PLANNING APPLICATION

FORREGULARLY SCHEDULED SERIES (RSSs)/ GRAND ROUNDS

RSS(Grand Rounds Series) NAME

Sponsor:

St. Luke’s-Roosevelt Hospital

1111 Amsterdam Avenue

New York, NY10025

Contacts: Kiersten

Stacy

Sponsoring Department/Division:

Day of Week:Time:

Location:

Frequency: (Weekly, Bi-weekly, Monthly)

Course Director:

Name
Phone
Fax
E-mail

Planners:

Name
Phone
Fax
E-mail
Name
Phone
Fax
E-mail

RSS Coordinator:

Name
Phone
Fax
E-mail

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1. TARGET AUDIENCE

Please list the target audience for the Regularly Scheduled Series (Grand Rounds series)

e.g. anesthesiologists, cardiologists, dermatologists, etc.

2. NEEDS ASSESSMENT/EDUCATIONAL GAPS

In accordance with our CME Mission, this educational intervention will address (1) physician competencies, as determined by national or specialty society guidelines, specialty credentialing boards, or other sources of national priority such as the Institute of Medicine and the US Surgeon General; (2) physician performance-in-practice; and/or (3) patient outcomes.

To identify these gaps, the planning committee will utilize the following resources/methods:

New methods of diagnosis or treatment (knowledge) / External requirements such as: National Committee for Quality Assurance (NCQA), Joint Commission on Accreditation of Healthcare (JCAHO) or Health Plan Employer Data and Information Set (HEDIS). (Competence and Performance)
Availability of new medication(S) or indications(s) (knowledge) / Continuing review of changes in quality of care as revealed by medical audit or other patient care reviews (Competence and Performance)
Development of new technology (knowledge) / Referral patterns (Competence and Performance)
Input from experts regarding advances in medical knowledge (knowledge) / Legislative, regulatory or organizational changes effecting patient care (Knowledge, Competence and Performance
Literature review (knowledge) / Joint Commission Patient Safety Goal/Competency:
Data from outside sources, e.g., public health statistics (knowledge) / Other:
Survey of target audience (knowledge)
Quality assurance/audit data (Competence & Performance)
Professional society requirements (competence & Performance)

These questions will be useful in capturing feedback from focus panels of learners or other qualitative needs assessments from the target audience associated with a CME intervention in the planning stage. Be sure to further link this information with other sources of needs, with the preparation of learning objectives, development of the educational design, and assessment of changes or improvements in physician competency, performance-in-practice, or patient outcomes.

1. What has changed in the practice of your specialty over the past year, and would therefore merit educational interventions focused on that issue?

2. Have there been areas where quality indicators suggest a focused departmental improvement is appropriate?

3. Is there breaking research in your specialty that physicians will find interesting and medically relevant to the quality of their care for patients? What are the educational strategies that will expedite the translation of the research to practice?

4. Are there traditional core performance areas in your specialty that are worth reinforcing and updating?

5. Have there been recent untoward patient incidents concerning safety and efficacy that would merit a RSS iteration?

3. SYSTEM BARRIERS AND OPPORTUNITIES

All educational interventions must give consideration to the system of care in which the learner will incorporate new or validate existing learned behaviors. Planners must be sure to address anticipated barriers that could block implementation. (e.g.., time not allotted for implementation of new skills, behaviors, insurance doesn’t reimburse for treatments/etc., organization does not support educational efforts, lack of resources).

This activity has no relevant system barriers.

The following barriers have been identified and will be addressed in this activity:

(EXAMPLES OF NON-EDUCATIONAL INTERVENTIONS INCLUDE FOLLOW-UP MECHANISMS, PATIENT HANDOUTS):

Identified Barriers (Select 1 at minimum) What potential barriers do you anticipate attendees may have in incorporating new knowledge, competency, and/or perfermance objectives into practice? Select all that apply. C18, C19
Lack of time to assess/counsel patients / Lack of consensus on professional guidelines
Lack of administrative support/resources / Cost
Insurance/reimbursement issues / No perceive barriers
Patient compliance issues / Other:
Will you try to address any of these barriers in this CME activity? Yes No
Please Explain:

4. PATIENT SAFETY CONSIDERATIONS

Planners should examine planned activities for patient safety concerns in accordance with the national public interest. Please list issues of patient safety associated with these educational interventions that need to be addressed in this activity:

There are no patient safety issues applicable to this activity.

The following patient safety issues have been identified and will be addressed in this activity:

Identified
Patient Safety Issues / Planned Discussion in
Activity Content / Non-Educational Interventions

5. PHYSICIAN COMPETENCIES AND ATTRIBUTES

Competencies and Attributes are national goals for physicians associated with the targeted specialty(ies) that should be addressed whenever possible in planning CME.

