Divison of Continuing Education
Individual Submitting Request:
If the activity is a Joint Providership, please complete the Letter of Agreement, found here: https://form.jotform.com/211605436755052
Overall Education Program Planning
This section of the application address the overall education program and answers why you are planning this program; E.g. why is it important and what is your desired outcome? As each question is answered, focus on the overall education program. When you and/or the presenter plan the agenda, each topic(s) should support the activity's overall learning objective(s).
The foundation of the CME planning process is the needs assessment, which serves to identify professional practice gaps of the intended audience, articulate the needs, and outline the objectives and expectations necessary to design learning activities that will change competency, performance, and/or, patient outcomes. ACCME defines this as the difference (or gaps) between what the professional is doing compared to what is achievable on the basis of current professional knowledge.
The planning process for the education program is as followed:
Professional Practice Gap:
What sources did you use to identify the professional practice gap(s)? Check all that apply. (Note: Documentation must be provided for each data item selected).
Statement of Purpose/Need for the Overall Program (ACCME Criteria 2, 3)
Please indicate the eucational need(s) that you determined to be the cause of the professional practice gap(s) as identified in previous questions.
Intended Change and Measurement (ACCME Criteria 2, 3, 16)
When activities have commerical support, it is required that all educational activities be developed indepenedntly of ineligilbe company. (ACCME Criteria 8, 9, 10)
If there is commerical support, please refer to the following:
In order to be good stewards of all types of resources, projected expenses and revenue must be determined prior the activity and submitted to the NE AHEC Education Coordinator. Please utilize the Activity Budget form provided by the NE AHEC.
Education Program Topics/Agenda
Once the agenda is finalized with session objectives, speakers, time and length of each presentation, please submit a completed agenda and corresponding Powerpoint presentation slides to Megan Littleton at NE KY AHEC (firstname.lastname@example.org). Additionally, a CE Financial Disclosure form is required for each speaker prior to the activity.
Note: educational contact hours, are for actual instruction (including Q & A), it does not include welcome/introductions, breaks, meals, etc. Final determination of CME credit hours will be made after review of the agenda.
Note: The final agenda is required before a marketing brochure can be produced.
Non-Educational Strategies to Enhance Change
What “non-educational” strategies will you use to enhance change as an adjunct to this activity? (ACCME Criterion 17)
Select all that apply.
Collaboration - Engagement with the Enviornment
Occasionally there are stakeholders both internal (e.g. Patient safety, Quality, Research, Physician Practices) and/or external (e.g., KY Departments of Health, insurers, specialty societies, patient advocacy groups) working on similar healthcare issues with whome parterning to address these issues may assist in addressing barriers or provide resources. (ACCME Criteria 18, 19, 20, 21)
Faculty Selection (ACCME Criteria 7, 13)
Please indicate the profess for faculty selection for this education program.
Planning Committee (ACCME Criteria 7, 22)
Please list members of your planning committee. Each member must complete a CE Financial Disclosure Form, which identifies financial relationships. A completed CE Financial Disclosure Form for each individual member must accompany this application.
This individual is responsible for operational and administrative support of the activity; including completion of all required documentation and follow-up reporting.
You must complete a Disclosure of Financial Relationships form.Click here to fill out the form.
For questions, please contact Megan Littleton at email@example.com.