SECTION #1 - CME ACTIVITY PLANNING WORKSHEET
ACTIVITY INFORMATION
ACTIVITY TITLE
Working
Final
Title
Title
Cultural Competency and TB: General Principles and Case Studies with Ecuadorian Migrants
Proposed Date and Time
October 2, 2007, 9:00 am – 4:30 pm
Proposed Location
New York State Department of Health Field Office
145 Huguenot Street, 6th floor, Conference Room #612
New Rochelle, NY 10801-5228
SPONSORING UMDNJ SCHOOL/DEPARTMENT
Name
NJMS Global Tuberculosis Institute
Activity Director
Nisha Ahamed, MPH
Academic/Clinical Title
Director, Education & Training
Address/Mail Code
225 Warren Street, 1st Fl., West Wing, P.O. Box 1709, Newark, NJ 07101-1709
Telephone
973-972-9008
Fax
E-mail
ahamedni@umdnj.edu
973-972-1064
ACTIVITY DIRECTOR’S ADMINISTRATIVE LIAISON
Name
Lauren Moschetta-Gilbert, MA
Address/Mail Code
225 Warren Street, 1st Fl., West Wing, P.O. Box 1709, Newark, NJ 07101-1709
Telephone
973-972-1261
Fax
E-mail
moschelb@umdnj.edu
973-972-1064
JOINT OR CO-SPONSORING ORGANIZATION
Name
Charles P. Felton National TB Center at Harlem Hospital
Activity Co-Director (from joint/co-sponsor)
Bill L. Bower, MPH
Address/Mail Code
Samuel L. Kountz Pavilion, 15 W 136th Street, 6th Floor, New York, NY 10037
Telephone
212-939-8258
Fax
E-mail
blb3@columbia.edu
212-939-8259
ACTIVITY CO-DIRECTOR’S ADMINISTRATIVE LIAISON
Name
Paul W. Colson, PhD
Address/Mail Code
Samuel L. Kountz Pavilion, 15 W 136th Street, 6th Floor, New York, NY 10037
Telephone
212-939-8241
Fax
E-mail
pwc2@columbia.edu
212-939-8259
PLANNING COMMITTEE
In addition to the activity director and co-director, list names, titles and affiliations, of persons
chiefly responsible for the design and implementation of this activity. Use additional sheet if necessary.
Name
Nisha Ahamed / Lauren Moschetta
Name
Martha Alexander / Xiomara Dorrejo
Name
Francesca M. Gany
Title
Director, Education and Training / Training
and Consultation Specialist
Title
Director, Education and Training / Training
and Consultation Specialist
Affiliation
NJMS Global Tuberculosis Institute
Title
Director
Affiliation
NYU Center for Immigrant Health
Affiliation
New York City Department of Health
and Mental Hygiene, Bureau of TB Control
CME STATEMENT OF ATTESTATION
I attest that this activity is within the guidelines of the ACCME definition for CME
and therefore eligible for accreditation.
____________ YES
_____________ NO
________________________________
Signature
SECTION #2 -EDUCATIONAL ELEMENTS
NEEDS ASSESSMENT
To establish a reason for the physician and/or other health professional for wanting to attend an educational activity is the first
step in providing a successful program. This reason (need) is the identification of problem(s) in clinical practice and/or gap(s)
in current knowledge.
NEEDS ASSESSMENT DATA AND SOURCES
Please indicate how the need for this program was brought to your attention. For CME accreditation purposes, please
provide examples of the sources that you have indicated. Please designate at least (2) TWO sources.
If you cannot provide documentation, do not check that source.
Continuing review of changes in quality of care as revealed by medical audit or other patient care reviews.
(Sources of documentation: audit reports/chart reviews)
Ongoing census of diagnoses made by the physicians on staff.
(Sources of documentation: summary of notes or minutes of meetings)
Advice from authorities of the field or relevant medical societies.
(Sources of documentation: list of expert names/medical societies and summary of recommendations)
Formal or informal requests or surveys of the target audience.
(Sources of documentation: description of the audience make-up and summary of informal requests or survey)
Formal or informal requests from members of staff or faculty.
(Sources of documentation: description of staff/faculty make-up and summary of informal requests or survey)
Periodic discussion in departmental meetings.
(Sources of documentation: departmental meeting minutes)
Perception of need from CME activity director and/or Departmental Chair.
(Sources of documentation: summary of notes or meeting meetings or note to file )
Data from library/government sources
(Sources of documentation: public health statistics, data, publications)
Literature review and/or consensus reports
(Sources of documentation: publication review and/or report)
Formal tests to determine physician competence
(Sources of documentation: test and summary of statistics)
*Evaluations and recommendations from previous CME activities.
