APPLICATION FOR
REGULARLY SCHEDULED SERIES
www.uams.edu/cme
RSS INFORMATIONRSS Series Title
/ Academic Year / 09/10 / New Series RenewalRSS Series Type
/ Grand Rounds/Lecture Series Case-base/M&M/Tumor ConferenceJournal Club Telemedicine Conference Other:
Frequency
/ Weekly Monthly Bi-Monthly Quarterly Other:Day(s) of the Week / Mon. Tue. Wed.
Thu. Fri. Sat. /
Time of Day
/ From AM PMTo AM PM
If monthly or bi-monthly, please specify the week of the month the activity is held:
First Week Second Week Third Week Fourth Week Every Other Week
Duration - months during the year the activity is available (i.e. July-June)
Location (conference room, facility)
SPONSORSHIP
Direct Sponsorship / UAMS College of Medicine Department of
Area Health Education Center (AHEC), Location:
If this activity is co-hosted with another department/division, please identify:
Joint Sponsorship
(Non-Accredited CME Educational partners)/ If this activity is jointly sponsored, please complete the “Joint Sponsorship Agreement” (A1) and include it with this application and list the educational partner(s) below. (attach list if needed)
Organization / Contact Name / Phone #
CONTACT INFORMATION
Identify the physician primarily responsible for planning and conducting this activity on an ongoing basis. UAMS Faculty? Yes No / Identify the CME Associate (the person within the department responsible for submitting activity session reports to the OCME on an ongoing basis.
Course Director
/CME Associate
Title
/ TitleDept./Div./Other / Dept./Div./Other
Address/Slot # / Address/Slot #
City/St/Zip / City/St/Zip
Telephone / Telephone
Fax / Fax
Email / Email
Signature / Date
INDEPENDENCE OF THE PLANNING PROCESS
The ACCME requires the following decisions in planning a CME activity be made free of control by a commercial interest (refer to ME and MS policies). These decisions include:1) Identification of needs
2) Determination of objectives
3) Selection and/or presentation of content
4) Selection of personnel and organizations who would be in a position to control the content
5) Selection of educational methodology
6) Evaluation of the activity
1. /PLANNING PROCESS
Attach planning meeting minutes, emails, etc. if possible / Planning Questions: The following questions can be used as a guide to the planning process as you begin to identify professional practice gaps that your CME activity will fill. A needs assessment is required as part of the planning process.· Who is your learner?
· What are some challenges they face in practice?
· What problem(s) could be addressed?
· What is causing or contributing to the problem?
· What needs to change in order to improve?
· Would education help? (If yes, what kind of education?)
Describe the process used to plan the curriculum or content. This involves how did you 1) identify the educational gaps and needs, 2) write the objectives that reflect measurable outcomes, 3) select topics and speakers to address the educational gaps and 4) develop the evaluation plan to determine the effectiveness of the CME activity?
Who is involved in planning this series? Please check all that apply:
Course Director Planning Committee
Other, please describe
2. / TARGET AUDIENCE
Check all that apply. / Continuing Medical Education consists of educational activities that are designed and directed to serve the clinical and professional performance of practicing physicians within their scope of practice. Educational activities specifically directed to or developed for residents or medical students are not considered for designation of AMA PRA Category 1 Credit(s) ™. For whom is this RSS series designed?
Please check all that apply:
Physicians Fellows Residents
Nurses Pharmacists Physician Assistants
Medical Students Other, please specify
Medical Specialty, if applicable
NEEDS ASSESSMENT
Needs Assessment is defined as "any systematic approach to collecting and analyzing information about the educational needs of individuals or organizations." A needs assessment is a tool to identify a gap, the difference or distance between what is occurring in practice and what is expected (the desired outcome), or, the difference between what is and what should be.
3. / Needs Assessment Methods and Documentation
ACCME Requires Documentation
Supporting documents MUST be included with the application.
Check all methods that apply.
