A Guide for and Documentation of the Planning of a CME Activity by tyndale

VIEWS: 33 PAGES: 11

									                                CME ACTIVITY PLANNING WORKSHEET
Title:
Type of Activity
    Live Event      Enduring Material
Date:
Location:
Sponsoring School:      NJMS     RWJMS               SOM         Other:
Sponsoring Department:
Activity Director:
UMDNJ Appointment:
Address/Mail Code:
Telephone:
Fax:
E-mail:
Administrative Liaison:
Credits requested:       AMA PRA           Nursing*           Pharmacy*


Required Attachments:
   Preliminary agenda (live event)
    Supporting documentation clearly defining the gap to be addressed
    Signed Disclosure Forms for all individuals involved in the development and/or implementation of the
    activity
    Budget summary indicating anticipated income and expenditures

This CME Planning Process has been designed based on the Criteria for Accreditation of the Accreditation
Council for Continuing Medical Education (ACCME) and accepted adult learning principles. For this
educational activity to be approved for AMA PRA Category 1 Credit™, the planning process outlined in this
document is required.

This CME Activity Planning Worksheet with all supporting forms and documents must be completed and
submitted to CCOE at least 90 days in advance of the proposed activity date. Incomplete worksheets will be
returned.

*If continuing nursing and/or pharmacy education credit is being requested in addition to CME credit, CCOE
will provide you with supplemental forms that must be completed.




                                                For CCOE Staff Use Only
 Date received: ________________ Date reviewed:
UMDNJ Activity Planning Worksheet – School-Based Activities   ________________ Approved by: ________________
Page | 1
      Approved for: _______ AMA PRA Category 1 Credit(s)™                   Course Code: __________________
SECTION 1: Gap AnalysisOutcomes DesignationLearning Objectives

Instructions for completing the grid on the following page
1. State the best practice under “Key Point.” A best practice may be from a national guideline or consensus
   statement from a credible organization, from peer-reviewed medical literature where more than one
   source agree on the practice, or from the considered opinion of the expert-planner in the case when no
   published guideline exists. This becomes the end-goal for the activity.

2. State the source used that provided you with the best practice (i.e., article from peer reviewed journal,
   name of consensus statement or clinical guideline, etc.).

3. State the current practice of the cohort of learners to which your educational activity is targeted. You can
   determine this based on interviews (formal or informal) with members of the target audience, a
   questionnaire, or a published article that reports on findings from learners. THE KEY IS TO GO BEYOND
   EXPERT PERCEPTION OF THE GAP AND TO INCLUDE THE PERCEPTION OF THE LEARNER.

4. State the source used that provided you with current practice (i.e., from questionnaire of membership,
   interviews with 6 family physicians, etc.).

5. State the gap based on the difference between best practice and current practice. This “resulting gap” will
   define the learning objectives you will develop, which in turn leads to the content of the activity. Indicate
   the “root cause” or reason for the gap [i.e., did the gap you isolated indicate learners lacked knowledge
   (K), competence (i.e., ability to apply the knowledge to a practice-based situation) (C), or that
   implementing it in practice or performance (P) was the issue]. Use those codes to indicate Root Cause in
   the chart that follows.

6. The gap should inform you of the type of outcomes that are appropriate for this activity (i.e., does the gap
   indicate a need to improve learner competence and/or performance-in-practice). The outcomes are
   NOTE: Once designated, this will define your choice of evaluation (outcome) measurement tools.

7. Prepare a learning objective for each identified gap. Each objective should include a verb that is chosen to
   describe something a physician will do in practice (and not what the teacher will teach). For example, do
   not use verbs such as “discuss” or “describe, learn or understand.” Use words such as “apply, develop a
   strategy to…, etc.” Ensure that the objective clearly states a standard against which one can judge the
   success in achieving the objective. The ‘standard’ helps inform the outcomes questions you will prepare.




UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 2
         GAP ANALYSIS—OUTCOMES DESIGNATION—LEARNING OBJECTIVES LINKAGE WORKSHEET

            BEST PRACTICE                               CURRENT PRACTICE    RESULTING GAPS (What           OUTCOME INDICATED         LEARNING OBJECTIVE
           (What should be)                                   (What is)    interventions are indicated?)    (Improvement in . . .)
Key Point:                                     Key Point:                                                     Competence
                                                                                                              Performance
Source:                                        Source:                     Root Cause:                        Patient Outcomes
                                                                              K    C       P

Key Point:                                     Key Point:                                                     Competence
                                                                                                              Performance
Source:                                        Source:                     Root Cause:                        Patient Outcomes
                                                                              K    C       P

Key Point:                                     Key Point:                                                     Competence
                                                                                                              Performance
Source:                                        Source:                     Root Cause:                        Patient Outcomes
                                                                              K    C       P

Key Point:                                     Key Point:                                                     Competence
                                                                                                              Performance
Source:                                        Source:                     Root Cause:                        Patient Outcomes
                                                                              K    C       P

Key Point:                                     Key Point:                                                     Competence
                                                                                                              Performance
Source:                                        Source:                     Root Cause:                        Patient Outcomes
                                                                              K    C       P

<Insert or delete rows as needed>

LEGEND:
   (1) SOURCE—Include journal references, name of survey, or other identifiers of the source from which you determined “key point” information.
   (2) ROOT CAUSE—After stating the “resulting gap” above, indicate what you have determined to be the root cause or the reason for the gap by inserting
       one or more of the following codes: Lack of Knowledge (K), Lack of Competence(C), and/or Failure to Perform in Practice (P).


UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 3
SECTION 2: Analysis of Current or Potential Scope of Practice
INSTRUCTIONS: Prior to writing learning objectives, which are the basis for the content of the CME activity, it is important to
assess the scope of practice of the targeted learners. The scope of practice may be a combination of current and potential
performance standards that are influenced by environment of the practice (e.g., is the practice environment of the learners an
urban area with cultural diversities that influence the scope of practice?), whether the practice is in an academic center, the
patient demographics, etc. The scope of practice also represents the vision of the specialty board as it impacts recertification in
the relevant specialty as well as the norms and guidelines developed by the national specialty society associated with the
specialty. All of this should be taken into consideration, together with the results of the gap analysis, as content is developed.

                                            CURRENT SCOPE OF PRACTICE
What is the clinical specialty of the targeted
learners?
Describe the patient demographics associated
with learners’ practices?
Describe the daily practice of these learners.

                                           POTENTIAL SCOPE OF PRACTICE
Ideal practice parameters expressed by the
relevant specialty board
Relevant practice guidelines from the relevant
national specialty society
        MATCHING THE CONTENT OF THIS ACTIVITY TO THE CURRENT OR POTENTIAL SCOPE OF PRACTICE
Indicate how the above analysis will be
reflected in the content of this activity.




UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 4
SECTION 3: Application of Desirable Physician Attributes to CME Content
INSTRUCTIONS: Planners are required to address nationally-established goals for physician core competencies as developed
by the Institute of Medicine, Accreditation Council on Graduate Medical Education (ACGME), Association of American Medical
Colleges (AAMC), and the American Board of Medical Specialties (ABMS) related to specialty maintenance of certification.
                                                                                                                            th
Based on the following chart that lists all of these related national and prioritized competencies please indicate in the 4
column specific areas of content (and the competency number identifier) in your planned CME activity that will address those
national competencies:
    Institute of Medicine Core                  ABMS (MOC)/ACGME                            AAMC                       Content Reflecting These
          Competencies                            Competencies                           Competencies                 Competencies in Your CME
                                                                                                                               Activity
             Provide patient-                        Patient care that is                    Evidence of                  INSTRUCTION: ENTER
             centered care – identify,               compassionate,                          professional standing,       APPLICABLE NUMBER(S) IN BOX
             respect, and care about                 appropriate, and                        such as an                   FOLLOWED BY DESCRIPTION OF
                                                                                                                          CONTENT YOU PLAN TO ADDRESS :
   patients’ differences, values,          effective for the treatment of         unrestricted license, a license
   preferences, and expressed              health problems and the                that has no limitations on the      
   needs; relieve pain and suffering;                promotion of health          practice of medicine and surgery
   coordinate continuous care; listen                Medical knowledge            in that jurisdiction.               
   to, clearly inform, communicate                   about established and                   Evidence of a
   with, and educated patients;            evolving biomedical, clinical, and                commitment to            
   share decision making and               cognate (e.g., epidemiological and                lifelong learning and
   management; and continuously            social-behavioral) sciences and the    involvement in a periodic self-     
   advocate disease prevention,            application of this knowledge to       assessment process to guide
   wellness, and promotion of health       patient care                           continuing learning.                
   lifestyles, including a focus on                   Practice-based learning                Evidence of cognitive
   population health.                                 and improvement that                   expertise based on       
              Work in                                 involves investigation                 performance on an
              interdisciplinary teams–     and evaluation of their own            examination. That exam should       
              cooperate, collaborate,      patient care, appraisal and            be secure, reliable and valid. It
   communicate, and integrate care         assimilation of scientific evidence,   must contain questions on           
   in teams to ensure that care is         and improvements in patient care       fundamental knowledge, up-to-
   continuous and reliable.                          Interpersonal and            date practice- related              
             Employ evidence-based                   communication skills         knowledge, and other issues
             practice – integrate best               that result in effective     such as ethics and                  
             research with clinical        information exchange and teaming       professionalism.
             expertise and patient         with patients, their families, and               Evidence of evaluation
   values for optimum care, and            other health professionals                       of performance in
   participate in learning and                       Professionalism, as                    practice, including the
   research activities to the extent                 manifested through a         medical care provided for
             feasible.                               commitment to carrying       common/major health problems
             Apply quality                 out professional responsibilities,     (e.g., asthma, diabetes, heart
             improvement – identify        adherence to ethical principles,       disease, hernia, hip surgery) and
   errors and hazards in care;             and sensitivity to a diverse patient   physicians behaviors, such as
   understand and implement basic                    population                   communication and
   safety design principles, such as                 Systems-based practice,      professionalism, as they relate
   standardization and                               as manifested by actions     to patient care.
   simplification; continually                       that demonstrate an
   understand and measure quality          awareness of and responsiveness
   of care in terms of structure,          to the larger context and system
   process, and outcomes in relation       for health care and the ability to
   to patient and community needs;         effectively call on system
   and design and test interventions       resources to provide care that is of
   to change processes and systems         optimal value.
   of care, with the objective of
                improving quality.
                Utilize informatics –
                communicate, manage,
                knowledge, mitigate
   error, and support decision
UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 5
   making using information
   technology.

SECTION 4: Barriers to Achieving Results and Strategies to Address Them
INSTRUCTIONS: Planners are encouraged to give consideration to the system of care in which the learner will incorporate
new or validate existing learned behaviors. Planners must be sure to (a) identify barriers that could block implementation (e.g.,
formulary restrictions, time not allotted for implementation of new skills, or performance behaviors, insurance doesn’t
reimburse for treatments, organization doesn’t support educational efforts, lack of resources, policy issues within organization,
etc.) and (b) apply strategies to address, discuss strategies to overcome or remove those barriers (if possible) in the content of
the CME activity. Please indicate below the barrier(s) you have identified and the strategies you will employ in this activity to
address or remove them:
 Identified System Barrier:

 Strategy to Address or Remove the Identified Barrier:

 Identified System Barrier:

 Strategy to Address or Remove the Identified Barrier:

<Insert or delete rows as needed>

SECTION 5: Format and Design Related to Sustaining Results
INSTRUCTIONS: The purpose of CME is change in behavior or validation that changes already made are consistent with best
practices. Format decisions include (a) venue appropriate to your target audience and to achieve best practices (desired
results), (b) methods used to engage learners in the educational process—especially those that serve to demonstrate
application of knowledge to performance, and (3) ancillary processes and tools that sustain learning goals. NOTE: Refer to
Appendix A for guidance on format choices. In the table below, indicate your choices for each element above and the rationale
for that choice:

  A. VENUE AND/OR MODE OF EDUCATIONAL INTERVENTION (HINT:                         RATIONALE APPROPRIATE TO
     use of multiple interventions serve to reinforce new behaviors):             OBJECTIVES/RESULTS:
     Live symposium                  Internet-based activity

       Print enduring material                  Electronic enduring material

     Journal supplement      Other
  B. METHODS TO ENGAGE LEARNERS (HINT: Click all that apply, but                  RATIONALE APPROPRIATE TO
     at least one):                                                               OBJECTIVES/RESULTS:
     Case studies            Audience response system

