NAVAL SCHOOL OF HEALTH SCIENCES PORTSMOUTH VIRGINIA

CME/CEU CRITIQUE FORM

Please complete this evaluation form. Your constructive feedback will assist with the assessment of the CME program at Naval School of Health Sciences, Portsmouth.


TITLE OF COURSE: Operational Obstetrics & Gynecology, Non-Resident Training Course No. 13109-A

DATE OF COMPLETION OF COURSE: ________________________


Please rate the program using numerical values given below:

1 = POOR 2 = FAIR 3 = AVERAGE 4 = VERY GOOD 5 = OUTSTANDING

CONTENT: Appropriateness of topic for your educational needs? [___]

MANUAL: Usefulness? [___] Clear? [___] Enough detail? [___]

Comments:_______________________________________________________________________________________

TEST: Was it fair? [___] Did it help insure careful reading of the text? [___] Was it understandable? [___]

Comments:_______________________________________________________________________________________

OBJECTIVES: How well did the course meet the educational objectives? [___]

OVERALL impression of the course? [___]

OVERALL Comments:_____________________________________________________________________________


[___] PHYSICIAN
[___] PHYSICIAN ASSISTANT
[___] NURSE
[___] NURSE PRACTITIONER
[___] NURSE MIDWIFE
[___] NURSE PRACTITIONER
[___] HOSPITAL CORPSMAN
[___] INDEPENDENT DUTY CORPSMAN
[___] OTHER____________________________________________

Name____________________________________

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