(Sources of documentation: evaluation summaries and data )*MUST be included for repeated activities.
Review of board examinations and/or re-certification requirements
(Sources of documentation: review/update requirements)
Planned periodic survey of the field
(Sources of documentation: a description of the audience make-up, survey and summary of statistics)
Review of problem cases managed by staff
(Sources of documentation: summary of patient problem logs)
Need suggested by an industry representative
(Sources of documentation: note to file of recommendations)
New technology
(Sources of documentation: description of new procedure and date of inception)
New legislation/regulations
(Sources of documentation: copy of the measure)
Other; please describe:
List the specific source(s) that you, along with your planning committee, used to assess the educational need(s)
for the activity. Attach planning meeting minutes or a summary of any notes, if applicable.
1. TB Control programs in the Tri-State Area report increasing numbers of TB patients from Ecuador who speak Quichua
(not Spanish). Staff need training in cultural competency and culturally-specific information to serve this group.
2. Working Group on TB among Ecuadorian Migrants met in May 2006 and one of their recommendations was to organize
training in cultural competency.
3. TB surveillance data from the Tri-State Area submitted to the Centers for Disease Control and Prevention reveals that
Ecuadorian migrants are now among the top three countries of origin of TB cases in the area.
TARGET AUDIENCE
Upon the assessment of the identified of needs, the target audience should then be determined.
Indicate the population for whom this activity is designed:
Physicians: list specialty(ies): Infectious disease, internal medicine, pulmonary medicine
Other Health Care Providers: list area(s) of interest: Public Health Nurse Supervisors, Public Health Nurses,
Physician Assistants, Nurse Practitioners, Managers of health care settings responsible for TB control, and nurse
managers.
Other: please specify: Disease Control Investigators, Outreach Workers
Any special background requirements necessary for effective learning?
No
Yes (please specify)
Participants must be responsible for implementing and enforcing TB control activities.
GOALS
We need to attract the physician’s attention otherwise he/she will never know about nor be interested in the activity.
(NOTE: Research has shown that physicians may not be aware of what they do not know.) This is best done by listing the
overall goal(s) of the activity. What are you trying to accomplish? What benefits will the physician accrue by attending this
activity? Emphasize how goals are derived from the needs and applied to the target audience .
Provide a brief synopsis of the activity’s overall goal(s):
The goal of this course is to impart general principles of cultural and linguistic competency in TB control and use Ecuadorian
examples to explore in-depth how to work effectively with this culture. The information and skills imparted will also be
generalizable – applicable to dealing with patients from other countries, as well.
LEARNING OBJECTIVES
To fulfill the promise that the activity will be beneficial, the next step is the development of specific, individualized
objectives. What should the physician be able to accomplish after successfully completing the activity? Think of it as
“What are the take-home messages the physician will leave with?” With the new directive in continuing medical education
on educational outcomes, what impact will this activity have on the physician’s performance and patient care?
Complete the chart below indicating linkages between identified needs, learning objectives and anticipated
outcome.
Identified Needs: Analyzing the data obtained and summarize the needs to be addressed. Why is there an interest in this
subject?
In many cities, counties, and states of the Northeast the majority of TB cases are occurring among foreign-born persons. In
some program areas, Ecuador is now among the top three countries of origin. Immigrants from rural areas of Ecuador
present special difficulties because of the high incidence of TB among this population and its historical alienation from the
modern health care system.
Objectives: List 3-5 objectives the target audience should be able to achieve at the conclusion of the activity.
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Explain why cultural and linguistic competency are important for healthcare/TB control
Describe the differences between race, culture, and ethnicity
Describe the impact of one’s own health beliefs and experiences on health care service delivery
Name at least one area of knowledge, one skill, and one attitude necessary for developing cultural and linguistic
competency
Describe at least three possible characteristics of Ecuadorian migrants and their experience with migration, health care
systems, and tuberculosis
Demonstrate techniques for effective cross-cultural communication
Describe how to enhance organizational cultural competency
Anticipated Result: How will the information presented in this activity impact the clinical practice and/or behavior of the
participants? Indicate how this change could be reasonably measured.
The knowledge, skills, and attitudes imparted in this course will equip participants with the tools to enhance both the
individuals’ and their TB control programs’ s competence to achieve successful outcomes of TB treatment and contact
investigations, in order to continue progress toward the elimination of tuberculosis.
At the conclusion of the course, participants will complete a brief survey regarding the value of the training and what changes
they plan to implement as a result of the learning activity. Follow-up surveys will also be sent to the participants 3 months
after the course to determine changes in current practices.
EDUCATIONAL DESIGN AND METHODS
Please indicate the educational methods you plan to use in order to achieve the stated objectives and check the
appropriate box of the teaching tools being used. The activity should be structured to achieve the stated learning
objectives.
