CME Activity Instructional Design Worksheet
This form is designed to assist you with planning your event as well as comply with ACCME standards.
It will walk you through the essential elements of instructional design as required in the application.
Event Title:
Date:
Location:
Name of Person completing worksheet:
INSTRUCTIONAL DESIGN
This is a step-by-step guide to walk you through the essential elements of instructional design listed
below:
I. Needs assessment – Identification of professional practice gaps
II.
Statement of Clinical/Scientific Importance
III.
Learning Objectives – How this activity will address the identified gaps
IV.
Target Audience - Specific audience for this activity.
I. Needs Assessment
Instructional design must be based on identified gap(s) in the professional practice of your learner
defined as the distance between current practice and an optimal practice and be evidence-based.
Answer the following questions to identify the practice gaps for this activity:
1. What is the optimal practice?
2. What is the current practice?
3. What is the difference or differences between current and optimal practice you wish to
address with this activity? These are your professional practice gaps.
CME ACTIVITY INSTRUCTIONAL DESIGN WORKSHEET
Page 1
4. What sources did you use to assess the needs of this target audience? Identify the methods
you used in determining this need by checking appropriate boxes below. Check all the sources
that apply, and describe where applicable.
Previous Participant Evaluations
If checked, please provide
documentation
Review of Current Literature
If checked, please give citations
Survey of Target Audience
If checked, please summarize
survey results
Self-Assessment Tests
(e.g. pre-test, post test, case
vignettes in surveys)
Planning Committee or Board
Recommendation
Advice from Authorities/Experts in
the Field.
If checked, please indicate
which Authorities/Experts
provided advice
Formal or Informal Requests from
Members
This is a follow-up at a higher level
to a previous course
If checked, please indicate
which course
New Medical Findings/Techniques
If checked, please
describe/provide citations:
New guidelines
If checked, please cite
guidelines
Quality improvement data
If checked, please explain
Formal needs assessment(s) by
scholarly investigators
Other, please explain
5. Please cite 2 or 3 resources or references that support the identified gaps.
1)
2)
3)
CME ACTIVITY INSTRUCTIONAL DESIGN WORKSHEET
Page 2
II. Statement of Clinical/Scientific Importance
Use this section to explain why the gaps identified in the previous section create a problem
(who is affected, how many people are affected). Explain how your activity will provide
evidence-based content to fill the need and narrow the gap. State what you would like
attendees to walk away with from attending this activity. You may also provide any relevant
background information needed to frame the problem. (approximately 250 words)
CME ACTIVITY INSTRUCTIONAL DESIGN WORKSHEET
Page 3
III. Overall Activity Learning Objectives
This section will guide you through writing 2-4 overall learning objectives for the activity based on the
gaps identified above. Once topics and speakers and presentations are selected, each topic will have
its own learning objectives as well. These learning objectives are required on the course brochure and
any printed course materials. They also form the basis for your evaluation metrics.
While professional practice gap(s) are the difference between actual and optimal practice, learning
objectives are a statement of how this activity can close the identified gap(s). Objectives should state
how the learner will be able to apply new knowledge, competence or performance/skill to his
practice or work, or improve the quality of life or health of a patient. For purposes of this activity
competence is defined as “Knowing how to do something” “… a combination of knowledge, skills and
performance..the ability to apply knowledge, skills and judgment in practice. ” Performance is defined
as “What one actually does, in practice. Performance is based on one’s competence but is modified
by system factors and the circumstances.”
Ultimately, learning objectives explain what will the learner be able to do/do better after attending
your session? Examples: At the conclusion of the session, the participant…:
•
•
•
•
•
•
•
•
“Will be able to apply…”
“Will learn new findings about…”
“Will be better able to diagnose…”
“Will more appropriately refer…” or “refer earlier…”
“Will have new strategies to manage care of…”
“Will improve…”
”Will integrate new treatment options in discussing xxx with patient…”
“Will be able to improve the quality of life/health status of your patients by xxx.”
At the conclusion of this activity, participants should be able to …
Learning Objective One
Does this objective result in a change in:
competence,
performance
patient outcomes
Does this objective result in a change in:
competence,
performance
patient outcomes
Does this objective result in a change in:
competence,
performance
patient outcomes
Does this objective result in a change in:
competence,
performance
patient outcomes
Learning Objective Two
Learning Objective Three
Learning Objective Four
CME ACTIVITY INSTRUCTIONAL DESIGN WORKSHEET
Page 4
IV. Target Audience
The educational activities and content should match the learners’ current or potential scope of
professional activities. Please list anticipated audience by specialty and number in each group. The
target specialty information is required to be listed on any brochure or invitation, as well as on course
materials.
Total Number of
Physician Learners:
Total Number of
Allied Healthcare
Provider Learners:
Pulmonary Specialists:
Physician Assistants
Critical Care Specialists:
Nurse Practitioners
Pediatric Pulmonary
Specialists:
Registered Nurses
Allergy/Immunology
Specialists:
Sleep Technologists
Internal Medicine
Respiratory Therapists
Family Practice
Pharmacists
Other (please specify):
What percentage of
participants will be from
the USA?
CME ACTIVITY INSTRUCTIONAL DESIGN WORKSHEET
Page 5