CME
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FEEDBACK FORM
Activity Title :
Institution :
Liaquat National Hospital
Other Institution
Medical College
Venue :
Lecture Hall 'A'
Lecture Hall 'B'
Lecture Hall 'C'
Lecture Hall 'D'
Lecture Hall 'E'
Tutorial Room
Other Venue
Auditorium
Outside LNH
Session Date :
Instructions:
This form is to seek your input regarding effectiveness of this CME Activity. For each of the statements given below, Please check the response which best represents your opinion
SA = Strongly agree; A = Agree; N = Neutral; D = Disagree; SD = Strongly disagree
Content
Rating
SA
A
N
D
SD
1. Objective (s) of the activity achieved
2. Activity was well organized
3. Environment promoted learning
4. Updated my knowledge/skills or both
5. Helped in filling the gaps in my Professional practice
6. Recommended for fellow colleagues
7. Name competency (skills)/performance/patient outcome likely to change as a result of this activity:
About Facilitators:
Facilitator Name:
SA
A
N
D
SD
1. Had a good grasp over the subject
2. Presentations used were brief &useful
3. Allowed adequate time for interaction
4. Emphasized & explained key concepts
5. Encouraged contribution of each participant
6. Responded well to questions
7. Used AV aids effectively
8. Maintained direction and control of sessions
Facilitator Name:
SA
A
N
D
SD
1. Had a good grasp over the subject
2. Presentations used were brief &useful
3. Allowed adequate time for interaction
4. Emphasized & explained key concepts
5. Encouraged contribution of each participant
6. Responded well to questions
7. Used AV aids effectively
8. Maintained direction and control of sessions
Comments:
Name three things you liked most in this CME activity:
Name three things you consider as the weakness of the activity:
The Topic(s) that you think should be added:
Any other comments:
