HOSPITAL FOR SPECIAL SURGERY
Education Division
Request for a New Professional Education Activity
Please attach a preliminary agenda.
Date request submitted:
Proposal submitted by:
Name: _______________________________________________________________________________
Title: _______________________________________________________________________________
HSS Department(s) sponsoring activity: __________________________________________________
Name and Address of External Organization Requesting Activity (if applicable):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Telephone:__________________________________E-mail:___________________________________
Type of activity being requested (check only one):
 Professional Education
 Continuing Medical Education
 Employee training for external organization
 Other
 Yes
Will you apply for CME Credit for this activity?
Will you apply for other CEU Credit(s) for this activity?
If yes, please check all that apply:
 Nursing CEU’s
 No
 Yes
 No
 Physical Therapy CEU’s  NATA Credits for ATC’s
 Other (specify)
Activity Title: ________________________________________________________________________
Proposed Activity Date(s): Start: _____________ End: _____________
 One Time Activity
 Internet CME
 Multiple Activities
 Enduring Material
 Regularly Scheduled Series
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Activity Director(s):
Phone #:
Email:
Planning Committee members:
DEFINITION OF CME
All activities must meet the definition of continuing medical education promulgated by the ACCME
and the AMA: “Continuing medical education consists of educational activities which serve to
maintain, develop, or increase the knowledge, skills, and professional performance and relationships
that a physician uses to provide services for patients, the public, or the profession. The content of CME
is that body of knowledge and skills generally recognized and accepted by the profession as within the
basic medical sciences, the discipline of clinical medicine, and the provision of health care to the
public.” Indicate below that you have read the Definition of CME and that the proposed activity
meets the Definition.

This activity meets the Definition of CME.
HSS CME MISSION
All activities must support the Mission of the Office of Continuing Medical Education (OCME).
Indicate below that you have read the OCME Mission Statement (attached) and that this activity
supports that Mission.

This activity supports the OCME Mission.
PROFESSIONAL PRACTICE GAPS
All activities must be based on identified professional practice gaps, which are the difference
between current practice and optimal practice. The sources for these gaps may be internal (e.g.,
HSS Committees) or external (e.g., review of literature, consensus guidelines, regulatory agency
mandates). For this activity, describe the current practices identified by the Planning Committee
and the optimal practice strategies that will be addressed by the activity content:
Current Practices:
Optimal Practice Strategies:
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What resources were used to determine the professional practice gaps for this activity (check all that apply):
 Recent research/literature reviews
 New techniques, procedures, materials
 Expert opinion/faculty/committee perceptions
 Departmental planning meeting minutes
 Previous participant evaluations
 Governmental/regulatory mandates
 National clinical practice data
 Practice guidelines
 Departmental QA/UR data reviews
 Other:
 Departmental CME self study/needs
EDUCATIONAL NEEDS
All activities must address the educational needs underlying the identified practice gaps. Identify
below the educational needs for this activity in terms of knowledge and/or competence and/or
performance. For example, is the practice gap caused by lack of knowledge (e.g., awareness of the
issue, possession of required information), lack of competence (e.g., ability to implement a practice
strategy), or failure to perform (e.g., actual implementation of a practice strategy).
Knowledge Needs to be addressed by this Activity:
Competence Needs to be addressed by this Activity:
Performance Needs to be addressed by this Activity:
TARGET AUDIENCE (check as many as apply):
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 Anesthesiologists
 Athletic trainers
 Nurses/ PA’s/NP’s
 Orthopaedists
 Physical therapists
 Physiatrists
 Primary care Physicians
 Resident/Fellows
 Rheumatologists
 Other health care professionals
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Estimated number of registrants:
Lab Component
1. Do you plan to have a laboratory component for this program?  Yes
2. Will you use the HSS-BSEL space?
 Yes
 No
 No
3. What supplies will you need (check all that apply)?
 Sawbones: (please specify)
 Cadaverous Specimen: (please specify)
 Basic Instrumentation Set
 Computer simulation
 Arthroscopic equipment
 Wire Instrumentation Set
 Other: (please specify)
4. Have you arranged for in-kind vendor support for any of the above as of this date?
 Yes
 No, none necessary
 Have not yet contacted, but plan to do so (company name and contact):
________________________________________________________
Live Video Feed
Do you plan to have a live video feed from either the BSEL or a surgical suite to the Richard L. Menschel
Education Center?  Yes
 No
BUDGET
For this activity, please estimate:
Total Income:
$__________________
Total Expenses:
$__________________
Funding sources (please check as many sources as apply):
 Registration fees  Industry/Commercial supporters  Department accounts
 Foundation grants  Government grants
 Other
List anticipated industry funding sources:
Activity Director:
Signature
Date
Department/Division Chairperson:
Signature
Date
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Please Return To: Allison Goldberg, MPA, Director, Professional Education
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Office of Continuing Medical Education (OCME) Mission
1.1 Mission
The mission of the Office of Continuing Medical Education (OCME) is to:






Promote life-long learning in the areas of orthopaedic surgery, rheumatology, and related sub-specialty
disciplines;
Advance the general competencies, medical knowledge and clinical skills of physicians and other
health professionals practicing in these specialty areas;
Work collaboratively with hospital staff to assess individual and collective educational gaps in practice
or knowledge that require an educational intervention(s);
Develop and offer needs-based educational interventions using a variety of formats the content of
which is balanced, unbiased and free of commercial interest;
Improve individual clinician performance that assures both patient safety and the best possible patient
outcomes; and
Evaluate improvements in clinical performance as a result of the Department’s continuing medical
education process, using both quantitative and qualitative measures.
By doing so, the OCME serves to support the overall mission of Hospital for Special Surgery and its staff,
to enhance the quality of life for all our patients by providing the highest quality patient care, and to
advance the overall practice of musculoskeletal medicine internationally.
1.2 Content Areas
The OCME develops, implements, and evaluates activities for physicians and other health-care providers in
the field of musculoskeletal health. The content of activities sponsored by Hospital for Special Surgery
encompasses primary care, specialty, and subspecialty topics in the science of medicine. All activities are
designed to present the most current clinical, technological, and evidenced-based information that affect
today’s practice of musculoskeletal medicine.
1.3 Target Audiences
Target audiences include practitioners in the specialties of orthopaedics and rheumatology, primary care
physicians, subspecialty physicians, nurse practitioners, physician assistants, and other providers with
subspecialty interest in these clinical areas. The Office of CME strives to reach a local, national, and
international audience by using a variety of CME formats and modalities.
1.4 Types of Activities
To address the educational needs of our target audiences, activities provided by Hospital for Special
Surgery’s Office of CME include regularly scheduled sessions, live courses and conferences, simulation
labs, workshops, live surgery televised presentations, Internet CME, monographs, CD-ROMs, and other
educational modalities.
1.5 Expected Results
All CME activities are evaluated for participant satisfaction, skills development, knowledge gained and
perception of the faculty, among other criteria. Through the use of follow-up surveys, activities are also
evaluated in the areas of knowledge retention and change in practice. OCME maintains an ongoing effort
to develop new assessment and evaluation tools that better correlate an educational intervention to a
specific set of performance measures or other outcomes-based criteria to assure compliance with ACCME
Essentials.
Date Issued: 1/01/08Approved by Professional Education Advisory Committee: 4/22/08;
Approved by CME Committee: 4/29/08Approved by GME Committee: 4/30/08;
Approved By Medical Board: 5/21/08
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