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2024/25 Case Sharing 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; optional otherwise)
First
Last
Email address (also required if you would like a certificate; optional otherwise)
1. Please tell us what your role is
(Required)
Family Physician
Nurse Practitioner
Specialist
Care Coordinator
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
What was the date of the Case Sharing event you are evaluating today?
(Required)
September 17, 2024
October 8, 2024
December 3, 2024
January 14, 2025
February 11, 2025
March 18, 2025
April 8, 2025
June 10, 2025
4. 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. Please describe the types of cases you would like to see highlighted in upcoming Webinars
14. 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
15. If you selected "yes," please indicate which future date(s) you may be interested in presenting and we will follow up with you.
October 8, 2024
December 3, 2024
January 14, 2025
February 11, 2025
March 18, 2025
April 8, 2025
June 10, 2025
Unsure at this time, but please follow up with me
If you selected "yes" above, please indicate the topic of the case you would like to share.
If you have any additional comments or general feedback you would like to share, please do so here.
Thank you for completing this evaluation form!