1. Setting the Foundation of your CPD Accreditation Program
Robin Kinch
November 2018

2. Conflict of Interest Disclosure
Robin Kinch
I am a full-time employee of the Royal College of Physicians and Surgeons of Canada
I have no relationships with commercial interests to disclose

3. Learning objectives
At the end of this session, participants will be able to:
Explain the criteria used to identify a physician organization;
Discuss the minimum activity accreditation standards that must be met for accreditation; and,
Identify at least one area for improvement in their current review process.
This workshop has been developed to meet the following objectives:
Participants will be able to explain the criteria used to identify a physician organization
Participants will be able to discuss the minimum standards that must be met for accreditation
Participants will be able to identify at least one area for improvement in their current review process

4. Introductions: Meet the RC CPD Accreditation Team!
Julie Lavigne
Manager
CPD Accreditation
Robin Kinch
Program Coordinator
Kate Runacres
Program Coordinator
Chanelle Goulet
Administrative Coordinator
Vacant
Program Coordinator
Provider Accreditation
Provider Support
National Standard
International Accreditation
NORs
Self-Approval

6. The CPD Accreditation System
We are All in This Together

7. Royal College Accredited CPD Providers
Community of providers (your colleagues):
29 National Specialty Societies
3 Limited Accredited Providers
16 Canadian University Offices of Continuing Medical Education
16 Accredited Canadian Simulation Programs
3 Accredited International Simulation Programs
The community of accredited CPD providers is comprised of national specialty societies, university offices of CME, accredited simulation programs, and other national and provincial organizations…

8. Maintenance of Certification Requirements
MOC Program cycles are 5 years in length
A minimum of 40 credits are required for each year
A minimum of 400 credits are required to complete the 5-year cycle
A minimum of 25 credits are required per section per cycle

9. CPD Activities: Section 1 – Group Learning
Accredited Section 1 Activities
Conferences, courses, seminars, workshops
Web-based group learning
Self-Approval
Hospital rounds, tumor boards, M&M rounds, journal clubs, and
small group learning

10. Comparison of Educational Standards
Under the Educational Standards there is a difference between the standards for group learning activities and assessment activities.
Section 1
Section 3
Educational Standard: Addressing Needs
Educational Standard: Learning Objectives
Educational Standard: Educational Format
Educational Standard: Assessment Format
Educational Standard: Interactivity
Educational Standard: Process to record answers (SAPs only)
Educational Standard: Feedback (SAPs and SIMs)
Educational Standard: Evaluation
Under Part 2: Educational Standards there is a difference between the standards for group learning activities and assessment activities.
Group learning activities have an interactivity requirement whereas the assessment activities have an assessment/feedback requirement.
We will explore these a little more as we go along.

11. Web-Based Activities

12. Section 1 Web-Based Group Learning Activities
Web-based programs must:
Provide an opportunity for interaction between participants and faculty;
Allow participants to log on to the interactive component to claim credit under Section 1;
provide evaluation feedback; and
Track participant attendance and provide certificate after the participants have logged onto interactive component;

13. Assessment Activities

14. CPD Activities: Section 3 - Assessment
Accredited Section 3 Activities
Self-Assessment Programs
Simulation Programs

15. Assessment Activities: What are They?
Assessment activities must describe the methods that enable participants to demonstrate or apply knowledge, skills, clinical judgment or attitudes.
Assessment activities can be developed as self-assessment programs or simulation programs
This standard is applicable to Section 3 activities.
It states that self-assessment programs must describe the methods that enable participants to demonstrate or apply knowledge, skills, clinical judgment or attitudes.
Self-assessment programs must provide participants with a strategy to assess their knowledge, skills, clinical judgment and attitudes in comparison to an established scientific evidence base (clinical practice guidelines, meta-analysis or systematic review, etc).
All self-assessment programs must use methods that enable participants to demonstrate these abilities across the key areas of the subject area, topic or problem(s). The selected format must also enable participants to review their current knowledge or skills in relation to current scientific evidence.
Applies to Section 3

16. All Assessment-Based Activities Must
be developed or co-developed by a physician;
be planned to address the identified needs of the target audience with a specific subject area, topic or problem;
include learning objectives that address the identified needs of the target audience;
provide detailed feedback to participants on their performance and knowledge; and,
provide participants with an opportunity to evaluate the accredited program.

17. Assessment: SAPs vs SIMs
SAPs are knowledge assessments that determine how participants apply their knowledge and identify any educational gaps.
SIMs are scenarios that mimic the doctor’s practice environment, where they are observed directly and are debriefed by observers.

18. Self-Assessment Programs Must
provide participants with a strategy to assess their knowledge, skills, clinical judgment and attitudes in comparison to an established scientific evidence base; and
identify which questions were answered correctly/incorrectly
provide learners with references for correct answers

19. Simulation Activities Must
provide a strategy to assess their knowledge, skills, and attitudes in comparison to established evidence (scientific or tacit);
provide a description of the scenario, an assessment tool and a copy of the feedback form (if written).
assess the appropriateness or relevance of the scenario (whether there was sufficient instruction time; practice time, etc.);
allow participants to assess whether the feedback received was related to their performance in relation to the desired competencies, skills and/or attitudes;

20. What if you Could Not Participate in the Simulation?
Observers of accredited simulation activities in a group learning setting can record their time in Section 1: accredited group learning.

21. How Long and How Many Credits?
Section 1 Accreditation = up to 1 year accreditation period
(1 credit per hour)
Section 3 Accreditation = up to 3 years accreditation period
(3 credits per hour)

22. How to Accredit A CPD Program

23. CPD Activity Accreditation
In order for an activity to be accredited for the MOC program it must:
be developed (or co-developed) by a physician organization;
be reviewed by an accredited CPD Provider.
meet the activity accreditation standards; and
The role as an accredited CPD provider is to review activities using the Royal College standards.
In order for an activity to be accredited for the MOC program, it must be developed (or co-developed) by a physician organization and reviewed by an accredited CPD Provider.
Each accredited group learning activity must meet the standards for accredited group learning activities to be eligible for MOC Section 1 credits. These activities include conferences, courses, and workshops. This, however, does not include rounds, journal clubs, or small group learning activities, as these can be accredited under the “self-approval process” through the Royal College CPD Unit.
Assessment activities must meet the standards for accredited assessment activities in order to recorded under Section 3 of the MOC Program. This includes accredited self-assessment programs and simulation-based activities.
Applies to both Section 1 and Section 3

24. Criteria for Physician Organizations
All accredited CPD activities must be developed or co-developed by a physician organization as defined by the Royal College.
A physician organization is defined as a not-for-profit group of health professionals with a formal governance structure, accountable to and serving, among others, its specialist physician members through:
* Continuing professional development;
* Provision of health care; and/or
* Research
All accredited CPD activities must be developed or co-developed by a physician organization as defined by the Royal College.
A not-for-profit group of health professionals with a formal governance structure, accountable to and serving, among others, its specialist physician members through:
* Continuing professional development;
* Provision of health care; and/or
* Research
Organizations that meet the Royal College definition of a physician organization can apply directly to an accredited CPD provider for accreditation.
Determining if an applicant organization meets the definition of a physician organization is an important accreditation standard, but it can also be a little tricky at times. Don’t be afraid to reach out to us if you ever need help determining if an organization meets the definition.
Applies to both Section 1 and Section 3

25. Physician and Non-Physician Organizations
Examples of physician organizations:
Examples of non-physician organizations:
Departments within faculties of medicine
Hospital departments or divisions
Medical societies/associations/academies
Physician research organizations
Health authorities not linked to government agencies
Canadian provincial medical regulatory authorities (MRAs)
Disease-oriented patient advocacy organizations (Heart and Stroke Foundation)
Government departments or agencies (Health Canada)
Industry (pharmaceutical, medical device companies)
Medical education or communications
'For-profit' on-line educators, publishing companies or simulation companies
Small number of physicians working together to develop educational programming

26. The Physician Organization is Responsible for…
receiving any financial and in-kind support.
approving all decisions to ensure that the accreditation standards the CPD activity are met.
paying expenses at an accredited activity.
providing attendees with certificates of participation.
maintaining attendance records for a five-year period.
submitting an application to an accredited CPD provider.
developing the CPD activity against established accreditation standards.

