First time attendee last year 1-5 More than 5| INSTRUCTIONS: PLEASE PRINT OUT, COMPLETE AND RETURN ONLY IF YOU ATTENDED THIS MEETING . SUBMIT AS INDICATED BELOW. |
1. How many NYSSA PGA Meetings have you attended?
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First time attendee last year |
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1-5 |
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More than 5 |
2. Are you an NYSSA Member?
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Yes |
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No |
3. What is your Anesthetic Practice?
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Private Practice Fee-for-Service |
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Private Practice Group |
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Hospital Salaried |
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Academic |
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Other _________________________________ |
4. Are you a/an?:
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M.D. |
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D.O. |
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CRNA |
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Resident |
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Other _________________________________ |
5. How many years have you been in practice?
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Less than 5 |
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5-10 |
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More than 10 |
6. In what type of community do you practice?
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Urban |
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Suburban |
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Rural |
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Other _________________________________ |
7. How many CME Activities have you attended in the past 12 months?
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0 |
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1-3 |
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3-5 |
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More than 5 |
8. What was your primary reason for attending PGA?
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Annual Meeting |
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Participant/Faculty |
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Reputation for Quality of Meeting |
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Location - New York City in December |
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Other _________________________________ |
9. Which sessions/learning styles do you find most helpful to you in your practice? (Rank in order 1-8, entering the number in the box provided with 1 being the most helpful.)
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Scientific Panels (large audience sessions) |
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Focus Sessions (singular topic discussed in-depth) |
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Workshops - Hands-On Interactive |
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Miniworkshops |
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Problem-Based Learning Discussions |
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Case Discussion Luncheons With the Experts (small group lectures) |
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Scientific Exhibits |
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Poster Presentations |
10. Did you/your department change staffing patterns in order for people to attend the PGA?
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Yes |
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No |
11. How much of what you learned was incorporated into your practice?
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None |
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10%-20% |
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20%-50% |
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50% + |
12. Do you believe the PGA meets your educational needs for CME?
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Yes |
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No |
| If no, why not: |
_________________________________ |
| _________________________________ | |
| _________________________________ |
13. Did the PGA Planning Committee meet its Educational Objectives as was stated in the Program-Journal?
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Yes |
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No |
| If no, why not: |
_________________________________ |
| _________________________________ | |
| _________________________________ |
14. Are there any educational interests that you would like to see addressed in the future?
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_________________________________________________________________ |
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_________________________________________________________________ |
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_________________________________________________________________ |
Comments:
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_________________________________________________________________ |
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_________________________________________________________________ |
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_________________________________________________________________ |
15. Were there any questions you would like us to direct to a specific faculty member regarding topics that were presented at PGA/61 and their relationship to any practice-related problems you may have?
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_________________________________________________________________ |
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_________________________________________________________________ |
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_________________________________________________________________ |
| Please print out and return by fax to: | 1-212-867-7153 |
| Or, by mail to: | The NYSSA 85 Fifth Avenue 8th Floor New York, NY 10003 (U.S.A.) |
| Or, by e-mail to: | NYSSA Headquarters |
| Please give us your: | ____________________________________ NAME |
| ____________________________________ ADDRESS |
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| ____________________________________ CITY |
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| ____________________________________ STATE/POSTAL CODE |
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| ____________________________________ COUNTRY |
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| ____________________________________ |