Needs Assessment Survey

Please take a few minutes to fill out our Needs Assessment Survey. Your responses will help us develop future courses. 1. Personal information First Name Last name E-mail address Name of organization Medical degree (M.D. or D.O.) 2. Area(s) of medical specialty: Please check each box that applies. Area of surgical specialty Other (optional) 3. How interested are you in taking category 1 CME courses on the Internet? Very interested Maybe interested Not interested 4. What educational topics would you like to see in future online CME programs? 5. What is your learning style preference? Please check each box that applies? Diadactic- lecture format Live Event, if so, what type: Enduring Material, if so, what type: Internet Hands-on practice Other: 6. What computer system would you most likely use when taking CME courses? PC Mac Either Other: 7. Please list your favorite Internet health care sites. Include Internet address (URL) if available. 8. Additional comments: