1. Annual meeting of coordinators for CME activities University of Vermont College of Medicine Continuing Medical Education April 3, 2012

2. Disclosures No relevant financial relationships to disclose Cheung Wong, MD

3. Objectives of meeting UVM CME office –Staff –Undergoing Reaccreditation Decision to be announced March, 2013 Recognize the efforts of CME coordinators in conducting CME accredited activities Review mechanism for planning, monitoring and evaluation of CME activities

4. UVM CME Cheung Wong, M.D. –Associate Dean for CME, UVM COM –Department of Obstetrics/Gynecology, FAHC –E-mail: cheung.wong@uvm.edu Who are we?

5. Terry Caron –Director of CME, UVM COM –Conference coordinator –E-mail: terry.caron@uvm.edu –Phone: 802-656-2292 UVM CME Who are we?

6. Mary Gagné –Regional Program Coordinator –Conference coordinator –E-mail: mary.gagne@uvm.edu –Phone: 802-656-2275 UVM CME Who are we?

7. Kate Martin –Conference Coordinator –E-mail: katherine.martin@uvm.edu –Phone: 802-656-8449 UVM CME Who are we?

8. Natalie Remillard –Conference Coordinator –E-mail: natalie.remillard@uvm.edu –Phone: 802-656-2292 UVM CME Who are we?

9. Karen Whitcomb –Regional Program Assistant –E-mail: karen.whitcomb@uvm.edu –Phone: 802-656-2292 UVM CME Who are we?

10. Deborah Rhea –Conference Assistant –E-mail: Deborah.rhea@uvm.edu –Phone: 802-656-2292 UVM CME Who are we?

11. Sheila Dooley –Conference Assistant –E-mail: sheila.dooley@uvm.edu –Phone: 802-656-2292 UVM CME Who are we?

12. Michele Morin –Conference Assistant –E-mail: michele.morin@uvm.edu –Phone: 802-656-2292 UVM CME Who are we?

13. Moira Delahanty –Business/Accounting Specialist –E-mail: Moira.delahanty@uvm.edu –Phone: 802-656-2292 UVM CME Who are we?

14. How should we communicate? Phone: 802-656-2292 E-mail: uvmcme@uvm.edu Letter (CME office-Lakeside Avenue) UVM CME web site –http://cme.uvm.edu This meeting!

15. UVM CME activities Postgraduate courses/seminars –Directly sponsored –Jointly sponsored Regularly scheduled conferences –Grand rounds –M & M –Tumor boards –Lecture series

16. UVM CME Planning and implementation Monitoring Evaluation Conducting CME activities

17. UVM CME Conducting CME activities Planning and implementation Monitoring Evaluation

18. UVM CME CME planning committee –Determines practice gaps/needs to be addressed –Sets goals and objectives to address the gaps/needs –Considers topics/formats appropriate to improving physician competence/performance or pt outcomes Application forms Disclosure forms Commercial support form Multiple speaker evaluation form Planning & implementation of CME activity Forms at : http://cme.uvm.edu

19. Forms –Application forms Planning document Checklist Biographical data form –Disclosure forms Disclosure statement/attestation form COI resolution form Disclosure documentation form Monitoring form –Commercial support –Multiple speaker evaluation forms UVM CME Planning & implementation of CME activity Forms at : http://cme.uvm.edu All forms have been revised.

20. http://cme.uvm.edu

21. UVM CME website-forms

22. UVM CME – Planning Document REVISED Easier format - check off boxes - pdf instead of word doc. - “walk you through” gap/need analysis Some new info: - barriers - partners - new evaluation choices

23. UVM CME – Biographical data form

24. Forms –Application forms Planning document Checklist Biographical data form –Disclosure forms Disclosure statement/attestation form COI resolution form Disclosure documentation form Monitoring form –Commercial support form –Multiple speaker evaluation forms UVM CME Planning & implementation of CME activity Forms at : http://cme.uvm.edu

25. UVM CME – Disclosure/attestation form Who Discloses? - Faculty - Course Director - Planning Committee What needs to be disclosed? Financial Relationship in the last 12 months with a commercial entity that provides healthcare products/services relevant to the topic of the presentation or series of presentations.

26. UVM CME – COI resolution form

27. UVM CME Planning and implementation Monitoring Evaluation Conducting CME activities

28. Forms –Application forms Planning document Checklist Biographical data form –Disclosure forms Disclosure statement/attestation form COI resolution form Disclosure documentation form Monitoring form –Commercial support –Multiple speaker evaluation forms UVM CME Planning & implementation of CME activity Forms at : http://cme.uvm.edu

29. UVM CME Goals & objectives of activity communicated to learners prior to activity Disclosure of sources of commercial support & relevant financial relationships from individuals controlling content (faculty and planners) made to learners prior to activity Relevant COIs resolved prior to activity Completed disclosure documentation, COI, and monitoring forms collected and sent to UVM CME office Monitoring of CME activity

30. UVM CME – monitoring form List Faculty and all planners. Remember to post and sign! (Disclosure can be “posted” via PPT slide. Attach slide to signed form)

31. Forms –Application forms Planning document Checklist Biographical data form –Disclosure forms Disclosure statement/attestation form COI resolution form Disclosure documentation form Monitoring form –Commercial support form –Multiple speaker evaluation forms UVM CME Planning & implementation of CME activity Forms at : http://cme.uvm.edu

