CME Activity Application Required Continuing Medical Education Activity Development Worksheet Question Title * 1. Activity: Question Title * 2. Proposed Date: CME activities sponsored by Flagler Hospital are meant to foster the continuing professional development of physicians and other health professionals. However, these activities are not simply meant to provide "education for education's sake". Rather, the educational offerings are intended to increase knowledge, enhance competency, and influence behavior for the ultimate purpose of improving health outcomes.Regarding commercial support, if any, and the planning process, Flagler Hospital is committed to ensuring: CME activities will be independent of commercial support interests. All commerical support will be appropriately managed. There will be a separation of promotion from education. The activity will promote improvements or quality in healthcare and not proprietary interests. Anyone in a position to control content will disclose relevant financial relationships. If any conflicts of interests exist, a mechanism will be in place to resolve them prior to the activity. Please complete the following information below: EDUCATIONAL GAP(S)/TARGET AUDIENCE Question Title * 3. What is/are the educational gap(s)? What do the needs assessment show? Said differently, what is/are the quality gap(s) that this CME activity is trying to address? What initiated the need to sponsor an educational activity on this topic? Question Title * 4. Is the gap(s) in: (check any/all that apply) Knowledge Competence Performance Patient Outcomes Question Title * 5. How was this gap(s) identified? What brought this gap(s) to light? (check any/all that apply) Recent literature on the subject Needs Assessment from CME (or other) activities Deficiency in meeting current medical standards Need to address patient population questions regarding newest treatment modalities Discussion among peers/medical societies or organizations Quality Improvement findings New process/service being offered Current medical controversy Other (please specify) Question Title * 6. What is/are the primary target audience(s) that will help close the identified education gap(s)? (check any/all that apply) All physicians Administration Nurses Other ancillary health professionals Certain specialty physicians Other (please specify) Question Title * 7. Based on the need/gap(s) the activity is addressing, what are the desired results of the activity? Said differently, "What is the activity designed to change?" Question Title * 8. What is the real, or potential barriers facing the learners who are trying to close the gap(s)? ACGME/ABMS COMPETENCIES Question Title * 9. Which of the ACCME Competencies is most relevant to the gap(s) identified? Patient Care (compassionate/appropriate/effective care) Medical/Clinical Knowledge (biomedical/clinical/social services) Practice-Based Learning and Improvement (scientific evidence/methods) Interpersonal and Communication Skills (professional relationship skills) Professionalism (ethics/sensitivity/diversity/attitudes) System Based Practices (systems in which healthcare is provided) INSTITUTE OF MEDICINE CORE COMPETENCIES Question Title * 10. Which of the Institute of Medicine Core Competencies is most relevant to the gap(s) identified? Provide Patient Centered Care (identify/respect/values/differences) Work In Interdisciplinary Teams (cooperate/collaborate/communicate/integrate) Employ Evidence Based Practice (participate in learning and research activities) Apply Quality Improvements (identify errors/implement basic safety design principles) Utilize Informatics (communicate/manage/knowledge/mitigate error/support decision) INTERPROFESSIONAL EDUCATION COLLABORATIVE Question Title * 11. Which of the Interprofessional Education Collaborative Competency is most relevant to the gap(s) identified? Values/Ethics for Interprofessional practice. Roles/Responsibilities Interprofessional Communication Teams and Teamwork OBJECTIVES Question Title * 12. Based on the desired results of the activity, what are the objectives of the activity? Question Title * 13. At the conclusion of this educational activity, the participant will be able to: PARTNERS/ALLIES Question Title * 14. Are the other initiatives within this institution working on this issue? Are we aware of other institutions that could be potential partners in working on this issue? Please list any/all possible contacts? Question Title * 15. In what ways could we include the internal or external groups in this activity to help address or remove barriers? CONTENT Question Title * 16. Based on the identified gap(s), desired results, and target audience, what is the right content to cover? How does the content relate to the scope of practice of the physician target audience? Should the content also relate to specific patient groups? Should the activity contain content outside the clinical topic? FACULTY/INSTRUCTORS Question Title * 17. Based upon the content, who is/are the right faculty to cover this material? ACTIVITY FORMAT Question Title * 18. What format is best to achieve this learning exercise? (check any/all that apply) Live Activity: Case-based discussion Lecture Panel Enduring Material Simulation Skill-based training Small group discussion Enduring: Narrated power point slides Webcast Written article Power point slides (no narration) Regularly Scheduled Series Internet Point-of-Care Other: Other (please specify) Question Title * 19. Do you want the faculty to focus on (check any/all that apply) Transfer of Information (lectures/monographs) Techniques to overcome gaps in competency (case-based discussion/algorithms) Strategies to overcome system problems (guidelines/policies/toolkits) Stimulation Other (please specify) NON-EDUCATIONAL STRATEGIES Question Title * 20. Studies have shown the CME "interventions" can increase knowledge, enhance competency, and/or change physician behavior. As such, there are many non-educational strategies that may play a crucial role in improving quality. Are there non-educational strategies (e.g., reminders, flyers, announcements, "pop quizzes", patient satisfaction survey, etc) that could dove-tail with this educational activity? What might they do? EVALUATION METHODOLOGY Question Title * 21. Levels of Evaluation (check any/all that apply): Participation of learners (evaluation form-quality of program/content/speaker) Satisfaction of learners (evaluation form-did activity meet expectations) Learning of learners (pre and post-test regarding activity content) Behavioral of change of learners-self report ("intent to change" after event) Behavioral change of learners-documented (3rd party documents actual change) Impact on specific patients (measured outcomes) Impact on patient populations/groups (measured outcomes) Return on educational intervention (cost savings due to educational event) Other (please specify) Question Title * 22. DESCRIBE YOUR CME ACTIVITY (in your own words.....what do you envision for this activity) Question Title * 23. Submitted By (please include contact information): If you have any further questions directed to the CME Activity Application please contact Celina via email at celina.makowski@flaglerhealth.org Submit
