree Please share any specific interest(s) of bias or conflict of interest.*How could this educational activity been enhanced?*List a minimum of two things you are going to change in your practice as a result of what you learned at this activity.* Describe the barriers anticipated when implementing the above changes.*Do you have suggestions for future topics to support and/or expand on what you have learned at this activity?*