CR A Ap plication Form for MOC Appro val
Approval of Accredited Group Learning Activities:
Section 1 of the Framework of CPD Options of the Maintenance of Certification Program
Program Title:
Location of Event/Program:
City
Province
Program/Event Dates:
Start Date
End Date
PART #1: ORGANIZATION REQUESTING APPROVAL
Activities submitted for approval under Section 1 must meet the requirements for either Option 1 or 2.
Option 1: We are a physician organization that is planning this educational event alone or in conjunction with another
physician organization.
Option 2: We are a physician organization that is co-developing this educational event with a non-physician
organization. We (the physician organization) have been involved in planning this event and accept accountability for its
entire program.
If you do not meet the criteria in Option 1 or 2, we will not be able to consider your application; the program is ineligible for
Section 1 credits. Other options for obtaining credit exist for CPD activities that have not been reviewed or approved;
please refer to the General Maintenance of Certification Information on the Royal College website.
Co-Development: If you wish CRA to consider a co-development program, please call the CRA Accreditation Office for
more information regarding the process. The first step prior to submitting an application will be to provide a “Letter of
Intent” outlining the project. The CRA needs to be involved in the planning process from the beginning. This includes
planning, the needs assessment, development of learning objectives, speaker selection, program design, implementation
and evaluation. This constitutes educational co-development. For co-development, CRA must be contacted before any
planning commences. Note that a sponsor cannot take part in the planning process, be on the planning committee, select
speakers nor be involved in the development of learning objectives.
Physician Organization: A not-for-profit group of health professionals with a formal governance structure, accountable to
and serving, among others, its specialist physician members through:
 Continuing professional development
 Provision of health care; and/or
 Research
This definition includes (but is not limited to) the following groups:
 Faculties of medicine
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Hospital departments or divisions
Medical (specialty) societies
Medical associations
Medical academies
Physician research organizations
Health authorities not linked to government agencies
Canadian Provincial Medical Regulatory Authorities (MRAs)
This definition excludes pharmaceutical companies or their advisory groups, medical supply and surgical supply
companies, communication companies or other for-profit organizations and ventures/activities.
Types of organizations that are not considered Physician Organizations:
 Disease-oriented patient advocacy organizations (e.g. Canadian Diabetes Association)
 Government departments or agencies (e.g. Health Canada, Public health Agency of Canada)
 Industry (e.g. pharmaceutical companies, medical device companies, etc.)
 Medical education or communications (MEC) companies (e.g. CME Inc.)
 For-profit online educators, publishing companies or simulation companies (e.g. Medscape, CAE)
 Small number of physicians working together to develop educational programming
Is the program sponsored by a physician organization: Yes
No
If yes: Name of the physician organization:
Name of any non-physician organizations involved in planning this program/event:
Chair of the Planning Committee Requesting Approval:
Address:
E-mail:
Fax: (
)
Phone: (
)
Contact person and email to copy correspondence:
Is this event on-line only? Yes
Is this a recurring activity: Yes
No
No
Number of times this activity will reoccur within one year from date of accreditation:
(A recurring event refers to one event occurring several times in the same year, with the same content, program, faculty,
objectives, etc. for each occurrence. If there is any variation, each event must be accredited separately.)
NOTE: if a program is covering travel, accommodation or other personal expenses to participants, the program is not eligible
for Section 1 credits. For further information, please refer to Section 32 of the CMA Guidelines for Physicians in Interactions
with Industry (2007) and the Royal College interpretation which states: “All accredited group CME/CPD events cannot provide
funding for physicians or their families to travel to attend events or to pay for their lodging or other related costs.”
PART #2: MANDATORY EDUCATIONAL REQUIREMENTS
Criteria 1: The activity must be planned to address the identified needs of the target audience.
Please provide an explanation or supporting documentation for each of the following questions:
1. Who is the target audience for this activity? Please indicate specific specialties and, if applicable, indicate other
health professionals for whom the activity is intended.
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2. List all members of the planning committee, their medical specialty or health profession, and indicate which are
representing the physician organization?
3. What sources of information were selected by the planning committee to define the content of this activity? For
example, reviews of the scientific or education literature; clinical practice guidelines; surveys or focus groups
conducted by the sponsoring organization.
Optional
4. What gaps in knowledge, attitudes, skills, or performance did the planning committee identify for this event? For
example, physician performance information from hospitals or provincial / national databases; self-assessment
tests; case scenarios; quality improvement activities or audits of practice.
Criteria 2: The activity must create learning objectives to address identified needs. The learning objectives must
be printed in the program brochure/materials or in the online information. Objectives should clearly state what a
participant will know or be able to do as a result of attending an event or session. Click here for information on creating
learning objectives.
Please provide an explanation and supporting documentation for the following issues or questions:
1. What learning objectives were developed for this activity?
a) The overall event?
b) Specific sessions?
2. How were the identified needs of the target audience utilized in the creation/development of the learning
objectives?
3. Do the learning objectives express what the participants will know or achieve by participating in the activity?
Yes
No
4. How are the learning objectives linked to the evaluation strategies for the activity? For example does the
evaluation form list the learning objectives or pose questions to participants about whether the learning objectives
were met?