       Reflection worksheet                     Small group work

       Panel Discussion                         Debate

     Question/Answer          Other:
  C. PROCESSES AND ANCILLARY TOOLS TO REINFORCE AND                               RATIONALE APPROPRIATE TO
     SUSTAIN LEARNING GOALS:                                                      OBJECTIVES/RESULTS:
     Email reminder            Ancillary case study online

       Patient reminder                         Algorithm Worksheet


UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 6
        Other

SECTION 6: Faculty/Planner Selection
INSTRUCTIONS: Faculty and activity planners that are selected should have a demonstrated expertise in the therapeutic
field, strong presentation and communication skills (if presenting), and ability to address the gaps and learning objectives
expressed in this planning document. It is advisable to select faculty with the most expertise and teaching skills and the least
amount of conflicts of interest. List the faculty and planners and their qualifications:

Name:

Title and Affiliation:

Role:       Planner          Speaker          Author          Editor   Peer Reviewer     Other:

Qualifications:

Name:

Title and Affiliation:

Role:       Planner          Speaker          Author          Editor   Peer Reviewer     Other:

Qualifications:

Name:

Title and Affiliation:

Role:       Planner          Speaker          Author          Editor   Peer Reviewer     Other:

Qualifications:

Name:

Title and Affiliation:

Role:       Planner          Speaker          Author          Editor   Peer Reviewer     Other:

Qualifications:

Name:

Title and Affiliation:

Role:       Planner          Speaker          Author          Editor   Peer Reviewer     Other:

Qualifications:


UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 7
<Insert or delete rows as needed or attach additional sheets>


SECTION 7: Marketing
INSTRUCTIONS: Indicate how this activity will be publicized to prospective participants and what materials will be developed
to promote this activity.

  A. METHODS TO RECRUIT THE IDENTIFIED AUDIENCE Select all that apply.
       Previous participants from another activity (please specify):
       Society membership list (please specify):
       Random list selected by: List mailing list sources(s) (AMA, medical assoc/society, etc.)
                 Geographic area (please specify):
                 Incidence of the disease (please specify):
                 Practice Patterns (please specify):
                 Expressed interest in CME courses
       Other:
  B. METHODS TO GENERATE AN AUDIENCE Select all that apply.
       Direct mail, fax, email of invitation/brochure/letter       Posters placed in hospitals/clinics
       Faculty distribution of invitation/brochure/letter          Web-based announcements
       Advertisements/journal announcements
     Save-the-Date card (Note: A Save-the-Date card cannot be used as the only method to generate an
  audience.)
     Assistance from grantor’s sales force (Note: A commercial interest can assist in the distribution of
  promotional materials for CME activities, but not be used as the only method for audience generation.)
      Other:




UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 8
SECTION 8: Budget
INSTRUCTIONS: In addition to providing an attached budget of anticipated income and expenditures, please indicate the
sources of expected financial support.

Sources of Expected Financial Support
Check all that apply and complete that specific section.
       Sources, if known                                      Estimated   Name of company, foundation, or organization,
                                                              Amount      contact and phone number.
       Registration Fees
             Physicians
             Residents/Fellows
            Other Health Professionals
           UMDNJ Faculty, Residents, Students, Staff
           Other
           School/Departmental Donation
       Commercial Support (Grant)                                         List as many as applicable, use additional sheet if
                                                                          necessary.



       Foundation Fund/Grant
       Federal/State Agency Award
       Exhibit Fees
       Other:




UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 9
SECTION 9: Attestation and Approvals

UMDNJ Activity Director
    I hereby certify that his worksheet was completed accurately and attest to the validity of the information contained
     within.
    I agree to collaborate with CCOE to ensure that the planning and implementation of the series are consistent with the
     continuing medical education policies of UMDNJ, CCOE, and other the agencies that regulate continuing medical
     education.

Name (Please Print )

Signature                                                                               Date

Department Chair – Academic Approval
Name (Please Print)

Signature                                                                               Date

Center for Continuing and Outreach Education
Name (Please Print)

Signature                                                                               Date




UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 10
                                                              APPENDIX A




UMDNJ Activity Planning Worksheet – School-Based Activities
Page | 11

								
To top