LIVE COURSE
Traditional
Teleconference (audio)
Mini-Residencies/Fellowships
Videoconference
Internet
Other:
Teaching Tools Used
Didactic Lectures
Audio/Video Presentations
Formal Discussion Group
Case Presentations
Hands-On Lab
Computer Program
Panel Discussions
Procedures Demonstration
Audience Response System
Q&A Sessions
Self-Graded Assessment
Other
Workshops
Skills Session
Indicate the method(s) of opportunities that will be incorporated into this activity that will allow the
exchange of ideas between participants and faculty.
Questions from the audience following each presentation
Formal question and answer segment(s)
Formal panel discussion session(s) with presentation of questions and cases from the audience
Interactive audience response system
Scheduled workshops and breakouts/tracks for discussion of a specific topic in-depth
Other: Demonstration of fit testing
Newsletter/Monograph
ENDURING MATERIAL
Journal Article/Supplement
Audiotapes
Videotape
CD-ROM
Internet
Other:
The learner must read/view listen/comprehend the entire educational piece and answer a series of multiple choice questions
in order to fully participate in the activity.
Teaching Tools Used
Case Studies/Presentations
Self-Graded Assessment
Didactic Material
Computer Interactive System
Panel Discussions
Chat Rooms
Q&A Sessions
E-Mail
Procedures Demonstration
Other:
EVALUATION TOOL
All educational activities should have a process to evaluate the educational effectiveness of the activity. The evaluation
should address and measure the following items:
 extent to which each of the
educational objectives were met
 effectiveness of each of the
speakers/moderators/discussants
 adequacy of learning aids (audiovisual,
syllabi, etc.) and facilities
 assessment of content as it relates to
objectivity, fair-balance and clinical
relevance
 actual or perceived impact on the
physicians professional
practice/effectiveness
 identification of future educational
needs
Please check the evaluation method(s) you plan to use:
Formal questionnaire
Follow-up questionnaire in the near future
Pre- and/or post-test
Skills /performance assessment
Informal discussion during the activity
Focus group at the completion of the activity
CME Observer
Interviews
Other:
FACULTY SELECTION
Attach a list of the proposed participating faculty including complete name, degree(s), academic rank,
clinical title(s), department, and affiliation(s).
Please see attached faculty list.
Describe the process for identification and selection of the faculty, moderators and discussants:
Faculty members were identified based on clinical expertise, knowledge and experience in TB infection control practices.
PROPOSED AGENDA
Attach a proposed agenda based on the planning process including topics, inclusive times and
participating faculty.
See attached agenda.
SECTION #3 - IMPLEMENTATION, MARKETING & BUDGET
IMPLEMENTATION, MARKETING AND BUDGET
Will other parties (non-UMDNJ affiliated) be involved in the planning and implementation of this activity (communication
companies, meeting planners, convention bureaus, joint/co-sponsors)?
No
If yes, please list companies, the individuals chiefly responsible, their credentials, and description of their anticipated roles.
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Bureau of Tuberculosis Control, New York City Department of Health & Mental Hygiene; Shama Ahuja, MPH, Martha
Alexander, MHS and Xiomara Dorrejo, BS; involved in planning agenda and presenting selected sessions.
Charles P. Felton National TB Center at Harlem Hospital; Bill L. Bower, MPH, Director of Education and Training;
convenor of Working Group on TB among Ecuadorian Migrants; overall course facilitator involved in planning agenda,
coordinating logistics, moderating sessions, designing and conducting evaluation.
Center for Immigrant Health, New York University School of Medicine; Francesca M. Gany, MD, MS, Director, Javier
González, Sapna Pandya, MPH; involved in planning agenda and presenting selected sessions.
Central Massachusetts Area Health Education Center; Germán Chiriboga; leading session about experience and world
view of Educadorian migrants.
Rockland County (NY) Department of Health; Germaine Jacquette, MD (retired); involved in planning agenda and
presenting selected sessions.
New York State Department of Health, Bureau of Tuberculosis Control; Margaret J. Oxtoby, MD, Director; planning and
presenting selected sessions.
Will this activity compete with any other meeting(s) that could affect attendance?
Yes
No
If yes, how will the competition not negatively affect this activity?
Estimated number of registrants 25
How were you able to come to this conclusion?
Based on the number of individuals who have expressed interest in the course content.
Has this activity been previously conducted?
Yes
No
If yes, but not as a UMDNJ activity, please attach copies of previous brochures/announcements/evaluation summaries
Has another sponsoring or certifying organization reviewed this activity?
Yes
No
If yes, please explain.
