ACOEM Course Proposal Question Title 1. Submitter Information Name Email Address Question Title 2. Title of the Proposed Course Question Title 3. Purpose of the Course Please provide a simple, high-level sentence describing what the course is meant to teach and for whom Question Title 4. Learning Gaps What knowledge gaps is this course meant to address? How were the gaps identified? Are there any recent regulatory or industrial changes that led to the need for such a course (e.g. requirement for certification to provide an opinion about fitness, new technology like nanotechnology) Question Title 5. Intended Audience Describe the primary target audience and something about their demographics (US, global, type of professional, age range), baseline knowledge on topic and anticipated comfort with online learning technology. Describe the secondary target audience (e.g. those who might benefit from some of the modules in the course, but perhaps not all) Question Title 6. CME Market AnalysisDescribe the pool of users who would benefit from this course, other than occupational medicine physicians. Are there stakeholders other than health care providers that may also take this course (i.e. legal professionals, HR, safety, etc.) Would this course be appropriate for advanced practice providers (PA or NP) or other types of medical specialists? Describe competing courses if known. Share support materials indicating need for this course in primary and secondary market. Question Title 7. How does this relate to any other current ACOEM courses?Describe whether this course would be an alternative to another current course, would build on another course, might serve as an introductory course for a more advanced current course, or otherwise relate to a live or online course currently offered by ACOEM (or offered in the past.) For a list of current ACOEM courses, click here. If not applicable, state so. Question Title 8. Course Director Name and Credentials Email Address Qualifications in Relation to Course Content Question Title 9. Please list any secondary faculty serving as subject matter expertsInclude name, email address, credentials, and briefly describe their qualifications in relation to the content. Question Title 10. Learning ObjectivesDescribe the primary high level learning objectives. This would normally be 3 to 5 sentences, and describe what the learner should be able to do after taking this course. Use active words, rather than words like “understand”. For more information on writing learning objectives, click here. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Question Title 11. Which of the following competencies does will this course plan to address?Select all that apply Clinical Occupational and Environmental Medicine OEM Related Law and Regulations Environmental Health Work Fitness and Disability Management Toxicology Hazard Recognition, Evaluation, and Control Disaster Preparedness and Emergency Management Health and Human Performance Public Health, Surveillance, and Disease Prevention OEM Related Management and Administration Question Title 12. Continuing Medical Education (CME) HoursHow many hours of learning will this course offer? Credit is designated based on the average time it would take a small sample group of the target audience to complete the material. Consider time to go through the online course, read associated documents or do research, perform exercises, interact in forums, take quizzes, or other course activities, as applicable. ACOEM staff will verify the CME count prior to the course being finalized. Has the content already been approved for continuing medical education or other professional accreditation by any other organization? If so, specify. Question Title 13. Measuring ImpactWhen possible, how will you measure what the participant learned in the course? Will you check baseline knowledge? Will you use knowledge checks throughout the course in the form of quizzes? A test at the end? Any plans to follow-up with participants to see what knowledge was retained or practice changed? Question Title 14. Instructional Delivery Method for Course (overall) Online Only Blended Learning (combination of e-module and live activities) [Considerations for a blended course include course run dates, faculty time requirements, platform for conference calling or web meetings and time zone challenges] Other (please specify) Question Title 15. Instructional StrategyPlease indicate what instructional strategies the course will include that fits with the learning strategy of: Absorb (narrated slides, reading, watching videos, listening to podcasts) Do (self-directed research, development/creation of something, quizzes, other interactions that require the learner to make decisions) Connect (discussion forum, web meetings, group projects, reflection on applicability to own practice) Redacted or fictional case studies Branching scenarios Discussion Forum Other (please specify) Question Title 16. MediaDescribe the type of media proposed. If you already have an authoring tool in mind (e.g. Articulate, iSpring, Captivate, etc.), name it. Narrated Slides Animation Videos Branching scenarios Simulations Authoring Tool Other (please specify) Question Title 17. What else do you want ACOEM to know about your course proposal, e.g. proposed contract structure, etc.? Done