CME Pre-Screening Application
RequiredRequired Question(s)
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Proposed Title of Activity

 

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Sponsoring Department

 

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Name and Email of Program Planner/Physician Leader:

 

350 characters left.
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Proposed Dates/Times/Frequency:

 

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Proposed Location:

 

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Activity type:

Case Conferences
Grand Rounds
Regularly Scheduled Lectures
Single one-day conference
Single multi-day conference
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Describe the intended target audience for this activity - specific medical specialties, roles, locations, etc. 

 

Note: Practicing physicians must constitute a majority of the targeted audience and the focus of the educational experience.

 

 

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Have you convened a planning committee for this activity?

 

Note: The planning committee must include at least two members of the targeted audience. This committee must meet to discuss the practice gap, the need, the objectives and the overall desired result. Include CME Coordinator and/or CME Director on committee.

Yes
No (This must be completed prior to submitting full CME application).
Required

List planning committee member names, titles, and specialties:

 

350 characters left.
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What professional practice gap is this activity designed to meet? 

(Gap = difference between current and best practice)

 

Some questions to consider: Have there been problems identified that this educational activity seeks to address? Have there been specific inadequacies in patient care observed? Is this a mission-critical area that is currently not being addressed from an educational standpoint?

 

1000 characters left.
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Provide evidence-based literature and references to support the practice gap.

 

350 characters left.
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Have you completed a needs assessment of your targeted audience to assure that this activity will meet their educational needs, AND that they would attend?
Yes
No (This must be completed prior to submitting full CME application)

The CME Department can assist in development of a needs assessment survey. 

Survey results must be included with CME application.

 
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What changes or improvements in clinical practice are sought as a result of this activity?

 

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List the preliminary objectives for the activity.

 

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List the proposed activity agenda with time frames:
 

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How will this program be funded? (check all that apply)

Sponsoring department's funds
Registration fees
Other  
  • Comment:

  • 500 characters left.
This information is used to assess whether the proposed activity qualifies for AMA PRA Category 1 Credit(s) ™.  If the CSRHC CME Committee determines that the proposed program qualifies, and that it is feasible to devote CME resources to this activity, then the applicant will be subsequently required to complete a full application packet, and final approval will be dependent upon favorable review of the completed packet by the CSRHC CME Committee.

 

Pre-Screening Applications will be reviewed on a quarterly basis during the CSRHC CME Committee meetings.   Deadline for submission is the 1st day of the month in which the committee meets (February, May, August, and November).

 

For assistance with any aspect of your CME request, please contact:

Jann Harrison, Director of Medical Education, ph 210.704.3785

email jann.harrison@christushealth.org or

Pamela Voorhies, CME Coordinator, ph 210.704.2701

email pamela.voorhies@christushealth.org