Criteria 3: At least 25% of the total education time must be devoted to interactive learning strategies.
Please send the proposed course schedule, with times, indicating discussion periods, workshops, small group sessions
etc., and provide an explanation or supporting documentation for the following issues or questions:
1. What learning methods have been incorporated to promote interactive learning? For example, discussion
periods, small group, workshops or seminars, audience response system?
Criteria 4: The activity must include an evaluation of the event’s established learning objectives and the learning
outcomes identified by the participants.
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The evaluation strategies for events approved under Section 1 must include an assessment of the achievement of the
identified learning objectives and provide opportunities for participants to identify what they have learned and its potential
impact for their practice.
Please provide a copy of the evaluation tools developed for this activity. The evaluation form should include opportunities
for the participant to identify what they have learned and its potential impact on stimulating further learning or for their
practice (i.e. Personal Leardning Projects (PLPs); commitment to change). For information on evaluation, please click
here.
Please provide a copy of the evaluation form and respond to the following questions:
1. Do you provide an opportunity for participants to identify if the stated learning objectives were achieved?
Yes:
No:
(If no, please revise accordingly before you submit)
2. Are there opportunities for participants to identify and/or reflect on what they have learned? (One example of this
would be a questions asking what the participants learned or plan to integrate into their practice)
Yes:
No:
The Royal College offers a toolkit on writing learning objectives: to view, please click here.
Optional (3, 4 and 5)
3. Does the evaluation strategy intend to evaluate enhanced participant performance?
Yes
No
If yes, please describe the tools or strategies used:
4. Does the evaluation strategy intend to evaluate improved health care outcomes?
Yes
No
If yes, please describe the tools or strategies used:
5. Will the participants receive feedback related to their learning?
Yes
No
If yes, please describe the tools or strategies used:
PART #3: MEETING ETHICAL STANDARDS FOR CONTINUING PROFESSIONAL EDUCATION
Group CPD events approved under Section 1 must meet the Canadian Medical Association’s Guidelines for Physicians in
Interactions with Industry (Update 2007) (http://policybase.cma.ca/dbtw-wpd/Policypdf/PD08-01.pdf). In the province of
Québec, the Code of Ethics for Parties Involved in Continuing Medical Education
(http://ww.cemcq.qc.ca/en/documents/guide_ethique.pdf) of the Conseil de l’éducation médicale continue du Québec
(CEMCQ)* must be met; and the CPD event or program evaluation form must include the following question: “Did the
activity comply with the Code of Ethics for Parties Involved in Continuing Medical Education?”
* The CEMCQ has changed its name. While documents still refer to the CEMCQ, future documents will include the new
name of the organization: Conseil québécois de développement professionnel continu des médecins (CQDPCM).
Please read: Any financial assistance provided (for travel or accommodation) to reimburse physicians or their families for
attending an educational event is not permitted would result in non-approval of this application. For more information on
the CMA guidelines regarding financial support from industry, please see the CMA Policy: Guidelines for Physicians in
Interactions with Industry (Update 2007) at the above website.
Each of the following ethical standards MUST be met for this event to be approved under Section 1:
1. The physician organization must have control over the topics and content of the activity, as well as the speakers
invited to present at the activity.
We comply with this standard
Yes
No
Describe the process by which the topics, content and speakers were selected for this event:
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2. The physician organization must assume responsibility for ensuring the scientific validity, objectivity, and
completeness of the content of the activity.
We comply with this standard
Yes
No
Describe the process to ensure validity and objectivity of the content for this event:
3. The sponsoring or co-sponsoring organization must disclose to participants all financial affiliations of faculty,
moderators or members of the planning committee (within the past two years) with any commercial
organization(s) regardless of its connections to the topics discussed or mentioned during the event
We comply with this standard
Yes
No
Describe how conflict of interest information is collected and disclosed to participants:
Note: Completed conflict disclosures from all speakers/faculty are required prior to an event. Conflicts, or lack
of conflicts, are to be disclosed on the second slide of the speaker’s presentation.
For a sample disclosure form, contact the CRA or click here.
4. All funds received in support of this activity must be provided in the form of an educational grant payable to the
sponsoring organization.*
We comply with this standard
Yes
No
Please include a copy of the detailed budget for this program that identifies each source of revenue and each
expenditure for this event.
Please describe how the physician organization(s) assumes responsibility for the distribution of these funds, including the
payment of honoraria to faculty.
Please identify all organizations that are funding this activity.
5. No drug or product advertisement may appear on or with any of the written material for this event.
We comply with this standard
6.
Yes
No
A) Generic names should be used on all presentations and written materials. If trade names are used they should be
accompanied by the generic name.
We comply with this standard: Yes
No
B) Describe the process to advocate speakers’ adherence to using generic names of medications and/or devices
included within all presentations or written materials.
We comply with this standard
Yes
No
Note: Accreditation statements cannot be located near any sponsorship recognition. Sponsorship recognition
cannot be located within the scientific content. The accreditation statement is to be located within the program.
