CME Activity Proposal for Consideration
In order for an activity to be eligible for CME certification, the CME activity must address actual
professional practice gaps that currently exist and are taking place in practice.
In order to ensure the planners follow the proper planning protocol for a CME event, planners are
required to:
 Outline the process of how the practice gaps were identified,
 Recall and provide examples of the sources used to identify gaps, and
 Detail how the educational activity will address those gaps.
In order to confirm that the proper planning process was followed, please answer the following
questions. If you require additional space, please add attachments to this form.
Proposed Program Title:
Proposed Program Date(s):
Please list all the members of your Planning Committee
(Activity Course Director(s) and Planning Committee members)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
I have included with this Proposal a Planning Committee Conflict of Interest Disclosure form for
each name listed above.
1.) Who is the target audience for this CME activity?
2.) In order to plan this educational activity and identify the professional practice gap(s) that exist for
your target audience, what evidence/data/sources were consulted? Sources must prove that the
need for this activity goes beyond the sponsor’s own perception/observation of need.
a.) Check all that apply:
Journal articles or other peer reviewed sources
Attach bibliography citing journals or other sources, include journal abstracts or relevant
paragraphs that support your educational needs assessment.
Clinical evidence/research
Attach abstract of evidence.
Discussion w/ faculty (clinical/research)
Attach minutes or notes of discussions and include any references to data, journals, and
other sources. Audio recordings of minutes should be digital and readily convertible to
MP3.
Needs assessment of audience
Attach summary of needs assessment and include description of representative
audience sampled.
Other:
Cite all studies, references, or data used to support educational needs.
b.) Please provide a description of your planning process and how you used the sources listed above
to identify professional practices gaps and the educational format of this activity.
3.) When identifying the professional practice gaps of your target audience, here are some questions
that may have been posed by members of the planning committee:
 What questions does my target audience have and what does that reveal about their deficit of
knowledge?
 What patient problems or professional challenges are they unable to address?
 Why are they unable to address the patient problems/challenges without some type of
intervention?
When considering the questions above and after analyzing the sources you identified in Question 2,
please identify the professional practice gap(s) that will be addressed in this CME activity? (C2)
4.) Identify other competencies or sources that were considered when identifying the professional
practice gap(s) and planning your educational activity? Refer to the List of Desirable Physician
Attributes (for example, IOM competencies, ACGME Competencies, etc.) found on the last page of this
Proposal. (C6)
5.) The professional practice gap(s) identified for this activity must be classified as a gap in physician
knowledge, competence and/or performance. Please classify each professional practice gap
identified for this activity as a gap in knowledge, competence and/or performance. (C2, C3)
Gaps in Knowledge = target audience does not have the answers or knowledge.
Gaps in Competence = target audience has the knowledge but does not know how to act on it.
Gaps in Performance = target audience has a strategy but is unable to implement the strategy or
implement the strategy properly in practice.
6.) Based on the need/gap the activity is addressing, what are the desired results of the activity? Said
differently, what is the activity designed to change? You must be able to detail how you plan to
measure these changes in question 7. (C3)
7.) What type(s) of evaluation method(s) will you use to know if the activity was effective at meeting
the need and creating change in competence, performance, or patient outcomes? (C11)
To measure a change in COMPETENCE, you must measure if the learner has developed new strategies
based on the information provided in the activity.
To measure a change in PERFORMANCE, you must measure if the learner made a change in their
practice or implemented new strategies as a result of the activity. (As a result of this activity, how
do you intend to change your practice? Evaluate learners intent to change, 6 month follow up)
To measure a change in PATIENT OUTCOMES, you must measure if the changes implemented by the
learner in practice have affected patient outcomes. (chart reviews, changes in quality improvement
numbers, etc.)
8.) Are there other initiatives within your institution working on this issue? Are there other
organizations we could partner with that are working on this issue?
Yes
No
If yes, what are those initiatives/ organizations and do you have any plans to partner with them?
(C18,C20)
9.) Given the information provided above, identify potential topics that may be covered in your
activity and how will they relate to the professional practice gap(s).
10.) Please answer the following questions about the educational format of your activity.
a.) What will be the format of this activity (Live, Enduring Material, Internet, Other?)
b.) What is the educational design of the activity (e.g. presentation, case studies, round table, and
simulation)?
c.) What is the benefit of this educational format? Why was this educational format
chosen/preferred?
Please remember to consider adult learning principles and the physician learning and change
process. (C3, C5)
Revised 2.13.13
Desirable Physician Attributes
Please “X” all competencies that apply to your conference/meeting.
Institute of Medicine Core
1. Provide patient-centered care
identify, respect, and care about patients'
differences, values, preferences, and
expressed needs; relieve pain and
suffering; coordinate continuous care;
listen to, clearly inform, communicate
with, and educate patients; share decision
making and management; and
continuously advocate disease prevention,
wellness, and promotion of healthy
lifestyles, including a focus on population
health
2. Work in interdisciplinary teams
cooperate, collaborate, communicate, and
integrate care in teams to ensure that care
is continuous and reliable
3. Employ evidence-based practice
integrate best research with clinical
expertise and patient values for optimum
care, and participate in learning and
research activities to the extent feasible
4. Apply quality improvement identify
errors and hazards in care; understand and
implement basic safety design principles,
such as standardization and simplification;
continually understand and measure
quality of care in terms of structure,
process, and outcomes in relation to
patient and community needs; and design
and test interventions to change processes
and systems of care, with the objective of
improving quality
5. Utilize informatics
communicate, manage, knowledge,
mitigate error, and support decision
making using information technology
ABMS(MOC)/ACGME
6. Patient care that is
compassionate, appropriate, and
effective for the treatment of health
problems and the promotion of
health.
7. Medical knowledge about
established and evolving
biomedical, clinical, and
cognate(e.g., epidemiological and
social behavioral) sciences and the
application of this knowledge to
patient care
8. Practice-based learning and
improvement that involves
investigation and evaluation of their
own patient care, appraisal and
assimilation of scientific evidence,
and improvements inpatient care.
9. Interpersonal and
Communication skills that result in
effective information exchange and
teaming with patients, their families,
and other health professionals
10. Professionalism as manifested
through a commitment to carrying
out professional responsibilities,
adherence to ethical principles, and
sensitivity to a diverse patient
population
11. Systems-based practice as
manifested by actions that
demonstrate an awareness of and
responsiveness to the larger context
and system for healthcare and the
ability to effectively call on system
resources to provide care that is of
optimal value
AAMC
12. Evidence of professional
standing such as an
unrestricted license, a license
that has no limitations on the
practice of medicine and
surgery in that jurisdiction.
13. Evidence of a
commitment to lifelong
learning and involvement in a
periodic self-assessment
process to guide continuing
learning
14. Evidence of cognitive
expertise based on
performance on an
examination. That exam
should be secure, reliable and
valid. It must contain questions
on fundamental knowledge,
up-to date practice-related
knowledge, and other issues
such as ethics and
professionalism
15. Evidence of evaluation of
performance in practice
including the medical care
provided for common/major
health problems (e.g., asthma,
diabetes, heart disease, hernia,
hip surgery) and physicians
behaviors, such as
communication and
professionalism, as they relate
to patient care