IPoC CME Evaluation

For UConn Health Affiliated Physicians

The University of Connecticut School of Medicine designates this point of care activity
for a maximum .5 AMA PRA Category 1 Credit(s)^TM. In order to claim CME credits, participants must complete the below verification/evaluation form. Please use one form for each clinical question searched.

First Name: (* Mandatory Field)

Last Name: (* Mandatory Field)

Degree(s): (* Mandatory Field)

Email: (* Mandatory Field)

Please enter the above information as you would like it to appear on your CME certificate.

Note: Your CME certificate will be sent to the email address provided in approximately 2 to 4 weeks.

1. What is the clinical topic/question researched?

(* Mandatory Field)

2. Is this question related to (check all that apply): (* Mandatory Field)

A rare condition

A condition not managed recently

A diagnostic dilemma

A need for new clinical information

A controversial clinical issue

Other (specify):

3. How would you define your findings? (* Mandatory Field)

Found clinical information that answered my question

Found clinical information that was related, but did not answered my question

Did not find any clinical information that addressed my question

Other (specify):

4. Please type (or copy and paste) 1-3 citations of the most relevant articles reviewed.

(* Mandatory Field)

5. Please check which database references were used in your research (check all that apply): (* Mandatory Field)

6. Describe the application of your findings to your practice (check all that apply): (* Mandatory Field)

Reinforced my clinical decision

Confirmed a diagnosis

Reviewed the condition

Applied new clinical guidelines to management

Changed course of management (please complete #7 below)

Unable to find clinical information that addressed my question

Other (specify):

7. If the course of management and/or diagnosis was changed, how was it changed? (check all that apply):
If the course of management and/or diagnosis was not changed please select that option. (* Mandatory Field)

Choice of treatment/management therapy

Changes in pharmaceutical therapy

Monitoring of therapy

Referral for a consultation

Changes in diagnostic tests

Recommendations for preventative care

Change in differential diagnosis

Course of management and/or diagnosis WAS NOT changed

Evaluation:

1. Define the difficulties in finding relevant information (check all that apply): (* Mandatory Field)

Did not have difficulty finding relevant information

Not enough full text journals available

Difficulties in searching

Insufficient database clinical information coverage

Access difficulties

2. Was this activity fair, balanced, and free from bias? (* Mandatory Field)

Yes

If “no”, please explain:

3. Rate the overall effectiveness of this activity: (* Mandatory Field)

Poor Excellent

4. Check all that apply: (* Mandatory Field)

This activity met my learning objectives

I learned something that will change how I manage patients

The information supports how I currently manage patients

I partially fullfilled my educational need

I did not find information to meet my original educational need

Comments:

5. Overall Activity: Comments/Suggestions:

Please allow 2 to 4 weeks for your CME certificate to arrive via the email address provided.

Thank you!