Select a track
Amount of time requested – 60 minutes, 75 minutes, 2 hours
Intended learners
Session description
Expected value to meeting attendees
Course director(s) name(s); years of experience
Disclosures
Expected learning outcomes
Description of the professional practice gap (e.g. change in competence, change in performance and/or change in patient outcomes)*
Describe the current state; describe the desired state; describe the identified gap (overall purpose of the activity):
Choose educational need(s) that underlies the professional practice gap (e.g. knowledge, skills and/or practice)
· Gap in Competence (knows)
· Gap in Performance (knows how)
· Gap in Patient Outcomes
· Other - describe
Desired learning outcome(s): What will the outcome be as a result of participation in this activity? (describe in terms of reflecting changes in competence, performance and/or patient outcomes). *
Competence (ability to apply knowledge): What new/additional strategies do you want the audience to be able to put into action?
Performance (what a practitioner actually does): How do you want to modify the learner’s practice?
Improved Patient Outcomes: What improvements in patient outcomes will be the result?
Describe any barriers that may prevent the learners from achieving the expected change in Competence, Performance, and/or Patient Outcomes described above.*
In reference to data, please provide a brief summary of data gathered that validates the need for this activity.
Evidence to validate the professional practice gap *(check all methods/types of data that apply)
Scientific evidence from the literature
Opinion from clinical or scientific experts
Information from the general public, the media and/or other environmental sources
Observed performance
Data from local or national databases
Surveys from past participants or prospective learners
QI data
Other
Educational format *Select all that apply
Didactic (lecture/presentations)
Case Study/Simulation
Audience Response (polling questions)
Audience discussion
Panel Discussion/Debate
Question and Answer
Small Group (Breakouts)
Other: please describe below
Why is this format appropriate?*Select all that apply
Didactic (lecture/presentations): Provide large amounts of information in a limited amount of time. Allows faculty to talk about chosen topic.
Case Study/Simulation: Provides an actual problem or situation an individual or group has experienced. An effective method of provoking controversy and debate on issues for which definite conclusions do not exist.
Audience Response (polling questions): Provides a simultaneous large audience respond to faculty questions allowing faculty to chose from each response category to discuss the topic.
Panel Discussion/Debate: Provide an opportunity for experts or a group of learners to present differing viewpoints on a topic, issue, or problem to other panelists and the audience.
Question and Answer: Provides an opportunity for faculty to answer specific participant questions and apply ways to implement it in their practice.
Small Group (Breakouts): Provides and a less formal setting for peer interaction, discussion and problem-solving.
AGME/ABMS Competencies *Choose all that apply
Patient Care
Procedural Skills
Medical Knowledge
Practice-based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
N/A
Institute of Medicine Competencies*Choose all that apply
Provide Patient-centered Care
Work in Interdisciplinary Teams
Employ Evidence-based Practice
Apply Quality Improvement
N/A
Interprofessional Education*Choose all that apply
Values/Ethics for Interprofessional Practice
Roles/Responsibilities
Interprofessional Communication
Teams and Teamwork
N/A
Scholarly, medical or scientific references
Is this novel content that has never been presented before?*
21. Learner Engagement
Course Director Disclosures