ASA CME ACTIVITY PLANNING ABSTRACT
Activity Information
Title
Date(s) –
Start/End
Location
Live events: city, state.
Type
Live Course, Internet Enduring Material, Performance Improvement, Journal-based CME, Manuscript Review, Test Item Writing
Providership
Direct
Joint
CME PLANNING MATRIX (C2, C3, C5)
Note: This matrix should be completed by Planning Committee. Identify a minimum of one gap/need and three learning objectives.
Professional Practice Gaps C2
Underlying Educational Needs C2
Desired Results C3
(Learning Objectives)
Education Design/
Methodology C5
Defined as: the difference between ACTUAL
(what is) and IDEAL (what should be). Ask
yourself, “What is the problem in practice?” It
can be clinical or practice management related.
Consider what kind of educational needs might be
contributing to the identified gap.
List the learning objectives that address the
professional practice gap(s) and underlying
educational need(s) – and specify what type of
change each one represents. At minimum, every
CME activity must be designed to change
learners’ competence, performance, or patient
outcomes.
Competence – knowing how to do something
(e.g., skills, abilities, strategies), which has not
yet been put into practice
(see * below)
Please include at least 1 source/reference for
each item.
Knowledge – having information
Competence – knowing how to do something (e.g.,
skills, abilities, strategies), which has not yet been
put into practice
Performance – the skills, abilities, and strategies
one implements in practice
For example, do the docs not know about the gold
standard specified by Y (knowledge change
required)? Or do the docs not know how to perform
X procedure according to the gold standard
(competence change required)? Or, do they know
about the gold standard and how to do the
procedure, but is there some other barrier (lack of
reimbursement, institutional limitations, etc.) that is
stopping them from performing the procedure as
desired (performance change required)?
List the educational method(s)/
format(s) that will be used to
achieve each stated objective(s).
Performance – the skills, abilities, and
strategies one implements in practice
Patient Outcomes – the consequences of actual
performance in practice
EXAMPLE:
Source(s):
Briefly Describe:
Some anesthesiologists either do not
Jones A, Smith B. The gold
know how to perform X procedure
standard technique in anesthesia.
Anesthesiol Clin, 2013;30:91-100.
according to the gold standard as
specified by Y, or there are other
Upon completion of this activity, learners will:
Didactic lecture
Describe a treatment plan that
(knowledge &
includes X procedure, according to
competence); and
the guidelines specified by Y.
Case presentations
(competence); and
Actual:
75% of anesthesiologists perform X
procedure according to the gold
standard technique as specified by
Y.
Ideal:
100% of anesthesiologists perform X
barriers (lack of reimbursement,
institutional limitations, etc.)
preventing them from performing the
procedure as desired.
Type(s) of educational need underlying this
professional practice gap:
Knowledge
Competence
Performance
(Change in competence)
Perform X procedure, according to
Workshops (competence
& performance).
the guidelines specified by Y.
(Change in performance)
Apply optimal coding practices
when treating Z in patients in order
to maximize reimbursement from
third party payers. (Change in
procedure according to the gold
standard technique as specified by
performance)
Y.
Report reduced incidence of post-
Gap:
operative infections in patients who
receive treatment for Z. (Change in
1 in 4 anesthesiologists is not
patient outcomes)
performing X procedure according
to the gold standard as specified by
Y.
Professional Practice Gaps C2
Source(s):
Actual:
Ideal:
Underlying Educational Needs C2
Briefly Describe:
Type(s) of educational need underlying this
professional practice gap:
Knowledge
Competence
Performance
Desired Results C3
(Learning Objectives)
Upon completion of this activity, learners will:
(Change in
)
(Change in
)
(Change in
)
Gap:
Source(s):
Actual:
Ideal:
Gap:
Briefly Describe:
Type(s) of educational need underlying this
professional practice gap:
Knowledge
Competence
Performance
Upon completion of this activity, learners will:
(Change in
)
(Change in
)
(Change in
)
Education Design/
Methodology C5
Source(s):
Actual:
Ideal:
Briefly Describe:
Upon completion of this activity, learners will:
Type(s) of educational need underlying this
professional practice gap:
Knowledge
Competence
Performance
(Change in
)
(Change in
)
(Change in
)
Gap:
Professional Practice Gaps C2 – Resource: CME Planning Matrix
What problem(s) need to be fixed? What are physicians doing or not doing in practice that is less than optimal? (100 words max)
Educational Needs C3 – Resources: CME Planning Matrix, Verbs for Learning Objectives
What do learners need in order to address or resolve the problem(s), e.g., close the gap?
