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1. Key documents generated through MTM (in most settings) include:

A. Standard paper or electronic medical record B. Templates mandated by the Centers for Medicare & Medicaid Services (CMS) C. Personal Medication List and Action Plan D. Drug information handouts generated by drug manufacturers

2. Pharmacy technicians' roles in generating and completing MTM documents:

A. may not involve direct patient contact B. should not involve changing or modifying MTM templates C. are related mainly to filing and organizing documents generated by the pharmacist D. are critical to supporting the MTM process

3. At the start of an MTM consultation with Mr. P., you show him a template for a Personal Medication List and say that you'll be helping the pharmacist to fill it in. He responds, “Oh, I already got one of those when I left the hospital.” Which of the following responses would be most consistent with MTM principles?

A. “Okay, great! Be sure that you use that and update it regularly.” B. “The pharmacist noticed you had other medicines that you were taking before you were hospitalized. We'd like to create just one list and try to make it easier for you to use.” C. “The hospital lists are almost never right. Let's use the one we have.” D. “So I guess you will have two—one for the medicines you got in the hospital, and this one for the new medicines.”

4. The Personal Medication List (PML) and the Therapeutic Action Plan:

A. are not necessary unless the patient is on multiple medications B. are key documents generated from an MTM patient encounter C. are given to different people: the PML to the patient and the Therapeutic Action Plan to the doctor D. are obsolete in MTM because of new electronic medical record (EMR) systems

Evaluation Questions

5. To what extent did the program meet objective #1?

A. Excellent B. Very Good C. Good D. Fair E. Poor

6. To what extent did the program meet objective #2?

A. Excellent B. Very Good C. Good D. Fair E. Poor

7. To what extent did the program meet objective #3?

A. Excellent B. Very Good C. Good D. Fair E. Poor

8. Rate the effectiveness of how well the program related to your educational needs:

A. Excellent B. Very Good C. Good D. Fair E. Poor

9. Rate how well the active learning strategies (questions, cases, discussions) were appropriate and effective learning tools:

A. Excellent B. Very Good C. Good D. Fair E. Poor

10. Rate the quality of the faculty:

A. Excellent B. Very Good C. Good D. Fair E. Poor

11. Rate the effectiveness and the overall usefulness of the material presented:

A. Excellent B. Very Good C. Good D. Fair E. Poor

12. Rate the appropriateness of the examination for this activity:

A. Excellent B. Very Good C. Good D. Fair E. Poor

13. Rate the effectiveness of how well the activity related to your practice needs:

A. Excellent B. Very Good C. Good D. Fair E. Poor

14. Rate the effectiveness of how well the activity will help you improve patient care:

A. Excellent B. Very Good C. Good D. Fair E. Poor

15. Will the information presented cause you to change your practice?

A. Yes B. No

16. Are you committed to making these changes?

A. Yes B. No

17. As a result of this activity, did you learn something new?

A. Yes B. No

18. What is your practice setting or area of practice?

A. Community Pharmacy/Independent B. Community Pharmacy/Chain C. Hospital/Health Systems D. Administrative/Pharmacy Director E. Critical Care Pharmacy F. Long-term Care G. Managed Care/PBM H. Oncology I. Specialty Pharmacy J. Industry/Manufacturing

19. How many years have you been in practice?

A. <5 B. 5 – 10 C. 11 – 20 D. >20

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