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P.E.P.

For

Saskatchewan

Physicians

Phone: (306)-966-7793

FAX:

(306)-966-7673

Practice

Enhancement

Program

CME, University of Saskatchewan

Box 60001RPO Univeristy

Saskatoon, SK S7N 4J8

This

Survey of Assessee Feedback

is sent to physicians six months+ after receiving

the Final Report from their PEP assessment to determine the value and measure any

impact and/or patterns of practice change resulting from a PEP assessment.

We appreciate your participation.

Please circle your answer: 1 = Most Agreed/Implemented 5 = Least Agreed/Implemented

1.

My PEP report was easy to understand

1

2

3

4

5

2.

Specialists: Feedback from Family Physicians was valuable 1

2

3

4

5

3.

Family Physicians: Feedback from Specialists was

valuable

1

2

3

4

5

4.

Feedback from patients was valuable

1

2

3

4

5

5.

The PEP program promotes quality improvement

1

2

3

4

5

6.

Participation in the PEP program was easy

1

2

3

4

5

7.

Based on my PEP report I have contemplated practice

change

1

2

3

4

5

8.

Comments:

Based on my PEP Final Report I have:

9.

Changed aspects of patient care (investigations, education, preventive care, etc.)

YES

NO – Don’t Agree NO – Don’t Need To

10.

Changed aspects of practice management (privacy issues, record keeping, health & safety issues)

YES

NO – Don’t Agree NO – Don’t Need To

11.

Changed how I communicate with patients

YES

NO – Don’t Agree NO – Don’t Need To

12.

Changed how I communicate with Specialists (for Family Physicians)

YES

NO – Don’t Agree NO – Don’t Need To

13.

Changed how I communicate with Family Physicians (for Specialists)

YES

NO – Don’t Agree NO – Don’t Need To

14.

Changed my pattern of CME

YES

NO – Don’t Agree NO – Don’t Need To

15.

Changed other areas of my practice (please explain):

Thank you for taking this opportunity to help evaluate the impact of PEP on medical practice.

SURVEY OF ASSESSEE

FEEDBACK Q - 6