1. Example
Slides 1 and 2  should have all fields completed.  The remaining slides are intended only  as guidance.  See written Executive Summary Guidance for more details
Outcome Report (label as Interim or Final) Program Title BMS grant # Educational Provider and Collaborator(s) Primary contact name & Date Submitted (data as of DATE)

2. Program Title & BMS Grant #
Outcome Report-Summary Slide (this slide must have all fields completed)
Program Title & BMS Grant #
ACTIVITY SUMMARY
PARTICIPATION
XXXX (n) 
Total Actual Unique Learners
Provider and Educational Partner(s)
Start and End Date(s) for each modality
Live (if applicable)
Enduring material(s) (if applicable)
Links: 
Total Cost of Activity (if multi-supported): $
BMS Support: $
BMS Cost per Learner: $xxxxx/xxxxx
TOTAL Learners
MDs/DO
NP/PA
PharmD
Other
XXXX
% (n)
Total Learners as of DATE
Breakdown of Physician Learners (if available)
TOTAL Physician Learners
Specialists
Subspecialists
PCP
XXXX
% (n)
EDUCATIONAL GAINS (aligned with learning objectives)
REMAINING  PRACTICE GAPS AND EDUCATIONAL NEEDS
(e.g., from responses to evaluation questions, cases, etc.,)
XX% (n)
Overall increase in knowledge, competence, confidence & performance (pre-post activity)
Gain #1
Gap # 1
Description / justification 5%
Gain # 2 6% 8%
Gap # 2
Description / justification 8%
43%
XXXXX
# of patients impacted
Gain # 3
18%
22%
Gap # 3
Description / justification
18%

3. Executive Summary Slides
BMS- Example of an Outcome Report

4. Gaps and Learning Objectives
Educational Purpose:
briefly describe the professional practice gap(s) the activity was intended to fill.
Learning objectives: 1. 2. 3. 4.
Target Audience(s):
BMS- Example of an Outcome Report

5. Educational Activity Details
Live Activity (if applicable):
Date(s):
Location(s):
Number and types of credits offered:
Enduring Activities (if applicable):
Type(s): e.g., webcast, podcast, print, etc.
Links for each modality:
Maximum number and type of credits offered for each modality:
Dates Posted and Expiration for each modality:

6. Faculty Name Affiliation(s) Name Affiliation(s) Name Name

7. BMS- Example of an Outcome Report
Outcomes Summary
Demographics and Participation
Educational Impact
Planned practice changes and barriers to change
Key practice gaps remaining
Testimonials from participants
BMS- Example of an Outcome Report

8. Demographics and Participation
Total Actual Unique Learners
XXXX (n)
TOTAL Learners
MDs/DO
NP/PA
PharmD
Other
XXXX
% (n)
Total Learners as of DATE
Breakdown of Physician Learners (if available)
TOTAL Physician Learners
Specialists
Subspecialists
PCP
XXXX
% (n)
BMS- Example of an Outcome Report

9. Knowledge, Confidence, Competence and Performance Outcomes (pre-post activity)

10. Educational Impact: HCPs & Patients
HCP Educational Impact
XX% Overall increase in knowledge, competence, confidence & performance(pre-post activity)
XX% gain in Knowledge
XX% gain in Competence
XX% gain in Confidence
XX% improvement in
performance
Describe the key highlights of the educational impact and overall increase in knowledge, competence, confidence and performance.
Patient Impact
Potential number of patients with [disease or condition covered in the activity] seen per week by participants, who are more likely to receive evidence-based care than those seen by non-participants.
XXXXX
# of patients impacted

11. There was a XX% increase in knowledge regarding xxxx
State the Knowledge question(s) showing gains pre-post activity
Repeat slide with questions showing gains in Confidence, Competence and Performance
There was a XX% increase in knowledge regarding xxxx
P=.001

12. Learners’ Planned Changes to Practice & Barriers (post-activity)
xxxxx (n)
xxxxx (n)
xxxxx (n)
xxxxx (n)
Describe the Barriers to Change

13. Learners’ Remaining Practice Gaps
Description
Justification
Gap #1
Gap #2
Gap #3

14. Testimonials and Comments from Participants (categorize them and list below)1. 2. 3. 4. 5.

15. Participant Satisfaction

16. Participant Satisfaction (overall % ratings from good to excellent)
Overall quality of education
Overall effective format
Faculty were knowledgeable
N=xxx
N=xxx
N=xxx
N=xxx
N=xxx
N=xxx