27. Benefits for Physician Organizations
Allowed to submit a completed program to an accredited CPD provider
The content does not need to be reviewed by an accredited CPD provider as the physician organization is responsible for ensuring that the content is free of commercial bias and meets the accreditation standards.

28. What about Non-Physician Organizations?
Non-physician organizations must enter into a co-development relationship with a physician organization

29. What is co-development?
Co-development is the process by which two or more organizations — at least one of which must be a physician organization — prospectively collaborate to develop and implement an accredited educational activity, learning resource or tool.
However, physician organizations may also co-develop activities with others — including other physician organizations, non-physician organizations, or an accredited CPD provider.
Applies to both Section 1 and Section 3

30. In a Co-Development Relationship the Physician Organization Must….
assume control over all aspects of the planning process as if they were planning the event independently.
be involved in planning all aspects of the CPD activity with the non- physician organization from the beginning of the planning process.
be represented on the scientific planning committee.
Recognize the co-development of the CPD activity with a co-development statement along with the accreditation statement on all program materials
For a program to be co-developed the physician organization must assign a rep to sit on the planning committee from the very start of development to ensure that the accreditation and ethical standards are complied with.
Applies to both Section 1 and Section 3

31. Required Accreditation Documentation
Needs assessment summary
Conflict of interest disclosure template
Activity budget
Activity evaluation form
Program/agenda/promotional brochures
Written agreement between physician organization and sponsors.
Minutes or notes from the planning committee
Access to online modules (Section 1 and 3)
Assessment sheet (Section 3 SAP)
Feedback template (Section 3 SIM)

32. When Receiving an Application, Ask Yourself…
Was the program developed by a physician organization?
Was the application signed by the Chair of the scientific planning committee?
Is this a co-developed program?
Is all of the required documentation included?

34. Accreditation Standards
Now that you’ve conducted your initial review for completeness, let’s move onto the specific standards.

35. CPD Planning Process Circle
Convene a scientific planning committee based on the target audience
Gather and review needs assessment information
Create learning objectives based on needs assessment
Choose the best educational format
Recruit faculty
Develop an evaluation strategy
EVENT OCCURS
Issue certificates to leaners
Review the evaluation s
When you review an application, you can see how the CPD planning circle echoes the structure of the accreditation application

36. Scientific Planning Committee Requirements
All accredited CPD activities must have a scientific planning committee that is representative of the target audience.
The physician organization is represented on the SPC
Industry is not involved in any decisions related to program content
Applies to both Section 1 and Section 3

37. Needs Assessment

38. Needs Assessment
Needs assessments are a means of identifying perceived and unperceived needs of the target audience by collecting data and other information from a number of sources.
Applies to both Section 1 and Section 3

39. Needs Assessments Must…
be planned to address the identified needs of the target audience.
identify either perceived or unperceived needs that address areas of knowledge, skills, and/or performance.
describe the approach used to identify the educational needs of their target audience.
Applies to both Section 1 and Section 3
A needs assessment of the target audience must be performed to identify areas of knowledge, skills, and/or performance that the CPD activity intends to address or improve.
The needs assessments can identify either perceived or unperceived needs and should be used to inform:
the development of learning objectives
the identification of appropriate learning format
the selection of relevant educational content
the development of evaluation strategies.

40. Perceived or Unperceived Needs
perceived needs assessments:
personal requests
Observations
questionnaires/surveys
focus groups
evaluation data
objective data (e.g. practice information, literature surveys, clinical practice guidelines and experience).
unperceived needs assessments:
Assessment of physician performance from hospitals
provincial or national databases
self-assessment programs
chart reviews
360 degree assessments
case scenarios
practice audits and/or quality improvement activities
CMPA data
Implementation of clinical practice guidelines-data
Performance and competency data
Applies to both Section 1 and Section 3

41. When Reviewing an Application, Ask Yourself…
Does the planning committee represent the target audience?
Was the needs assessment conducted for the identified target audience?
What gaps in knowledge or in performance were identified in the needs assessment?
Do the results of the needs assessment inform the development of the learning objectives?
What does the needs assessment tell you about the best learning format?
When you are reviewing the application, have a look at the primary target audience – does the planning committee represent the target audience?

42. Learning Objectives

43. Learning Objectives
Allow participants in a learning activity to understand what information or skills they will acquire during the session or event.
For this standard, Learning objectives must clearly describe the intent of the educational activity, be written from the perspective of the learner, and express the expected outcomes determined by the planners and faculty.
Learning objectives must be created for the overall CPD activity and each individual session.
The learning objectives must be printed on the program, brochure and/or handout materials
The identified learning needs of the target audience should be utilized in the creation/development of the learning objectives.
It I all about showing the traceability between the identified needs and the learning objectives
Supporting documentation can include the program and the needs assessment summary
Applies to both Section 1 and Section 3

44. Learning Objectives Must…
clearly describe the intent of the educational activity;
be written from the perspective of the learner; and,
express the expected outcomes determined by SPC and faculty.
start with the sentence:
At the end of this session, participants will be able to:
For this standard, Learning objectives must clearly describe the intent of the educational activity, be written from the perspective of the learner, and express the expected outcomes determined by the planners and faculty.
Learning objectives must be created for the overall CPD activity and each individual session.
The learning objectives must be printed on the program, brochure and/or handout materials
The identified learning needs of the target audience should be utilized in the creation/development of the learning objectives.
It I all about showing the traceability between the identified needs and the learning objectives
Supporting documentation can include the program and the needs assessment summary
Applies to both Section 1 and Section 3

45. Learning Objectives Must Also Be…
created for the overall CPD activity and each individual session;
printed on the program, brochure and/or handout materials;
made available to participants prior to the activity; and,
incorporated into the evaluation strategy.
Applies to both Section 1 and Section 3

46. When Reviewing an Application, Ask Yourself…
Is there a defined link between the needs assessment and the learning objectives?
Have learning objectives been developed for both the overall activity AND the individual sessions?
Are the learning objectives written from the perspective of the learner by including action verbs describing what the participant will be able to do or the action they will be able to undertake?
Have the objectives been communicated to participants in advance?

47. Learning Formats

48. Learning Formats
To facilitate adult learning, a variety of educational methods that address the learning needs and objectives that you have identified should be used.
No matter which methodologies are used in content delivery, incorporating interactivity is essential.
Applies to both Section 1 and Section 3

49. Learning Formats Must…
link to identified perceived and /or unperceived educational needs to established learning objectives; and,
address CanMEDS Framework beyond the medical expert role.
Applies to both Section 1 and Section 3

50. Examples of Learning Formats
plenary sessions
small-group sessions
round tables
workshops
break-out sessions
debates
online programs (with interaction between participants and faculty)
Applies to Section 1

51. When Reviewing an Application, Ask Yourself…
What does the needs assessment tell you about the best learning format?
Is there traceability between the learning objectives and the chosen educational format?
Is there traceability between the needs assessment and the selection of topics and/or speakers?
Applies to both Section 1 and Section 3

52. Interactivity

53. Interactivity
At least 25% of the total education time must be allocated for interactive learning.
Interactive learning helps participants to understand, translate and apply content to their specific practice contexts.
This standard is applicable only to section 1 activities
It states that at least 25 per cent of the total education time must be allocated for interactive learning
Interactive learning can be promoted through question and answer periods, case discussions, skills training, etc.,
Interaction builds a relationship between (and among) participants and the faculty, contributes to a supportive learning atmosphere and enables speakers to determine the degree to which participants understand the content.
Applies to Section 1 only

54. Interactivity Examples of Interactivity: Q&A periods
Case discussions/debates
Skills training/simulation
Small group discussion/group work
Think/pair/share

55. Section 1 Web-Base Group Learning Interactivity
The following are some acceptable options to incorporate interactivity for accredited web-based group learning activities:
discussion forums and chat groups
teleconferencing and videoconferencing
Twitter and

56. When Reviewing the Program Ask Yourself:
Is there a minimum of 25% interactivity?
Do the selected learning formats allow for interactive learning?
Are the opportunities for interaction communicated in the program?
If web-based, is there a means to allow participants to log on to the interactive component?
INCLUDE FOR WEB AND LIVE

57. Evaluation

58. Evaluation
Evaluations provide feedback about whether the target audience’s needs were addressed, learning objectives were met and participants were engaged.
A good evaluation strategy is extremely useful for planning and improving future events or sessions.
Evaluations also promote participant reflection by gearing questions toward what participants learned and changes they are planning to make in their practice.
Participants must be provided with an opportunity to evaluate individual activities and the overall series of activities. The evaluation system must:
allow participants to identify whether the learning objectives were achieved
provide opportunities for participants to identify the potential impact for their practice.
ask participants to identify whether the content was balanced and free of commercial or other inappropriate bias.
provide opportunities for participants to identify the potential impact of the CPD activity for their practice.
Supporting documentation could include a copy of the evaluation form or tool
Applies to Section 1 and Section 3

59. The Evaluation Strategy Must:
Allow participants to identify whether the learning objectives were met;
Provide opportunities for participants to identify the potential impact for their practice;
Allow participants to identify CanMEDS professional competencies;
Ask participants to identify whether the content was balanced and free of commercial
Allow participants to suggest any topics that they would like to learn about
Applies to Section 1 and 3

60. Evaluation Strategies May Also Include:
an intent to measure improved patient performance;
an intent to measure improved health care outcomes; and,
an option for participants to receive feedback related to their learning.
No matter which methodologies are used in content delivery, incorporating interactivity is essential.
Applies to Section 1 and 3

61. Certificate of Attendance

62. Certificate of Attendance
The certificate of attendance must include the following elements:
The title of the activity;
The date(s) the activity took place;
The location of the activity (i.e. city, country, web-based);
The total number of hours for which the activity is accredited;
All applicable accreditation statements (include co-development statement when necessary); and,
All accredited CPD providers must maintain attendance records for a minimum of 5 years.
This standard states that the physician organization must maintain records of attendance for a 5 year period and provide confirmation of attendance to participants which includes the appropriate accreditation statement.
Here are specific elements that must be included on the certificate…(activity title, name of physician organization, activity date, location, # of hours for which activity is accredited, all applicable accreditation statements)
We have sample accreditation statements on our website for your reference. Please make sure that you are always using the most up-to-date version of the accreditation statements.
Applies to both Section 1 and Section 3

63. Accreditation Statements
Accreditation statements should be placed on all promotional materials once accreditation approval has been received
Statements indicating that an activity is “pending approval” are strictly prohibited.
Applies to both Section 1 and Section 3

64. When Reviewing the Application Ask Yourself…
Are participants provided with an opportunity to evaluate both session specific and overall learning objectives?
Are participants provided with an opportunity to provide details if they did detect an inappropriate bias?
Are all of the required elements present on the certificate of attendance?
JULIE

65. The activity is accredited.
JULIE

66. Accredited CPD Provider Post-review Responsibilities
After the accredited educational program takes place:
provide the appropriate accreditation statement(s) to the applicant.
notify the Royal College of the approval using the “Notice of Review (NOR)” form.
ask for a list of attendees (for distribution of certificates of attendance and for credit validation purposes).
ask for a summary of the evaluation for the activity
JULIE

67. Ethical Standards

68. Content Development
The physician organization(s) must have control over the topics, content and speakers selected for this activity.
The physician organization(s) must assume responsibility for ensuring the scientific validity, objectivity and balance of the content of the activity.
Participants or sponsors can suggest faculty or topics; however, they cannot direct the selection process and the final decision must reside with the physician organization.
The process by which the topics, content and speaker(s) are selected for an educational activity must be in the control of the physician organization and planning committee at all times.
Participants or sponsors can suggest faculty or topics; however, they cannot direct the selection process. The final decision must reside with the physician organization.
All faculty, speakers, and planning committee members must complete Conflict of Interest Declaration forms irrespective of whether a direct conflict exists. Forms must be submitted to the planning committee prior to the start of the activity. 
All conflicts must be disclosed to participants either verbally, displayed in writing on a slide at the beginning of a presentation or included in the written activity materials.
The planning committee must have policies and procedures in place to manage identified conflicts of interest once they are disclosed.

69. Conflict of Interest (COI)
COI declarations must be received from everyone who influenced content (e.g., all faculty, planning committee, moderators, authors and/or co-authors) irrespective of whether a direct conflict exists.
All faculty, speakers, and planning committee members must complete Conflict of Interest Declaration forms irrespective of whether a direct conflict exists. Forms must be submitted to the planning committee prior to the start of the activity. 
All conflicts must be disclosed to participants either verbally, displayed in writing on a slide at the beginning of a presentation or included in the written activity materials.
The planning committee must have policies and procedures in place to manage identified conflicts of interest once they are disclosed.

70. Disclosure Process
Conflict of interest (COI) declarations must be submitted to the planning committee prior to the start of the activity. 
The planning committee must have a management process in place to address identified conflicts
All conflicts must be disclosed to participants either verbally, displayed in writing on a slide at the beginning of a presentation or included in the written activity materials.

71. What to Disclose
Relationships with for-profit and not-for-profit organizations over the previous 2 years
Any direct financial payments including receipt of honoraria;
Membership on advisory boards or speakers’ bureaus;
Funded grants or clinical trials;
Patents on a drug, product or device; and
All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity.

72. Managing Conflict of Interest
The speaker can alter the focus of the talk to limit the areas where conflict of interest is significant.
The topic selected could be changed, but the same speaker be used.
peer review of the content to ensure that balance has been respected.
if a significant conflict of interest cannot be managed the topic and speaker can be eliminated.

73. Sponsors may also provide “in-kind” support.
Sponsorship
All funds received in support of the CPD activity must be provided in the form of an educational grant payable to the physician organization.
Sponsors may also provide “in-kind” support.
The terms, conditions and purposes by which sponsorship is provided must be documented in a written agreement signed by the CPD provider organization, scientific planning committee and the sponsor.
Sponsors may provide support for an activity in the form of an educational grant payable to the planning committee.
Sponsors may also provide “in-kind” support which can include logistical support, goods or services to support the educational activities, learning resources or tools.
Additional funds management responsibilities of the physician organization(s) include:
The distribution of funds to all faculty and speakers, including the payment of honoraria, travel, accommodations or hospitality.
Ensuring that all hospitality and other in-kind arrangements are modest and paid for directly by the planning committee.
Ensuring that sponsors are recognized in a location separate from the educational content.

74. The Agreement Should Include:
whether sponsorship is financial or in-kind support;
the dollar amount of financial support provided;
the specific in-kind resources provided;
the sponsor’s agreement to comply with the National Standard;

75. The Agreement Should Also Include:
that the scientific planning committee is not be required to accept advice from a sponsor as a condition of receiving financial and in-kind support;
that specific interests must have no direct or indirect influence on any aspect of the development, delivery or evaluation of an accredited CPD activity;
how sponsorship will be recognized; and
how sponsorship will be disclosed to participants.

76. Managing Commercial Promotion
Drug or product advertisements must not appear in:
locations where accredited CPD sessions are occurring;
preliminary or final programs;
brochures;
slides; and/or
Communications to participants.

77. Managing Commercial Promotion
It is the responsibility of the planning committee and faculty to ensure consistent use of just generic names, or both generic and trade names.
Therapeutic recommendations for the off-label use of medication must be declared.

78. Tagging
Tagging is the linking or alignment of a sponsor’s name to a specific educational session within an accredited group learning activity.
Tagging” is strictly prohibited.

79. Unaccredited Activities
Unaccredited group learning activities must:
not conflict with or compete with accredited group learning activities.
not be listed or included within conference programs, brochures or schedules (preliminary or final).
This standard pertains to Satellite Symposia (which is defined by the Royal College as unaccredited group learning activities developed independently by non-physician organizations).
Satellite symposia may not:
occur at times that would conflict with or compete with accredited group learning activities; and
May not be listed or included within conference brochures or schedules of accredited group learning activities.
Tagging (which is defined by the Royal College as the linking or alignment or a sponsor’s name to a specific educational session) is strictly prohibited.

80. When Reviewing an Application, Ask Yourself…
Does the COI reflect the requirements for the National Standard?
Do the funds flow through the physician organization?
Is there an agreement in place between the physician organization and sponsors?
Are there any drug or product ads in the activities material?
Is there tagging within the program?
Are unaccredited activities managed appropriately?

81. Your organization’s policies and procedures Royal College website
Resources
Your organization’s policies and procedures
Royal College website (
CPD Accreditation Unit staff
Julie
Robin Kinch
Kate Runacres
Chanelle Goulet

82. The Best Resource is Each Other
Suggest creating a community of practice