For more information about needs assessment refer to the
Needs Assessment Guidelines
and the Types of Needs Assessment Data Sources guide. / Evidence of Needs Assessment What data sources are used to identify the educational NEED(s) or GAP(s) in knowledge, competencies, and/or performance to be addressed by the CME Activity? Please check all that apply:
Previous evaluation summary* (Required for renewal applications)
Clinical expert opinion (CME activity faculty, planning committee members, department chair, etc.) This choice also needs to be combined with one or more forms of data. Please list the names of those giving expert opinion and their credentials:
Choose at the minimum one additional data source:
Evidence-based information (provide copy of summary or source)
Peer-reviewed literature (provide summary)
Research findings, please specify
Medical School requirements, please specify
Government laws/regulations, please specify
National guidelines (NIH, NCI, AHRQ, etc.) please specify
Specialty society guidelines, please specify
Other, please specify
Participant Needs (provide summary for each method checked)
Needs Assessment survey of target audience
Focus group discussion/interviews
Requests by affiliated institutions
Requests from other physicians
Other, please specify
Observed Needs (provide summary or copy of data for each method checked)
Adverse drug events
Database analysis (e.g., RX changes, diagnosis trends, etc.)
Epidemiological data
Hospital/Clinic Quality Assurance data
Pharmacy & Therapeutic or Quality Improvement data/guidelines
Morbidity & Mortality data
Chart reviews within your department (attach summary)
Referral data
Other clinical data
Other, please specify
Environmental Needs (provide a copy of the standard/law/etc.)
Joint Commission Standards/Core Measures
Laws/Regulations
Lay Press (specify):
Other societal trends (specify):
4. Based on the analysis of needs assessment above, please use this table to summarize the needs or professional practice gaps that were identified and the desired results that are intended for the learners. Attach a separate page if more room is needed.
Please note: Every session of the RSS does not have to address these gap areas. Many sessions can address other topic areas. These identified gaps and desired results, however, should be the areas in which content is developed, delivered, and measured for effectiveness in reducing or eliminating these professional practice gaps, over the course of the year.
Consider at what level your professional practice gaps are focused.
Are they gaps in 1) knowing information about a topic (knowledge), 2) what the learners are able to do when they combine knowledge, experience and judgement if given the opportunity (competence), or 3) in the skills, abilities and strategies that are implemented into practice (performance), 4) patient outcomes (the measures of individual or group health status)? Is it a combination of these that will be the focus of the RSS?
Examples:
Identified GAP/Learners’ Needs / Desired Result / Level of Content Focus
M&M on patients who suffer stroke are higher in Mid City than State of Arkansas / Reduce the number of stroke patients in Mid City / X Knowledge
Treatment plans are missing key components / Accurately written treatment plans / X Competence
How to recognize role of fatigue in drug errors / Reduction of fatigue related incidents due to drug errors over a 12 month period / X Patient Outcomes
There is a need to improve patient safety procedures during transition times / Demonstrated improvement in transition procedures / X Performance
Identified GAP/Learners’ Needs / Desired Result / Level of Content Focus
Knowledge
Competence
Performance
Patient Outcome
Knowledge
Competence
Performance
Patient Outcome
Knowledge
Competence
Performance
Patient Outcome
Knowledge
Competence
Performance
Patient Outcome
Physician Competencies and Attributes
The Maintenance of Certification (MOC) competencies designated by the American Board of Medical Specialties (ABMS) and Accreditation Council of Graduate Medical Education (ACGME), and the Attributes identified by the Institute of Medicine (IOM) are national goals for physicians and, when possible, should be addressed in CME planning.
Patient Care or Patient-Centered Care: identify, respect, and care about patients’ differences, values, preferences, and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.
Medical Knowledge: established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social behavioral) sciences and the application of this knowledge to patient care.
Practice-Based Learning and Improvement: involves investigation and evaluation of a physician’s own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.
Interpersonal and Communication Skills: that result in effective information exchange and teaming with patients, their families and other health professionals.
Professionalism: commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.
System-Based Practice: actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
Interdisciplinary Teams: cooperate, collaborate, communicate and integrate care teams to ensure that care is continuous and reliable.
