1.

AMERICAN COLLEGE OF SURGEONS |   DIVISION OF EDUCATION 
Blended Surgical Education and Training for Life 
JOINT PROVIDERSHIP PROGRAM

American Radium Society 97th Annual Meeting
May 2 – 5, 2015
Kauai, Hawaii

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Degree(s)

Question Title

* 4. Email

Question Title

* 5. Are you a member of ACS?

Question Title

* 6. ACS Member #________
IF YOU ARE A MEMBER OF THE ACS, YOU MUST PROVIDE  YOUR ACS MEMBER #.  If you do not, your CME certificate will not be transferred to your MY CME record on the ACS Portal.  In addition, providing us with your ACS member number will ensure proper credit is posted faster and to the correct page.

Question Title

* 7. As a participant at this educational activity, I attended _______  hours* of sessions.
(*1 hour = 1 AMA PRA Category 1 Credit™) - Maximum of 24.25 credit hours

Program Objectives

At the end of this activity, participants will be able to:

1. Direct care for patients with lung cancer in a multidisciplinary environment.
2. Review management of complex cases involving head and neck cancer.
3. Further appreciate the delicate balance needed to integrate “high technology and high touch” medicine to improve both the quantity and quality of life for cancer patients.
4. Analyze the issues involved in the application of stereotactic body radiation therapy for limited or oligo-metastases.

Question Title

* 8. Please select the appropriate response.

  Excellent Very Good Good Fair Poor
Overall, how would you rate this educational activity?

Question Title

* 9. Please select the appropriate response for each question.

  Strongly Agree Agree Neutral Disagree Strongly Agree
Program topics and content met the stated objectives
Content was relevant to my educational needs
Educational format was conducive to learning
Acquired knowledge will be applied in my practice environment
I will seek additional information on this subject
Program was fair, objective, and unbiased toward any product or program

Question Title

* 10. List a minimum of two things you are going to change in your practice as a result of what you have learned at this activity.

Question Title

* 11. Describe the barriers anticipated when implementing the above changes

Question Title

* 12. Do you have any suggestions for future topics to support and/or expand on what you have learned at this activity?

Question Title

* 13. Additional Comments:

( Privacy & Cookie Notice

T