CNE Evaluation – MOBI & TIES QI Training (2/28/18) Name * First Last Name * Last Credentials * Practice/Organization * Email Address * Phone Number * Address * Address 2 City * State * ------ Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * OUTCOMES: At the conclusion of this activity, are you able to: Describe recent changes in immunization recommendations and MOBI/TIES Program * Yes No Present MOBI/TIES slides effectively * Yes No Integrate quality improvement strategies into your MOBI/TIES Presentation * Yes No Assist attendees in the Plan-Do-Study-Act (PDSA) cycle Yes No SPEAKERS: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. Speaker demonstrated teaching effectiveness: Beth Barker, RN, BSN * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Samantha Anzeljc, PhD * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Robert Frenck, Jr., MD, FAAP * 1 2 3 4 5 Speaker demonstrated teaching effectiveness: Rebecca Brady, MD, FAAP * 1 2 3 4 5 OVERALL PRESENTATION: On a scale of 1-5, with 1 being Strongly Disagree and 5 being Strongly Agree, please rate the following statements. The presentation was well organized and logically sequenced. * 1 2 3 4 5 The material was not too difficult to understand. * 1 2 3 4 5 I gained new information. * 1 2 3 4 5 How would you rate your overall satisfaction with this activity? * Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Additional Comments: By signing or typing your name, you confirm your identity and attest to attending the entire educational activity. * Clear If you are human, leave this field blank.