Quality Improvement: identify errors and hazards in care: understand and implement basic safety design principles such as standardization and implications; continually understand and measure quality of care in terms of structure, process and outcomes in needs; and design and test interventions to change processes and systems of care, with the objective of improving quality.
Utilize Informatics: communicate, manage knowledge, mitigate error, and support decisions making using information technology.
Employ evidence-based practice: integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible.
5. / Physician Competencies and Attributes / Based on the professional practice gaps the activity is addressing, indicate the physician competencies and attributes that will be addressed by this Regularly Scheduled Series.
Please check all that apply:
Competencies / Attributes
Patient/Clinical care / Patient-centered care
Medical knowledge / Interdisciplinary team work
Practice-based improvement / Evidence-based practice
Communication skills / Quality improvement practices
Professionalism / Utilization of informatics
System-based practice
OBJECTIVES
Terminology for educational objectives usually begins with, "Following this activity, the participant should be able to . . ." followed by phrases that communicate a measurable performance capability, by the participant. Think of performance as the action of doing something. Whenever possible, think in terms of improving patient care outcomes.
Use verbs that convey doing such as: describe, analyze, discuss, compare, differentiate, examine, formulate, propose, evaluate, assess, measure, select, and choose when writing your objectives.
Avoid verbs that are not easily measured and do not convey doing something, such as understand, appreciate, and know. For more information, please visit Florida State University Medical School’s website about writing medical education objectives: http://med.fsu.edu/education/FacultyDevelopment/objectives.asp
Objectives help develop the content and are used to measure effectiveness of the CME activity. Did the activity meet the objectives?
6. / OVERALL SERIES OBJECTIVES
ACCME Requirement:
The participants must be provided information about the activity’s goals and/or objectives before the activity occurs. / What should the learners be able to: know (knowledge), be capable of (competence), or be able to do (performance) after they participate in this series?
Please list at least 3 measurable learning objectives “outcomes” in terms of changes in knowledge, skills, attitudes, and/or professional practice.
These are overall series objectives that will be used to measure outcomes for the RSS that are designed to reduce or eliminate professional practice gaps over the course of the year, not at each RSS session.
7. /
EDUCATIONAL FORMATS
Consider what will be the most effective method(s) for achieving your objectives to eliminate or reduce the professional practice gap(s) identified for the series.Active learning formats are the most desirable for bringing about changes in physician behavior that will result in improved patient outcomes. / What instructional methods will be used? (Check all that apply)
Lectures with discussion and question and answer period
Case presentations/discussions
Procedure Demonstration
Individual assignments/literature reviews
Journal Club (reading of peer reviewed literature with open discussion)
Mini lectures with small group activities
Simulation with real/or simulated patients
Hands-on skill workshops
Other, please describe.
EVALUATION
ACCME Requirement: (see Essential Area 3)
All CME activities MUST be evaluated to determine the effectiveness of meeting the identified educational needs.
Plan an evaluation method that can demonstrate a change in the participant’s knowledge, competence, and/or performance to result in improved patient care. There must be a plan to measure this change.
8. EVALUATION
ACCME Requirement Please provide an explanation of the evaluation method. Methods should reflect whether changes were made in physician knowledge, competence, and/or performance to result in improved patient care.
If this is a renewal application, a copy of the summarized results from the 2008-2009 academic year MUST be submitted with the final “Activity Closing Report”.
What method(s) will be used to assess what the participants have learned as a result of attending this educational activity? Please select all that apply:
Individual session evaluation for participants (samples available on the CME website www.uams.edu/cme)
Quarterly evaluation for participants (samples available on the CME website www.uams.edu/cme)
Annual evaluation summary (MINIMUM REQUIREMENT)
Focus Group (summary required)
Meeting of planning committee to assess activity’s overall effectiveness (summary required demonstrating how the well the objectives were met)
Review of departmental quality improvement data
Practice data Example: Evaluation question: Have measures been implemented to lower cholesterol in your diabetic patients? Evaluation plan: will review 20 - 30 patient charts in 3 months to measure significance in implementing proper treatment plans.
Or, describe alternative evaluation method
DISCLOSURE OF FINANCIAL RELATIONSHIPS