2021/22 Case Sharing Webinar Evaluation Form Thank you for completing this form, to help CAMAP improve this program and meet the requirements of CFPC and the Royal College. If you would like a CPD certificate for your records, please make sure you include your first and last name. The certificate will be emailed to you once you submit this form.Name (required if you would like a CPD certificate) First Last Email address Please enter your email address if you'd like us to send you a CME certificate.1. Please tell us what your role is(Required) Family Physician Nurse Practitioner Specialist Other clinician Non clinician 2. What is your role in the delivery of MAiD?(Required) Assessor Provider I do both assessing and provision I do neither role 3. What was the month the Case Sharing occurred that you are evaluating today?(Required)September 21, 2021November 2, 2021November 30, 20214. Did the speakers disclose their respective Conflicts of Interests?(Required) Yes No 5. Did you perceive any degree of bias in this program?(Required) Yes No 6. If you answered "yes" to the question above, please explain the bias you perceived 7. For participants from Quebec, does the content respect the Code of Ethics of the CQDPCM (http://cqdpcm.ca/tool/code-dethique/)?(Required) Yes No Not applicable as I do not live / work in Quebec 8. Do you feel the objectives for this program were met?(Required)Our objectives for this MAID Case Webinar series are that after participating, attendees will be better able to: (1) Identify the elements of complex clinical scenarios when persons request (2) Critique various approaches to assess and/or provide MAiD in those complex scenarios (3) Interpret standards and guidelines in MAiD provision with patients and healthcare provider colleagues (4) Devise, develop and implement high quality end of life care (5) Explain how other colleagues ensure that MAiD medico-legal criteria are assessed and evaluated appropriately Yes No 9. If you answered "no" to the question above, please let us know what you felt needed to be different 10. Did you feel there was adequate time for discussion?(Required) Yes No 11. What changes will be you be making as a result of today’s program? 12. Please indicate which of the CanMEDS-FM Roles you feel were addressed by your participation in the Webinar. Please select all that apply. (This question is required by CFPC; if you are not a family physician, you can note that below).(Required) I am not a family physician Family medicine expert Communicator Leader Health Advocate Scholar Professional 13. Do you plan to attend a future Case Sharing Webinar?(Required) Yes No 14. Please describe the types of cases you would like to see highlighted in upcoming Webinars 15. Would you be willing to present at a future Case Sharing Webinar?If you answer "yes" to this question, please make sure you have included your name at the start of this from. Yes No Thank you for completing this evaluation form!