Knowledge (factual information); Briefly describe:
Competence (knowing how to do something – e.g., strategies – not yet put into practice); Briefly describe:
What specifically do you want your learners to be able to do or change in terms of this competence need, as a result of participating in this activity?
Performance (implementing skills, abilities, or strategies in practice); Briefly describe:
What specifically do you want your learners to be able to do or change in terms of this performance need, as a result of participating in this activity?
What, if any, Patient/Health Care Outcomes will this activity change as a consequence of changes in actual performance in practice?
Educational Format C5
Explain why this educational format is appropriate for this activity. (25 words max)
Desirable Physician Attributes C6
Which desirable physician attributes (ACGME/ABMS/IOM Competencies) are addressed in the content of this activity? Check all that apply.
Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Medical Knowledge about established and evolving biomedical, clinical and cognate sciences and their application in patient care.
Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families and professional associates (e.g. fostering a
therapeutic relationship that is ethically sound, uses effective listening skills with non-verbal and verbal communication; working as both a team member and at times as a leader).
Professionalism as demonstrated through a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient
populations.
Systems-based Practice as demonstrated through an awareness of and responsibility to larger context and systems of healthcare, and the ability to call on system resources
to provide optimal care (e.g. coordinating care across sites or serving as the primary case manager when care involves multiple specialties, professions or sites).
Practice-based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence and improvements in
their practice of medicine.
Provide patient-centered care
Work in interdisciplinary teams
Employ evidence-based practice
Apply quality improvement.
Utilize informatics
Identification and Resolution of Conflicts of Interest
C7
Requires completion of Online Disclosure Form and – in cases where an individual has disclosed a relevant financial relationship – selection of one of the available mechanisms for
resolving the conflict of interest (COI). Refer to the COI Report and Resolution Form.
List below the names of all individuals in a position to control the content of this CME activity (planners, faculty, staff), their role in the activity, and if they disclosed a relevant
financial relationship – the name of the commercial interest, the nature of the relationship, and the selected mechanism to resolve the conflict of interest. Insert rows as needed.
Name of individual
Individual’s role in activity
Name of commercial interest; means of resolving the
conflict of interest (COI)
Nature of relationship
Example: Jane Smith
Example: Tom Jones
Course Director
Faculty
None
Pharma Co, US
N/A
Research Grant
COI Resolved: Peer Review of Presentation by Planning Group in
advance of activity
Appropriate Management of Commercial Support C8
If commercial support has been provided, list below the name(s) of the supporter, the amount of monetary support and/or description of in-kind support, and whether or not the
required Letter of Agreement has been enclosed. Insert rows as needed.
Name of commercial supporter:
Monetary amount of support:
Example: XYZ Pharma Company
$5,000
In-kind support:
REQUIRED
Letter of Agreement attached:
Describe:
Example: ABC Medical Device Company
Describe: Ultrasound
Describe:
Describe:
Evaluation C11
Describe the evaluation method(s) or instrument(s) you will to use to determine if learning objectives were achieved.
*********************************************************************************
Submitted by: ____________________________________________________________________________________
APRROVALS REQUIRED BEFORE IMPLEMENTING ACTIVITY:
_____________________________________________
Elizabeth Lepkowski
Date: _______________________________________
Please forward a copy of this form to Ed Dellert for reference purposes only.
**** Keep signed copy of this abstract form in the activity file, or attach copies of email(s) indicating approval. ****