Web Survey

Required Information:

1. Please check all of the SELF STUDY you have used in the previous 12 months:

Audiotape/CD

Videotape/DVD

Journal

Internet resources

Performance improvement projects

Point of Care

Other, please explain:

2. Are you involved in any systematic ambulatory care quality improvement program? (If you answer no, please go to question 4)

Yes No

3. If so, who initiated the program?

Your practice

Your professional association

One or more insurance companies

Other, please specify:

4. Are you enrolled in any pay for performance program?

Yes No

5. If you answered “yes” to either question 2 or 4, would you be interested in a performance improvement program that offers CME credits?

Yes No

6. What potential clinical area(s) would be of interest to you? (Select all that apply)

Addiction

Emergency Medicine

Neurology

Sleep Disorders

Allergies

Endocrinology

Obstetrics & Gynecology

Sports Medicine

Alternative Medicine

ENT-Otolaryngology

Occupational Medicine

STD's

Arthritis

Family Practice

Oncology

Surgery

Asthma

Genetics

Ophthalmology

Trauma Surgery

Breast Cancer

GI

Orthopedics

Toxicology

Cardiology

Hematology

Pain Management

Transplantation

Cardiovascular

Infectious Diseases

Pediatrics

Urology

Chronic Diseases

Internal Medicine

Practice Issues

Vascular Medicine

Clinical Pharmacology

Lung Cancer

Psychiatry

Women's Health

Colon/rectal Cancer

Men's Health

Public Health

Other (specify)

Critical Care

Minimally Invasive Sur.

Pulmonary Disease

Dermatology

Nephrology

Radiology

7. What specific topic(s) would you like CME to offer?

8. Please list two clinical/practice management problems you most frequently encounter.