Signage with sponsor recognition cannot be located within the room where the educational activity is taking
place.
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DOCUMENTATION REQUIRED: All documentation must be included with your application.
Applications are to be submitted 6 weeks before program start date. Incomplete applications will delay
the review process.
 Completed application form emailed to accreditation@rheum.ca Yes
 Detailed program/course outline Yes
No
No
 If applicable, the evaluation summary of this program from last year Yes
 Learning objectives for each presentation Yes
No
NA
No
 Detailed budget (Revenue sources and expenses need to be itemized) and sponsorship information (please contact us for a
sample budget template) Yes
No
 A copy of the evaluation form (each presentation is to be evaluated) Yes
No
 Completed conflict disclosures for all faculty/speakers/planning committee members Yes
 Copy of the certificate of attendance/participation Yes
 Application Fee Yes
No
No
No
 For online programs, I have reviewed the document Criteria for Approval of Online CPD Events Yes
 For co-developed applications only: a copy of the minutes of the planning committee Yes
and a copy of the needs assessment Yes
No
No
No
DECLARATION: As Chair of the Planning Committee, I accept the responsibility for the accuracy of the information
provided in response to the questions listed on this application and, to the best of my knowledge, certify that the CMA’s
guidelines, entitled “Physicians and the Pharmaceutical Industry (2007) (sections 21-40) have been met in preparing for
this CPD event.
I confirm that the required documentation is complete and attached.
If this event is held in Québec, we are aware that it is mandatory to adhere to the Conseil québécois de développement
professionnel continu des médecins (CQDPCM) (CQDPCM), Code of Ethics for parties involved in Continuing Medical
Education.
Chair of the Planning Committee:
Print name:
Signature:
Date of application:
NOTE: The date of review commences on the date the completed application is received. The application fee is nonrefundable even in the event the application is declined. If the application is approved, this fee will be applied to the full
accreditation fee.
In order to give the CRA the opportunity to adequately review your program and make any suggestions for improvement,
please submit your application as soon as possible in advance of the event. Please allow up a minimum of six (6)
weeks for Section 1 review and several months for co-development applications.
Applications submitted three weeks from the start date of the program may be rejected. Upon exception, the application
may be reviewed as a rush and an Expedited Accreditation Fee will be applied. If you have a rush application, please
contact the CRA prior to submission of the application. Co-developed programs are not eligible for expedited review.
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FEE STRUCTURE
PROVIDER
ACCREDITATION PROCESS
FEE
NON-REFUNDABLE
APPLICATION FEE*
Physician organization with
no private sector funding
Section 1 Approval
$500
(plus HST)
$100
(plus HST)
Physician organization with
funding from private sector
Section 1 Approval
$1,000
(plus HST)
$200
(plus HST)
Physician organization
Section 3 Approval
$1,000
(plus HST)
$200
(plus HST)
$7,500
$750
(plus HST)
Non-physician organization
Educational co-development
where CRA would be represented
on the planning committee from
the onset of planning.
(Section 1 and 3)
Plus a $1,500 Administration fee
Plus a $250 Maintenance Fee
per each recurring event five and
more (taxes apply to all fees)
* Non-refundable application fee must accompany the application (if approved, this fee will be applied to the full accreditation fee)
APPLICATIONS FOR CO-DEVELOPMENT CONSIDERATION: Please include a non-refundable application fee of $750
plus HST for consideration of co-development applications. Should your application be approved, the application fee will
be applied to the accreditation fee. In the event that a co-developed program does not take place or is declined, the nonrefundable application fee and the administration fee will not be refunded.
The applicant should keep an electronic copy of the completed application form and submitted documentation.
The non–accredited provider has the responsibility for maintaining and documenting an ethical relationship with industry
supporters; maintaining records of the evaluations and participation rests with the non-accredited provider.
GENERAL INFORMATION
 Applications may NOT be submitted after an event.
 Section 1 approval is valid for 12 months.
 Applicants should keep a list of their attendees for record purposes for a period of five (5) years.
 The non-accredited provider is to maintain records of CPD activity (materials, attendance) and submit information to
the Validation Program on request by the Royal College.
 General Maintenance of Certification information can be found on the Royal College website.
 Notice of approval of this activity will be forwarded to the Royal College of Physicians and Surgeons of Canada in
order to list your event on the Royal College web site. The College will also be notified of applications that are
declined.
 Click here for the Royal College Accreditation Tool Kit.
 Guidelines for Accredited Providers of CPD Activities
The Notification of Review of a Group Learning Activity will be completed by the Accredited Provider upon approval of
your program/workshop and the information will be forwarded to the Royal College of Physicians and Surgeons of
Canada. The information provided on the notification form will be used to list your event on the Royal College web site.
Email completed application form with documentation to:
CRA Accreditation Office
421 Gilmour Street, Suite 300
Ottawa ON K2P 0R5
Tel: 613-986-2746 / accreditation@rheum.ca
Please advise the CRA Accreditation Office promptly if you do not receive a Notice of Receipt of Submission within 72 hours of
submission. It is the applicant's responsibility to ensure the completed application is received.
May 2015
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