Based on the Maintenance of Certification (MOC) competencies designated by the American Board of Medical Specialties (ABMS), which competency areas will you address in this CME activity? Check all that applies (see the appropriate specialty board’s criteria for each area as they are additional needs to include in your planning for this activity (

ABMS Competencies / Strategies Incorporated into
the CME Activity
Patient care. Provide care that is compassionate, appropriate and effective treatment for health problems and to promote health
Medical knowledge. Demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences and their application in patient care
Practice-based learning and improvement. Able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their practice of medicine
Interpersonal and communication skills. Demonstrate skills that result in effective information exchange and teaming with patients, their families and professional associates (e.g. fostering a therapeutic relationship that is ethically sounds, uses effective listening skills with non-verbal and verbal communication; working as both a team member and at times as a leader
Professionalism. Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations
System-based practice. Demonstrate an awareness of and responsibility to a larger context and system of healthcare. Be able to call on system resources to provide optimal care [e.g. coordination of care across sites or serving as the primary case manager when care involves multiple specialties, professions or sites]

Other physician attributes have been identified by the Institute of Medicine, the National Institutes of Health, and various national and specialty society guidelines—all of which assist you in defining best practices. Consult those sources and attach documentation of which sources you used and information utilized from them in this activity.

6. GLOBAL LEARNING OBJECTIVES

Please write the global objectives in terms of physician performanceand/or patient care outcomes. Will any patient safety considerations be addressed in this series? If so, please identify how these considerations will be discussed in the sessions.

7. INSTRUCTIONAL METHODS

Please check all that apply.

Didactic / Case Presentations / Lab Exercises / Self-Assessment
Panel Discussions / Q & A Sessions / Video / Teleconference
One-to-One Instruction / Quiz / Other:

8. SPEAKER CONFLICT OF INTEREST/FACULTY DISCLOSURE

In order to present at a CME meeting, it is mandatory that eachindividual involved in the planning of the activity or faculty member submit a Conflict of Interest / Full Disclosure Form. Speakers will not be allowed to present if they do not comply with this ACCME regulation. This form must be completed as soon as the planners/faculty members have agreed to participate so that any conflicts of interest can be identified early in the planning process and either resolved, or a replacement speaker identified. Please see our website to download the form. This form must be sent with your speaker invitation letter. The ACCME requires that conflicts of interest be resolved prior to the activity. Resolution of COI must be performed by a non-conflicted individual, usually the course director. If the course director has conflicts, an independent reviewer must review speaker presentations and validate the content to ensure fair balance and objectivity exists within the presentations.

Please note: Each planner and speaker MUST fill out the disclosure form even if they have nothing to disclose.This information must be included in the disclosure handout to the participants.

  • IDENTIFICATION OF RESOLUTION OF CONFLICT OF INTEREST

BIMC & SLRHC must ensure that Content Validation is performed by a reviewer whose responsibility is to review course materials for scientific objectivity, fair balance and of appropriateness of patient care recommendations when there is a potential for a Conflict of Interest.

Please read the Policies on Conflict of Interest and Validation of Content and Resolution of Conflict of Interest Policies before you start this process. Once you have reviewed the speaker presentations and identified and resolved any conflicts of interest, please fill out and sign the Validation of Content Form. All of these policies and forms can be found on our website

9. COURSE PLANNER’SCONFLICT OF INTEREST/FACULTY DISCLOSURE STATEMENT

A completed and signed Faculty Disclosure form for each of the course planners named below must be provided with the CME application.

Name / Role
Course Director
Planning Committee/ Academic Planner
Planning Committee/ Academic Planner

10. CURRICULUM

Please attach an outline of topic areas for period of January 2009 to December 2009. Although specific lecture topics may not as yet be determined, submission of expected curriculum is required. An actual schedule of 2009conferences must be submitted to the CME Office.

11. 2008 RSS EVALUATION

Evaluation measures overall success of your activity, how well the needs/ objectives were met. Evaluations also provide information that helps us to determine if improvements need to be made in the series or that expected outcomes, in terms of changed physician knowledge, skills, performance in practice and/or patient health status have been applied. Please note: A SUMMARY OF 2008 PROGRAM EVALUATONS MUST BE COMPLETED (see questions below)

1. Did your planning committee identify educational or practice gaps that have were successfully addressed in your grand round series (RSS)? Yes No

If yes, please describe:

If no, will these topics be addressed in future activities? Yes No

2. Please tell us how your attendees have applied the knowledge, skills or competencies learned to their practice of medicine.

3. Were your 2008 objectives met? Were there any changes in practice as a result?

4. Does your series address physician competencies? Yes No

If yes, please list the competency areas in your series

5. If, by attending your series, there has been an improvement in patient outcomes, please provide evidence or examples.

6. Have the learners perceived any bias in these presentations? Yes No

If yes, what have you done to address the conflict of interest?

7. After evaluating your 2008RSS, what improvements do you plan to your program in 2008?

12. FINANCIAL STATEMENT

Please explain how guest speakers will be paid.

Departmental FundsIndustry Support*We do not accept industry support

*If any form of Industry Support is used (this includes catering and in-kind contributions), a Letter of Agreement with all appropriate signatures must be submitted to the Office of CME.

Departments must provide documentation of any expenses or honoraria paid to planners or faculty at RSS sessions. All funds paid must be in compliance with CME policy.

Pharmaceutical Companies CAN NOT pay speakers directly

and CAN NOT purchase food to bring to Grand Rounds themselves.

This application must be completed, submitted electronically (to ) and returned with associated documents to:

Office of Continuing Medical Education

St. Luke-Roosevelt Hospitals- 1059 Scrymser, Ground Floor

(p) 212-523-2138

(f) 212-523-2074

Course DirectorDate

Signature of RSC CoordinatorDate

Approved

Lois GrossmanDate

Corporate Director, CME

BIMC & SLRHC

Effective Date
Department Notification

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