Continuing Education Credit Form

Breast Cancer: Women at Risk, Prevention Strategies  and Current Treatment Options
 

The American Association of Colleges of Nursing will award 1.5 contact hours of continuing education (up to a total of 15 hours for the entire Bench to Bedside series) for viewing this tape/CD-ROM as an educational activity.  This Continuing Education Credit (CEC) Form must be submitted to verify you viewed the tape/CD-ROM and earned the credit. 

Steps

1.      Print this copy of the Continuing Education Credit Form

2.      View the videotape or CD-ROM

3.      Complete all information requested

4.      Copy the completed form for your records of contact hours earned.  No additional verification will be sent to you.

5.      Send original copy of completed form to:  CenterNet/HMTV,  529 14th Street, N.W., Suite 1292, Washington, DC 20045

Breast Cancer: Women at Risk, Prevention Strategies and Current Treatment Options is part of the Bench to Bedside Video/CD-ROM Series for clinicians.  At the conclusion of this activity, the learner will be able to:
• Describe trends in breast cancer incidence and mortality in the U.S. by ethnic group and age
• Identify selective exposures related to risk of breast cancer
• Identify women at high risk of developing invasive breast cancer and strategies to decrease this risk
• Discuss recommendations for adjuvant treatment of breast cancer
• Discuss future directions in breast cancer research


(Please print)

 

Name________________________________________________ RN License # and state______________________
                        (Last)                         (M.I.)                        (First)

Address______________________________________________ City/State/Zip_____________________________

 

Date tape viewed______________ CE form printed on:    Signature  _____________________________

 

 

1.   Relationship to program purpose. Learning objectives for “Breast Cancer” support the overall purpose for which the series is designed.
___Yes   ___Partially   ___No
       

2.  Objectives   Has this program enabled you to have a better understanding of the objectives  listed above:
___Yes   ___Partially   ___No       

   

3.   Presenters

Please rate effectiveness of each presenter:

JoAnne Zujewski, MD _____Somewhat Effective _____Effective _____Very Effective 
Sandra M. Swain MD _____Somewhat Effective _____Effective _____Very Effective 
Michele Forman, PhD, MS _____Somewhat Effective _____Effective _____Very Effective 


4.   Overall Program

Overall this educational activity was:   _____Marginal                       _____Good               _____Excellent

      Comments: