Plan for a CME Activity Sponsored by The
University of Utah School of Medicine
Activity Name:
Date(s):
Department and/or Organization:
Sponsorship:
Direct
Joint with another organization
Name of Joint Providership:
Type of CME Activity: Live Activity:
Course or
Regularly Scheduled Series;
Enduring Material
Performance Improvement
Activity location:
Course Director:
Check if this has been held previously
Phone:
Course Coordinator:
Contact Person:
Phone:
Phone:
CME Office only: Event ID:
Email:
Email:
Email:
Fax:
Payment Chartfield (UofU departments)
Instructions:
This plan describes how this CME activity has been designed to comply with the ACCME’s expectations.
UUCME accepts only electronic forms, therefore no signatures are required. Upon final approval UUCME
will e-mail a copy to both the course director and course coordinator.
To select or deselect a check box, double click and change between check and uncheck..
1. THERE’S A PROBLEM. WHAT IS IT and WHY DOES IT EXIST?
a) What is/are the problem(s)/shortcomings we want to address? Problems can be in any area of
professional practice (for example, delivery of care, diagnosis, decision making, teaching, research,
administration, leadership, communication, other?). Is this a team-based problem? [ACCME C2]
b) What are the root causes?
Knowledge need - Don’t know information … (unaware or mistaken facts or data)?
Competence/Strategies need - Don’t know how … (incomplete or outmoded strategies)?
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Performance need - Don’t do… or should stop doing?
c) What do you want to change in terms of learners’ strategies, and/or performance and/or patient
outcomes? [ACCME C3]
This activity is designed to change:
Competence/strategies
Performance
Patient Outcomes
2. THE EDUCATIONAL PLAN
a) Instructional methods. [ACCME C5]
Lecture
Case vignettes
Panel discussion
Simulation
Small break out groups
Proctoring new
procedure skills
Other (please specify):
Why this educational format is appropriate for what you’re trying to accomplish.
b) Who is your target audience? Are there other members of the healthcare team that ought to take
part (i.e. other physician specialties, mid-level providers, social work, nursing, pharmacy, physical
therapy)? Are there other initiatives within UUHSC or elsewhere in the medical community
directed at the issue(s)? How can this activity bring value to the organization? (ACCME C20 & C21)
c) Desirable physician competencies/attributes which will be addressed: [ACCME C6]
ACGME/ABMS Competencies
Patient Care & Procedural skills
Medical Knowledge
Practice-based learning &
improvement
Interpersonal and Communications
skills
Professionalism
Systems-based Practice
Institute of Medicine Competencies
Provide patient-centered care
Work in interdisciplinary teams
Employ evidence-based practice
Apply quality improvement
Interprofessional Education Collaborative
Competencies
Values/Ethics for Interprofessional Practice
Roles/Responsibilities
Interprofessional Communications
Teams & Teamwork
Utilize informatics
d) For courses, please attach a copy of the proposed program with topic and presenter names.
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e) Optional: Learning Objectives are not required for CME certification, but may be required if you are
simultaneously seeking certification for other professions.
3. EVALUATION: IS THE PROBLEM SOLVED?
a) We will determine how effective we’ve been in producing change by measuring: ACCME C11
Level 1: Participation – attendance records
Level 2: Satisfaction - Questionnaires completed by attendees after a CME activity
Level 3A: Learning: Knowledge or Facts; Pre- and Posttests of knowledge of facts, data and/or information
Level 3B: Learning: Knowledge of how to do; Pre- and Posttests of strategies for applying information
Level 4: Learning: Competence; Observation in educational setting; commitment to change
Level 5: Performance – Observation of performance in a patient care setting; patient charts
Level 6: Patient health – Health status measures recorded in patient charts or administrative databases
Level 7: Community health – Epidemiological data and reports
b) Commitments to change: List up to 5 specific changes you want to see the learners incorporate.
This is only about making changes from their current practice. In several months attendees will be
queried about their own progress at implementing these changes. You should word these desired
changes so they are specific, measurable, achievable, relevant and time-bound.
Specific changes that you want learners to
incorporate into their practice.
1.
2.
3.
What type of change does this represent?
(Please double click on the box)
Clinician-Patient Communication/Customer Service
Diagnosis
Documentation (appropriate)
Patient Education
Quality Improvement
Patient Safety
Treatment approach
Medication
Research
Clinician-Patient Communication/Customer Service
Diagnosis
Documentation (appropriate)
Patient Education
Quality Improvement
Patient Safety
Treatment approach
Medication
Research
Clinician-Patient Communication/Customer Service
Diagnosis
Documentation (appropriate)
Patient Education
Quality Improvement
Patient Safety
Treatment approach
Medication
Research
4/4/14
4.
Clinician-Patient Communication/Customer Service
Diagnosis
Documentation (appropriate)
Patient Education
Quality Improvement
Patient Safety
Treatment approach
Medication
Research
Clinician-Patient Communication/Customer Service
Diagnosis
Documentation (appropriate)
Patient Education
Quality Improvement
Patient Safety
Treatment approach
Medication
Research
5.
c) Absence of undue commercial influence: Please include the following in your evaluation.
Do you feel a commercial product, device, or service was inappropriately promoted in the
educational content?
No
Yes; if yes, please comment: ________________________________
Improvement Consider the following:
Here are some suggestions for improving this conference so future activities will be more effective::
d) Will there be any other evaluation questions?
4. ENGAGEMENT WITH THE ENVIRONMENT
a) Can you provide tools beyond the formal instruction that will enhance change or facilitate
attendees to make changes in their professional practice? Examples include: patient educational
materials, email reminders, flow sheets, discussion groups, Facebook page, Twitter or URLs useful to
physicians and/or patients. [ACCME C17]
No, we do not intend to use any non-educational strategies.
Yes, we will use these non-educational strategies:
Non-educational strategies
b) What are system or population barriers that can impede implementation, for example: teamwork,
handoffs, patient travel distances, insurance, patient fear of pain or treatment, formulary restrictions,
insufficient organizational resources, technology not available or inadequate, institution doesn’t support
educational efforts, policy issues within institutions, lack of evidence-based guidelines, lack of
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applicability of guidelines to current practice/patients, patient adherence/compliance, and treatment
related adverse events, language barriers, literacy, culture, fear, misinformation, etc.. [ACCME C18]
No, there are no relevant barriers identified.
Yes, this barrier(s) exists:
System and Population Barrier(s)
c) What countermeasures have been planned to address barriers to physician change, for example
barriers could include: lack of or inadequate physician reimbursement, formulary restrictions,
competing demands on physician time, lack of technical skills, lack of consensus on professional
guidelines, lack of time to assess/counsel patients, resistance to change or inertia, and professional
interpersonal communication, etc. [ACCME C19]
No, there are no relevant barriers identified.
Yes, these barriers will be addressed:
Barrier(s) to physician change
Countermeasures for addressing barrier(s )
e) Can this education address patient safety and quality, a decrease in unnecessary expenses, more
appropriate prescribing, and implementation of best practices or a reduction in medical errors? [ACCME
C21]
No, by its nature, the curriculum does not lend itself to addressing performance improvement.
Yes, these aspects of performance improvement will be addressed:
Aspect of performance improvement
Patient safety and quality
Decrease in unnecessary expenses
More appropriate prescribing
Implementation of best practices
Reduction in medical errors
Other (please specify):
5. COMMERCIAL RELATIONSHIPS, BUDGET and FINANCE
a) Screen planners for potential conflicts of interest that need to be resolved before they can proceed:
Do ANY of these personal relationships with a financially-interested company (that is, a company with health care
products or services directly related to the topic under discussion) apply to you or spouse/partner?
1. Do you expect to receive anything of value in any form during the current or previous calendar year from a
financially-interested company? [Honoraria provided by industry for other presentations and contracted research
(even when the check from industry went to the academic institution) are considered commercial support. However,
501 – not for profits, organizations that provide clinical service directly to patients, and governmental agencies and
their subsidiary facilities, and the NIH are not considered commercial supporters.]
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2. Do you have any royalty, stock, or financial interests of any other types involving a financially-interested company,
excluding any mutual fund stocks and/or blind trusts which you might hold?
3. Do you serve as an officer or any other position in any financially-interested company?
Planners: List the name and response of each planner to the above questions:
Name
Response to Conflict of Interest questions
b) Submit disclosure form for all Planners, Speakers, Moderators, and anyone else in control of content:
http://medicine.utah.edu/cme/forms/docs/Speaker%20Planner%20.pdf
c) Budget: Prepare a proposed budget, with an individualized listing for each item equal to or greater than
20% of the budget. All financial transactions including honorarium and financial support from industry
must conform to University of Utah School of Medicine Office of CME policy, which is in accordance
with ACCME Updated Standards for Commercial Support and AMA ethical guidelines.
The University of Utah School of Medicine Continuing Medical Education is not liable for expenses or
losses associated with activities seeking CME certification. No state funds may be used to cover a
financial loss for this activity.
Projected Revenues
Registration Fees/Tuition
$
Department Support
$
Other Support (specify)
$
Commercial Support Grants List Companies and amount
requested
$
$
$
$
$
$
Exhibitors - List Companies
and exhibitor fee
Projected Expenses
Speaker Honoraria
Travel
Food/Catering
$
$
$
Meeting Room Rental
$
A/V Charges
Brochure Printing
Syllabus Printing
Postage
Fax, phone, etc
Faculty Dinner
CME Fees
Estimate of Attendance: MD/DO
$
$
$
$
$
$
$
$
$
Other
1.
CME activities aimed primarily at an internal
School of Medicine audience are free of charge.
2.
Live activities (e.g. courses, regularly scheduled
series, webinars, learning from teaching)

Directly sponsored (UofU only): $1000 +
$100 per CME credit; OR small group flat
rate of $100 per attendee (physician or
non-physician)

Jointly provided (UofU plus some other
organization): $1000 + $100 per CME
credit + $2500 jointly provided fee; OR
small group flat rate of $150 per attendee
(physician or non-physician)
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Projected Revenues


3.
Projected Expenses
Multiple presentations of same material:
initial fee plus one-half of the initial fee for
each subsequent activity
Depending on location, there may be an
on-site supervision fee plus travel
Enduring materials (e.g. printed material,
CD/DVD, web archive)

Directly sponsored (UofU only): $1000 +
$35 per registrant for CME credit

Jointly provided (UofU plus some other
organization): $3500 + $35 per registrant
for CME credit
CME Accreditation Fee:
CME Onsite Fee: Staff travel, lodging, per diem (if
applicable):
Onsite Fee Explanatory Note:
-Salt Lake City Metro/Campus Courses: CME
Staff Onsite Monitor – No Charge
-Utah: Park City/Snowbird/Other Locations
outside Salt Lake City Metro Courses: CME
Staff Onsite Monitor: $200 + mileage, lodging
and per diem (if applicable)
-Out of State CME Staff Onsite Monitor fee
$300 per day (out of CME office) + travel +
lodging + per diem; UUCME will attempt to
contract with local CME provider to provide
onsite observation
$
$
$
Total Revenue:
$
Additional Expense (Specify)
Additional Expense (Specify)
Additional Expense (Specify)
Total Expenses:
$
$
$
$
Detail any source that represents greater than 20% of the total revenue or the total expense.
Note: The expectation is that a finalized revenue/expense spreadsheet
http://medicine.utah.edu/cme/forms/financial_summary.xls will be submitted by e-mail to UUCME no later
than 30 days following completion of the CME activity.
d) The Letter of Agreement for Conducting a Continuing Medical Education Event
http://medicine.utah.edu/cme/forms/loa_for_conducting_a_cme_activity_2012.pdf will be sent to you
with a draft copy of the planning application for your review and edit. A signature is not required.
By checking here, I attest that I have provided my Supervisor/Department Chair with a copy of this
CME plan and s/he is in agreement. Signatures are not required—only the name of the Course
Director and approving Supervisor/Department Chair.
4/4/14
_______________________________
Date
Course Director
_______________________________
Date
Supervisor/Department Chair
SUBMIT THIS COMPLETED PLAN TO UUCME VIA E-MAIL. We’ve gone ‘green’ and do not accept paper
format.
APPROVAL PROCEDURE: Only fully completed plans will be considered and incomplete plans will be returned to
the course director. Please allow 5 working days for processing by the University of Utah Office of CME. Upon its
approval, you will be notified by e-mail. The final galley proof of brochures and/or written announcements must be
approved by the University of Utah Office of CME prior to printing.
Approved by The University of Utah School of Medicine Office of CME
____________________________________
Date
Approved for __________ AMA PRA Category 1 Credit(s)™
4/4/14