Please rate the following aspects of this educational activity on a descending scale where 5 = excellent to 1 = poor. *

	5	4	3	2	1
Overall quality of the educational activity	Overall quality of the educational activity - 5	Overall quality of the educational activity - 4	Overall quality of the educational activity - 3	Overall quality of the educational activity - 2	Overall quality of the educational activity - 1
Teaching strategy employed	Teaching strategy employed - 5	Teaching strategy employed - 4	Teaching strategy employed - 3	Teaching strategy employed - 2	Teaching strategy employed - 1
Relevance of the educational activity to your practice	Relevance of the educational activity to your practice - 5	Relevance of the educational activity to your practice - 4	Relevance of the educational activity to your practice - 3	Relevance of the educational activity to your practice - 2	Relevance of the educational activity to your practice - 1
Quality of the materials used in the activity	Quality of the materials used in the activity - 5	Quality of the materials used in the activity - 4	Quality of the materials used in the activity - 3	Quality of the materials used in the activity - 2	Quality of the materials used in the activity - 1
Helpfulness of the information presented	Helpfulness of the information presented - 5	Helpfulness of the information presented - 4	Helpfulness of the information presented - 3	Helpfulness of the information presented - 2	Helpfulness of the information presented - 1
Contributed to my knowledge, skills, and attitude to enhance the delivery of patient care	Contributed to my knowledge, skills, and attitude to enhance the delivery of patient care - 5	Contributed to my knowledge, skills, and attitude to enhance the delivery of patient care - 4	Contributed to my knowledge, skills, and attitude to enhance the delivery of patient care - 3	Contributed to my knowledge, skills, and attitude to enhance the delivery of patient care - 2	Contributed to my knowledge, skills, and attitude to enhance the delivery of patient care - 1

The intended result of this activity is improvement in competence, performance, and patient care. Please rate the effectiveness of this activity to fulfill these learning outcomes and achieve the intended result on a descending scale where 5 = excellent to 1 = poor. *

	5	4	3	2	1
Implement the Stepped Care Model for pain in their patient-centered medical homes.	Implement the Stepped Care Model for pain in their patient-centered medical homes. - 5	Implement the Stepped Care Model for pain in their patient-centered medical homes. - 4	Implement the Stepped Care Model for pain in their patient-centered medical homes. - 3	Implement the Stepped Care Model for pain in their patient-centered medical homes. - 2	Implement the Stepped Care Model for pain in their patient-centered medical homes. - 1
Train and mentor intake staff, primary care managers and other members of the PCMH.	Train and mentor intake staff, primary care managers and other members of the PCMH. - 5	Train and mentor intake staff, primary care managers and other members of the PCMH. - 4	Train and mentor intake staff, primary care managers and other members of the PCMH. - 3	Train and mentor intake staff, primary care managers and other members of the PCMH. - 2	Train and mentor intake staff, primary care managers and other members of the PCMH. - 1
Promote and reinforce behaviorally-based treatments for pain provided by the internal behavioral health consultant’s (IBHC).	Promote and reinforce behaviorally-based treatments for pain provided by the internal behavioral health consultant’s (IBHC). - 5	Promote and reinforce behaviorally-based treatments for pain provided by the internal behavioral health consultant’s (IBHC). - 4	Promote and reinforce behaviorally-based treatments for pain provided by the internal behavioral health consultant’s (IBHC). - 3	Promote and reinforce behaviorally-based treatments for pain provided by the internal behavioral health consultant’s (IBHC). - 2	Promote and reinforce behaviorally-based treatments for pain provided by the internal behavioral health consultant’s (IBHC). - 1
Use data and evidence-based sources such as the VA/DoD clinical practice guidelines to provide consultative/clinical support for PCMH staff.	Use data and evidence-based sources such as the VA/DoD clinical practice guidelines to provide consultative/clinical support for PCMH staff. - 5	Use data and evidence-based sources such as the VA/DoD clinical practice guidelines to provide consultative/clinical support for PCMH staff. - 4	Use data and evidence-based sources such as the VA/DoD clinical practice guidelines to provide consultative/clinical support for PCMH staff. - 3	Use data and evidence-based sources such as the VA/DoD clinical practice guidelines to provide consultative/clinical support for PCMH staff. - 2	Use data and evidence-based sources such as the VA/DoD clinical practice guidelines to provide consultative/clinical support for PCMH staff. - 1
Use updated Tri-Service Workflow forms relevant to the SCM for pain.	Use updated Tri-Service Workflow forms relevant to the SCM for pain. - 5	Use updated Tri-Service Workflow forms relevant to the SCM for pain. - 4	Use updated Tri-Service Workflow forms relevant to the SCM for pain. - 3	Use updated Tri-Service Workflow forms relevant to the SCM for pain. - 2	Use updated Tri-Service Workflow forms relevant to the SCM for pain. - 1

Please rate Jennifer Bell, M.D. for this educational activity using a descending scale where 5 = excellent to 1 = poor. *

	5	4	3	2	1
Presentation Style	Presentation Style - 5	Presentation Style - 4	Presentation Style - 3	Presentation Style - 2	Presentation Style - 1
Organization and Clarity	Organization and Clarity - 5	Organization and Clarity - 4	Organization and Clarity - 3	Organization and Clarity - 2	Organization and Clarity - 1
Expertise	Expertise - 5	Expertise - 4	Expertise - 3	Expertise - 2	Expertise - 1
Relevance to Outcomes	Relevance to Outcomes - 5	Relevance to Outcomes - 4	Relevance to Outcomes - 3	Relevance to Outcomes - 2	Relevance to Outcomes - 1

Please rate CAPT. Christopher L. Hunter, Ph.D., ABPP. for this educational activity using a descending scale where 5 = excellent to 1 = poor. *

	5	4	3	2	1
Presentation Style	Presentation Style - 5	Presentation Style - 4	Presentation Style - 3	Presentation Style - 2	Presentation Style - 1
Organization and Clarity	Organization and Clarity - 5	Organization and Clarity - 4	Organization and Clarity - 3	Organization and Clarity - 2	Organization and Clarity - 1
Expertise	Expertise - 5	Expertise - 4	Expertise - 3	Expertise - 2	Expertise - 1
Relevance to Outcomes	Relevance to Outcomes - 5	Relevance to Outcomes - 4	Relevance to Outcomes - 3	Relevance to Outcomes - 2	Relevance to Outcomes - 1

Do you feel that the activity was objective, balanced, and free of commercial bias? *

Yes

No

Please explain why you felt this activity was not objective, balanced, and free of commercial bias. *

Was disclosure (financial relationships, unapproved or unlabeled use of drugs or products) made available to you during the activity? *

Yes

No

Was the activity supported by scientifically-rigorous or evidence-based data? *

Yes

No

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