32. UVM CME – commercial support form List $ received and/or In-Kind” contribution –Non-monetary such as equipment, supplies, etc. Two signatures needed –Company Representative –UVM CME

33. UVM CME Planning and implementation Monitoring Evaluation Conducting CME activities

34. UVM CME Activity was evaluated in terms of effectiveness at meeting objectives Participants did not perceive commercial bias from the presentation Changes/improvements in practice will result from presentation Evaluation of presentation

35. UVM CME – immediate post activity evaluation form Affiliated/Jointly sponsored Grand Rounds

36. UVM CME Did the activity adequately address an identified professional gap and result in improved physician knowledge, performance, or patient outcomes? 3-4 month post-activity evaluation or chart audits, etc. (See planning doc for more options) Evaluation of overall activity

37. 3-4 Month Post Activity Survey (Sample) 1. Regarding the treatment of osteoarthritis, my care for these patients has changed based on information presented at the course. a. Yes b. No c. I do not see patients with this condition 2. Based on what I learned at the course, I am now more likely to identify and treat osteoarthritis patients with NSAIAs. a. Yes b. No 3. The lecture on “XXX” has altered at least one aspect of my use of “Z” in my practice. a. Yes b. No c. I do not use “Z” in my practice

38. UVM CME – Planning document

39. Professional practice gap Definition : “The difference between actual and ideal performance or patient outcomes.”

40. Planning Doc -Practice gaps Examples: 1.Best/Ideal Practice: 100% of patients with osteoarthritis treated properly with NSAIAs. Current: Nationwide, only 20% of patients properly treated (AHRQ data). 2.Best/Ideal Practice: 0 Central Line Infections Current: X Central Line Infections last year due to significant variation in techniques. (Internal Data) 3.Best/Ideal: All shoes with laces would be tied Current: X% of providers have untied shoes (Observed)

41. Planning Document Needs Analysis BASED ON THE GAPS…. What do the learners need to know, be able to do, or perform? (Knowledge, competence, performance) What strategy do they need to achieve “best practice”?

42. Planning Doc. - Needs Analysis Examples: 1.Providers need to understand the use of NSAIAs in treating osteoarthritis (Knowledge) 2.Providers need to become standardized in their approach to central line placement. (Performance) 3.Providers need to tie their shoes so that fewer people trip. (Performance)

43. Objectives What can the learner expect to achieve by attending the lecture/event?

44. The participant should be able to… 1.1 …explain the use of NSAIAs in the treatment of osteoarthritis. 1.2 … determine when and how to properly use NSAIAs. 2.1 …discuss the need for a standardized approach in central line placement. 2.2 …successfully complete the standardized approach to central line placement. 3.1 …discuss the statistics of injuries associated with untied shoes. 3.2 …identify shoes that do not require laces.

45. Barriers (New) What potential barrier might prevent participants from implementing their new knowledge?

46. Evaluation (Revised) Post Activity Evaluation – still required 3-6 month measure of change still required but… Other options: chart audits, patient outcomes… Or, you may still prefer to do a follow up survey.

47. Summary Activity planned by committee using multiple sources to identify gaps (QA, lit, evals) Objectives tied to gaps/needs Course structured to address gaps Evaluation –Participants evaluated to assess change in knowledge and performance post activity –QA data analyzed to assess impact of activity

48. Case examples Regularly scheduled conference Tumor board

49. XYZ Hospital XYZ Hospital conducts a weekly tumor board The activity has a CME planning committee, comprised of a radiologist, a CME coordinator, an oncologist, a radiation therapist, a pathologist, and a surgeon The committee identifies 2 specific objectives for the activity based on identified gaps in physician knowledge, performance, or in patient outcome for lung cancer patients: Planning & implementation of tumor board

50. XYZ Tumor Board 1. Reduce the time interval for patients from presentation to diagnosis –Average time = 28 days –Goal = < 14 days (national statistics) 2. Increase number of patients referred for minimally invasive treatment of lung CA –Emergence of thermal ablation techniques (literature, annual ASCO meeting) Objectives

51. XYZ tumor board The tumor board will track the following data for the year’s activity: –1. Number of days between initial office visit for chief complaint and tissue diagnosis for cancer patients –2. Number of patients referred to XYZ Hospital for thermal ablation of unresectable lung tumors Planning & implementation of postgraduate course

52. XYZ tumor board Number of days between presentation and diagnosis of CA –2012 = 35 –Institute organizational measures to reduce this Patients referred for radiofrequency ablation of lung cancer –2012 = 1 –Create mechanism to refer to XYZ for RFA Post activity evaluation

53. XYZ tumor board Planned by committee using multiple sources to identify gaps (QA, lit, meetings) Objectives tied to gaps Parameters of cancer patient care measured Changes implemented to improve on deficiencies in system

54. Common Mistakes Planning committee (including Course Director) does not make disclosure. Commercial support forms not completed. Monitoring forms – appropriate boxes not checked, forms not signed. Forget to evaluate 3-6 months post activity (by survey, chart audit, etc.)

55. Helpful Hints are listed on our website with the other forms!

56. Questions?