Midland Memorial Hospital
CME Activity Evaluation/Disclosure of Relevant Financial Relationships

Date:	2/4/2012
Title:	Team STEPPS
Speaker:	On-line presentation

Speaker disclosure of commercial affiliations:

Policies and standards of the Texas Medical Association, the Accreditation Council for Continuing Medical Education, and the American Medical Association require that speakers and planners for continuing medical education activities disclose any relevant financial relationships they may have with commercial interests whose products, devices or services may be discussed in the content of a CME activity.

This program has no commercial support.

Objectives:

• Discuss the components of implementing Team STEPPS at Midland Memorial Hospital.
• Review evidence-based success factors and practical tips for promoting Team STEPPS.
• Discuss sustainment of Team STEPPS behaviors.

Program Evaluation

Please rate each of the following by circling your response.

	Strongly agree Agree Neutral Disagree Strongly disagree
1.Content met program objectives
2.Level of material was appropriate
3.Amount of material was appropriate for the format and objectives
4.Content was free of commercial bias
5.Format/teaching methods were appropriate to meet program objectives
6.There was adequate time for questions/audience interaction
7. Lecture was timely and will influence how I practice.
8. Lecture will assist me in improving patient care.
9. Speaker was knowledgeable of the subject

10.Based on objectives and presentation today, what changes do you see yourself making in your practice?

Comments or suggestions

Name: Signature:

E-Mail:

(Please provide if you wish to receive CME reminders via e-mail. Please note that you may be contacted regarding follow-up in changes you may have made to your practice, following this program.)

Midland Memorial Hospital is accredited by the Texas Medical Association to provide continuing medical education for physicians.

Midland Memorial Hospital designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.