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CME Activity Application & Planning

Administrative Items










Single Event
Regularly Scheduled Series
Other - Please explain

Daily
Weekly
Monthly
Quarterly
Other - Please explain


Dean Amphitheater
Other - Please explain
If yes, explain, otherwise skip this section:


Honorarium
Travel and Housing
PowerPoint/Handout Preparation
Other - Please explain




Educational Detail

Identify the Practice Gap
The professional practice gap is the difference between the practice that actually occurs and what the ideal practice should be. In other words, what is the problem or issue in practice that needs to be addressed? For any topic proposed, how does that topic relate to a problem in practice? (Only one is required)








Activity Learning Objectives - Learner will be able to:
The objectives should directly state the desired outcomes of the activity in terms of improved knowledge, competence, performance and/or patient outcomes. The objectives should reflect the ultimate goal of CME, that is to improve the delivery of patient care.

Suggestions on Writing Objectives
* 1.
2.
3.
4.
5.
6.

Identify the Specifc Source of Your Topic/Practice Gap


If no, explain, otherwise skip:



Physician Competencies (check all that apply)

Patient Care: Provide care/treatment that is compassionate, appropriate and effective for health problems.

Medical Knowledge: Demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences and their application in patient care.

Practice-Based Learning and Improvement: Able to investigate and evaluate their patient care practice, appraise and assimilate scientific evidence, and improve their practice of medicine.

Interpersonal and Communication Skills: Demonstrate skills that result in effective information exchange and teaming with patients, their families and professional associates.

Professionalism: Responsibilities conducted adhering to ethical principles.

System-Based Practice: Show awareness of responsibility to a larger context and system of healthcare.


Educational Format (check all that apply)

Lecture-discussion presentation
Moderator directed panel discussion
Moderator directed group discussion
Case studies
Audience response system
Demonstration
Other:

What professional practice improvement issues will be incorporated in the activity? (check all that apply)

Appropriate prescribing
Decrease in unnecessary expenses
Implementation of best professional practices
Patient safety
Reduction in medical errors
Other

Evaluation of Activity Outcomes

Two to 3 months after your activity we will send a questionnaire to the attendees to determine if the content of the activity was used in practice or otherwise made a difference in competence, performance or patient outcomes. This is a requirement for ACCME accreditation. Please develop 2 yes or no questions which would be relevant to this activity.

Example: One question that would be asked for KMC Grand Rounds on 6/9 titled "Beyond LDL-Cholesterol: The Scientific Justification for Advanced Blood Risk Markers" is "Have you started checking Sd LDL in your patients?"


Other instruments planned for follow-up evaluation of the event: (check all that apply)

Live data with Audience Response System
Survey of specific changes
Medical staff survey
Quality improvement data
Pre post test
Other:

* Advertisement

Event is to be advertised on KHN CME database
Please send out reminders with other weekly events
Event will be by invitation only by planners and not to be advertised by KHN CME






Contacts:  Email Us

Julie Dicken Julie Dicken
CME Coordinator
(937) 395-8359

Martin Jacobs, MD
CME Chair
(937) 395-8611

Alan Klein, MD
CME Exec Group Member