Continuing Medical Education Office
Phone: 908-685-2423
Fax: 908-685-2869
rwjsomlib@rwjbh.org 

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* 1. Today's Date

Date

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* 2. Event Name

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* 3. Event Date(s) and Time(s)

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* 4. This planning document will not be considered "completed" by the CME Office until you have delivered a copy of the meeting announcement (flyer, save the date, pamphlet, brochure) to the CME Office, which must include the following language:
AMA PRA CREDIT DESIGNATION:  Robert Wood Johnson University Hospital Somerset designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ACCREDITATION:  Robert Wood Johnson University Hospital Somerset is accredited by the Medical Society of New Jersey to provide CME for physicians.
Have you submitted a copy of the meeting announcement with the required language to the CME Office?

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* 5. Learning Objectives (3 Required) (Please refer to the “Formulating Objectives" document for guidance)

Example:
“Describe the diagnosis and treatment of Purple People Eater Disease”

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* 6. What is the practice-based issue you want to address?

Please consider answers to these questions:

What aspects of practice are we concerned with (e.g. Clinical care, administrative, research, teaching, other?)

What is the difference between current practice and best practice?

Who are the stakeholders of this problem?

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* 7. Why does this problem exist?

Please consider answers to these questions:

How did we become aware of this problem?

What data or information do we have about the nature and extent of the problem?

How does the problem apply to our physicians, other health professionals, and stakeholders?

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* 8. What do you wish to change? 

Please consider answers to these questions:

What aspects of the problem do you want to target to change with education, training, or consultation?

What kind of change do you want this activity to promote in participants?

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* 9. Can the change be measured?

Please consider answers to these questions:

What change(s) can you measure to determine the impact of this activity?

How can you demonstrate the value of this activity in addressing the problem you identified?

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* 10. Has the issue/problem been solved?

Please consider answers to these questions:

If the problem wasn’t resolved, do you know what issues or obstacles remain?

What additional approaches might you take to solve this problem in the future?

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* 11. Please provide your name and contact information

0 of 11 answered
 

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