Continuing Education Credit Form

Prostate Cancer: New Opportunities for Diagnosis and Treatment.
 

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

Prostate Cancer: New Opportunities for Diagnosis and Treatment 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:
• Know the incidence of prostate cancer in the U.S.
• Be familiar with the trends in prostate cancer mortality and morbidity in the U.S.
• Understand the potential reasons for the decrease in death rates for this disease.
• Understand the basis by which clinically localized prostate cancer is diagnosed.
• Know the various treatment modalities available to men with clinically localized disease.
• Be familiar with the efficacy of radiation therapy for the treatment of prostate cancer.
• Be aware of new areas of research in technological and biological approaches to the use of radiation therapy for localized prostate cancer.
• Understand the term “Clinical States” and how it is useful in the treatment of patients with prostate cancer.
• Understand what treatment protocols are available for patients with advanced prostate cancer at the NIH Clinical Center.


(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 “Prostate Cancer: New Opportunities for Diagnosis and Treatment” 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:

W. Marston Linehan, MD _____Somewhat Effective _____Effective _____Very Effective 
William H. Dahut, MD _____Somewhat Effective _____Effective _____Very Effective 
John Phillips, MD _____Somewhat Effective _____Effective _____Very Effective 
Norman Coleman, MD _____Somewhat Effective _____Effective _____Very Effective 


4.   Overall Program

Overall this educational activity was:   _____Marginal                       _____Good               _____Excellent

      Comments: