This application should be completed with the assistance of the physician faculty member familiar with the activity.
Please feel free to ask for help from the CME staff as you complete your application. We can be reached at (330) 543-8407 (x38407).
All planning is done independent of commercial interests.
Everyone who is in a position to control content discloses all relevant financial relationships with a commercial interest.
We implement a mechanism(s) to indentify and resolve all conflicts of interest before the education activity is delivered to learners.
Competence (Strategy) - "knowing how to do something" "...a combination of knowledge, skills and performance...the ability to apply knowledge, skills and judgement in practice." "The simultaneous integration of knowledge, skills and attitudes required for performance in a designed role and setting."
Performance - "What one actually does, in practice."
Knowledge - awareness or familiarity gained by experience of a fact or situation
Gap - The difference between health care processes or outcomes observed in practice, and those potentially achievable on the basis of current professional knowledge.
Please describe what prompted you to develop this course for physicians? What is the quality gap or professional gap to be addressed? Briefly describe the reasoning for the selection of your speaker(s).
If you are having difficulty identifying a gap here are some ideas. (Please provide an explanation of specific resources utilized)
Expert Sources (required): (example sources include: www.cms.hhs.gov, www.cdc.gov, www.aap.org, www.ahrq.org, nachri, www.abp.org)
Participant Sources (required):
Observed Sources (required): (example sources include: http://groups/ce/Safety/idex.htm, www.ihi.org, www.nih.gov)
Other (required): (example sources include: www.healthpeople.gov, www.jointcommision.org, www.apha.org)
Planners are required to address nationally-established goals for physician core competencies as developed by the Institute of Medicine, Accreditation Council on Graduate Medical Education (ACGME), Association of American Medical Colleges (AAMC), and the American Board of Medical Specialties (ABMS) related to specialty maintenance of certification.
Please check all competencies that your activity will address: (required) (C6)
Linking the needs, desired outcomes, and objectives: The learning objectives are the link between the needs and desired outcomes. The learning objectives for your activity should reflect this. See the example below:
Identified Educational Need:
Make correct Therapeutic choices in the treatment of allergic rhinitis in patients with asthma.
Learning Objectives:
Assess the clinical efficacy of medications and therapeutic Options used to treat allergic Rhinitis as recommended by ACAAI.
Desired Outcome
Improved patient compliance and outcomes due to a physician's appropriate choice of therapy.
Are your objectives s.m.a.r.t.?
s Specific – What exactly are we going to do, with or for whom?
m Measurable – Is it measurable and can we measure it?
a Attainable – Can we get it done in the proposed time frame?
r Relevant – Will this objective have an effect on the desired goal or strategy
t Timely – When will we accomplish this objective?
Learning objectives should utilize action statements and be written from the perspective of what you expect the learner to do in the practice setting with the information you are teaching. They should describe the expected results of the activity.
What are the learning objectives for this activity? (required)
(Example: Policies and procedures, clinical practice guidelines, just in case reminders, safety alerts, newsletters, patient feedback) (C17)
List the evaluation method(s) planned for this activity. (Check all that apply)
Example measurement tool: CHMCA evaluation form
Example measurement tool: Pre and Post tests And/Or CHMCA evaluation form
Example measurement tools: Post-activity survey (3 months follow-up), observation, review of individual provider patient care data
Example measurement tools: Organizational/population data review.
CHMCA does not accept commercial support for CME activities in the form of educational grants, marketing or other involvement, except for exhibitors (C7-10)
If yes, please email budget to Katrina Wolford at kwolford@akronchildrens.org right after this application is submitted.
Have other information supporting this application? Please submit materials to the Medical Education office at least eight weeks prior to activity.