SPONSORSHIP TYPE
UMDNJ sole sponsored activity
Joint Sponsored with a non-accredited entity
Name of Organization
Other:
Co-Sponsorship with another accredited entity
UMDNJ as primary sponsor
Other accredited entity as primary sponsor
Name of Organization
CREDITS
Certification of AMA PRA Credit Hours
Category 1
Do you wish CCE to apply for other certification?
Yes, Indicate the type below
AOA (American Osteopathic Association)
AAFP (American Academy of Family Physicians)
ACOG (American College of Obstetricians & Gynecology)
Nursing
No
Pharmacy
Social Worker
General CEU’s
Other:
MARKETING
How will the activity be publicized to prospective participants?
Geographic Area of the target audience: Northeast region of U.S. (Maine, New Hampshire, Vermont, Massachusetts, Rhode
Island, Connecticut, New Jersey, New York City, New York, Philadelphia, Pennsylvania, Detroit, Michigan, Indiana, Ohio,
West Virginia, Delaware, Baltimore, Maryland, and Washington DC.)
Direct mail. List the mailing list source(s) (AMA, medical assoc./societies, etc)
Journal advertising. List the publication(s).
Other marketing methods; please specify (ex.: distribution of brochures by the grantor’s sales force).
Northeastern Regional Training and Medical Consultation Consortium Website, posting on the TB Education and Training
Network listserv, email announcement to TB programs within the Northeast region noted above.
PRINTED MATERIALS
What forms of printed materials will be developed to promote this activity?
Announcement card (“Save the date”)
Brochure
Invitation-type letter with program materials
Materials posted at specific locations (e.g. hospitals)
Other:
FUNCTIONS, FACILITY AND MATERIALS
Indicate the needs that are required for this activity.
Meal Functions
Not applicable (e.g. enduring material)
Luncheon
Boxed
Coffee break(s)
Buffet
Plated
Breakfast
Continental
Buffet
Plated
Dinner
Buffet
Plated
Mid-morning
Mid-afternoon
Reception
Other:
Facility Needs
Large conference room
Small board-type room
Reception area (food functions, registration, etc.)
Educational Materials
None
Syllabus, Handouts
Posters, Educational
Other
Workshop breakout rooms (Number of rooms
Exhibition area
Laboratory
)
SOURCES OF EXPECTED FINANCIAL SUPPORT
Check all that apply and complete that specific section.
Sources, if known
Registration Fees
Physicians
Residents/Fellows
Other Health Professionals
UMDNJ Faculty, Residents, Students, Staff
Other
School/Departmental Donation
Commercial Support (Grant)
Foundation Fund/Grant
Estimated
Amount
Name of company, foundation, or
organization, contact and phone number.
$375
List as many as applicable, use additional sheet if necessary.
$3167.50
NJDHSS TB Program (RTMCC Funds)
Thomas Privett, (609) 588-7522
Federal/State Agency Award
Exhibit Fees
Other:
BUDGET
Attach a budget summary indicating your anticipated income and expenditures.
See attached budget.
ACADEMIC ENDORSEMENTS
The Activity Director and/or Co-Director must have a UMDNJ appointment and is responsible for the content, quality and
scientific integrity of this activity. The Activity Director and/or Co-Director will develop this activity to conform with UMDNJ
policies and guidelines, the ACCME Essential Areas and the AMA Ethical Opinion on Gifts to Physicians.
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Requirements for Obtaining Sponsorship & Credit Designation for Jointly Sponsored Activities .................... # 50-20.req
Or
Requirements for Obtaining Sponsorship & Credit Designation for Solely Sponsored Activities ...................... # 50.35.req
Or
Requirements for Obtaining Sponsorship & Credit Designation for Solely or Jointly Sponsored Series .......... # 50.25.req
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Guidelines for Needs Assessment ..................................................................................................................... # 40-20.gdl
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Disclosure Requirements ............................................................................................................ # 50-05.req + # 50-10.req
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Requirements and Standards for Commercial Support of CE Programming .................................................... # 50-60.req
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Guidelines for Promotional Brochure Development ........................................................................................ # 40-40.gdl
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Activity Faculty Letter Template ......................................................................................................................... # 40-10.gdl
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UMDNJ Activity Director (Medical Liaison or Advisor) and Joint Sponsor, if applicable
The Activity Director and Joint Sponsor, if applicable, signatures imply that the above stated polices and guidelines
have been read, are understood, and will be adhered to.
Activity Director
Nisha Ahamed, MPH
Joint Sponsor
Signature
Date
Signature
Date
Department Chair – Academic Approval
Name (Please Print)
Jerrold J. Ellner, MD
Signature
Date
Center for Continuing and Outreach Education
Name (Please Print)
Signature
Date