CME Activity Proposal for Consideration

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					CME Activity Proposal for Consideration

Program Title:                                         Program Date(s):

     I have attached a list of those responsible for the planning of this activity to this proposal
(Activity Course Director(s) and Planning Committee members).

In order for an activity to be considered for CME certification, the sponsor of the activity must
identify a professional practice gap the activity will address. To assist in the identification of
possible practice gaps, please answer the following questions. If you require additional space
for your answers, please add attachments to this form.

1.) Who is the target audience for this CME activity?

2.) When considering your target audience,
    a.) What are some questions they have and where is their deficit of knowledge evident?

   b.) What patient problems or professional challenges are they unable to address?

   c.) Why are they unable to address the patient problems/challenges articulated above?

3.) Using the answers to the questions above (2a-c), please identify the professional practice
gap(s) that will be addressed in this CME activity? (C2)

4.) What evidence/data/sources were consulted in your planning of this educational activity
and identification of professional practice gap(s)? Sources must prove that the need for this
activity goes beyond the sponsor’s own perception/observation of need.
a.) Check all that apply:

               Journal articles or other peer reviewed sources
               Attach bibliography citing journals or other sources, include journal abstracts or
               relevant paragraphs that support your educational needs assessment.
               Clinical evidence/research
               Attach abstract of evidence.
               Discussion w/ faculty (clinical/research)
               Attach minutes or notes of discussions and include any references to data,
               journals, and other sources. Audio recordings of minutes should be digital and
               readily convertible to MP3.
               Needs assessment of audience
               Attach summary of needs assessment and include description of representative
               audience sampled.
               Cite all studies, references, or data used to support educational needs.

b.) Please provide a description of your planning process and how you used the sources listed
above to identify professional practices gaps and the educational format of this activity.

5.) Identify other competencies or sources that were considered when identifying the
professional practice gap(s) and planning your educational activity? Refer to the List of
Desirable Physician Attributes (Example: IOM competencies, ACGME Competencies, etc.) found
on the last page of this Proposal. (C6)

6.) The professional practice gap(s) identified for this activity must be classified as a gap in
physician knowledge, competence or performance. Please classify each professional practice
gap identified for this activity as a gap in knowledge, competence or performance. (C2, C3)
Gaps in Knowledge = target audience does not have the answers or knowledge.
Gaps in Competence = target audience has the knowledge but does not know how to act on it.
Gaps in Performance = target audience has a strategy but is unable to implement the strategy
or implement the strategy properly in practice.

7.) Based on the need/gap the activity is addressing, what are the desired results of the
activity? Said differently, “What is the activity designed to change?” You must be able to detail
how you plan to measure these changes in question 8. (C3)
8.) What type(s) of evaluation method(s) will you use to know if the activity was effective at
meeting the need and creating change in competence, performance, or patient outcomes? (C11)
To measure a change in COMPETENCE, you must measure if the learner has developed new
    strategies based on the information provided in the activity.
To measure a change in PERFORMANCE, you must measure if the learner made a change in
    their practice or implemented new strategies as a result of the activity. (As a result of this
    activity, how do you intent to change your practice? Evaluate learners intent to change, 6
    month follow up)
To measure a change in PATIENT OUTCOMES, you must measure if the changes implemented
    by the learner in practice have affected patient outcomes. (chart reviews, changes in quality
    improvement numbers, etc.)

9.) Are there other initiatives within your institution working on this issue? Are there other
organizations we could partner with that are working on this issue?         Yes      No

If yes, what are those initiatives/ organizations and do you have any plans to partner with
them? (C18,C20)

10.) Given the information provided above, identify the topics that will be covered in your
activity and how will they relate to the professional practice gap(s).

11.) What is the right format to use for the activity? What type of activity will it be (Live,
Enduring Material, Internet, Other?)? What will be the educational design of the activity (e.g.
presentation, case studies, round table, and simulation)? What is the benefit of this
educational format? Please remember to consider adult learning principles and the physician
learning and change process. (C3, C5)

Revised 9.24.10
                                                 Desirable Physician Attributes

                              Please “X” all competencies that apply to your conference/meeting.

Institute of Medicine Core                           ABMS(MOC)/ACGME                            AAMC

   1. Provide patient-centered care                    6. Patient care that is                   12. Evidence of professional
   identify, respect, and care about patients'         compassionate, appropriate, and           standing such as an
   differences, values, preferences, and               effective for the treatment of health     unrestricted license, a license
   expressed needs; relieve pain and                   problems and the promotion of             that has no limitations on the
   suffering; coordinate continuous care;              health.                                   practice of medicine and
   listen to, clearly inform, communicate                                                        surgery in that jurisdiction.
   with, and educate patients; share decision          7. Medical knowledge about
   making and management; and                          established and evolving                  13. Evidence of a
   continuously advocate disease prevention,           biomedical, clinical, and                 commitment to lifelong
   wellness, and promotion of healthy                  cognate(e.g., epidemiological and         learning and involvement in a
   lifestyles, including a focus on population         social behavioral) sciences and the       periodic self-assessment
   health                                              application of this knowledge to          process to guide continuing
                                                       patient care                              learning
   2. Work in interdisciplinary teams
   cooperate, collaborate, communicate, and            8. Practice-based learning and            14. Evidence of cognitive
   integrate care in teams to ensure that care         improvement that involves                 expertise based on
   is continuous and reliable                          investigation and evaluation of their     performance on an
                                                       own patient care, appraisal and           examination. That exam
   3. Employ evidence-based practice                   assimilation of scientific evidence,      should be secure, reliable and
   integrate best research with clinical               and improvements inpatient care.          valid. It must contain questions
   expertise and patient values for optimum                                                      on fundamental knowledge,
   care, and participate in learning and               9. Interpersonal and                      up-to date practice-related
   research activities to the extent feasible          Communication skills that result in       knowledge, and other issues
                                                       effective information exchange and        such as ethics and
   4. Apply quality improvement identify               teaming with patients, their families,    professionalism
   errors and hazards in care; understand and          and other health professionals
   implement basic safety design principles,                                                     15. Evidence of evaluation of
   such as standardization and simplification;         10. Professionalism as manifested         performance in practice
   continually understand and measure                  through a commitment to carrying          including the medical care
   quality of care in terms of structure,              out professional responsibilities,        provided for common/major
   process, and outcomes in relation to                adherence to ethical principles, and      health problems (e.g., asthma,
   patient and community needs; and design             sensitivity to a diverse patient          diabetes, heart disease, hernia,
   and test interventions to change processes          population                                hip surgery) and physicians
   and systems of care, with the objective of                                                    behaviors, such as
                                                       11. Systems-based practice as
   improving quality                                                                             communication and
                                                       manifested by actions that
                                                                                                 professionalism, as they relate
         5. Utilize informatics                        demonstrate an awareness of and
                                                                                                 to patient care
                                                       responsiveness to the larger context
   communicate, manage, knowledge,                     and system for healthcare and the
   mitigate error, and support decision                ability to effectively call on system
   making using information technology                 resources to provide care that is of
                                                       optimal value

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