Required Continuing Medical Education Activity Development Worksheet

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* 1. Activity:

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* 2. Proposed Date:

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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:
  1. CME activities will be independent of commercial support interests.
  2. All commerical support will be appropriately managed.
  3. There will be a separation of promotion from education.
  4. The activity will promote improvements or quality in healthcare and not proprietary interests.
  5. Anyone in a position to control content will disclose relevant financial relationships.
  6. 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

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* 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?

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* 4. Is the gap(s) in: (check any/all that apply)

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* 5. How was this gap(s) identified?  What brought this gap(s) to light?  (check any/all that apply)

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* 6. What is/are the primary target audience(s) that will help close the identified education gap(s)?  (check any/all that apply)

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* 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?"

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* 8. What is the real, or potential barriers facing the learners who are trying to close the gap(s)?

ACGME/ABMS COMPETENCIES

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* 9. Which of the ACCME Competencies is most relevant to the gap(s) identified? 

INSTITUTE OF MEDICINE CORE COMPETENCIES 

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* 10. Which of the Institute of Medicine Core Competencies is most relevant to the gap(s) identified? 

INTERPROFESSIONAL EDUCATION COLLABORATIVE

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* 11. Which of the Interprofessional Education Collaborative Competency is most relevant to the gap(s) identified?

OBJECTIVES

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* 12. Based on the desired results of the activity, what are the objectives of the activity?

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* 13. At the conclusion of this educational activity, the participant will be able to:

PARTNERS/ALLIES

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* 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?  

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* 15. In what ways could we include the internal or external groups in this activity to help address or remove barriers?

CONTENT

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* 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 

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* 17. Based upon the content, who is/are the right faculty to cover this material?

ACTIVITY FORMAT

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* 18. What format is best to achieve this learning exercise?  (check any/all that apply)

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* 19. Do you want the faculty to focus on (check any/all that apply)

NON-EDUCATIONAL STRATEGIES 

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* 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

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* 21. Levels of Evaluation (check any/all that apply):

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* 22. DESCRIBE YOUR CME ACTIVITY (in your own words.....what do you envision for this activity)

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* 23. Submitted By:

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* 24. Date:

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If you have any further questions directed to the CME Activity Application please contact Celina via email at celina.makowski@flaglerhospital.org and/or Andrea via email at andrea.bakken@flaglerhospital.org

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