Shock Step 11 Questionnaire (must complete this part of module to receive final credit): Feedback Please identify up to three concrete, measurable changes you plan to apply as a result of participating in this program. Your responses will help us better evaluate specific areas of impact and future conferences. As a result of this program, I commit to change the following:*Will Information gained from this module result in enhancing patient care?*YesNoPlease rate your confidence in implementing these changes* high moderate low no Please identify any barriers you perceive in implementing these changes: Cost Lack of Time Lack of administrative support Insurance/reimbursement issues Patient compliance issues Lack of Consensus of Professional Select all that applyThe material was presented at an appropriate level*Please enter a number from 1 to 5.(choose a number from 1-5 1 representing the lowest possible score and 5 representing the highest possible score).I have gained knowledge that will improve patient care*Please enter a number from 1 to 5.(choose a number from 1-5 1 representing the lowest possible score and 5 representing the highest possible score).The program met my expectations in accomplishing the educational objectives*Please enter a number from 1 to 5.(choose a number from 1-5 1 representing the lowest possible score and 5 representing the highest possible score).The program content was objective, balanced, and free from commercial bias or influence*Please enter a number from 1 to 5.(choose a number from 1-5 1 representing the lowest possible score and 5 representing the highest possible score).Your overall rating of the quality of the education offered at this program*Please enter a number from 1 to 5.(choose a number from 1-5 1 representing the lowest possible score and 5 representing the highest possible score).Additional Comments (How can this program be improved?, etc):Email
