How To Create A Cme Course

1. CME application

2. Pre-activity documentation

3. Post-activity documentation

Rush fee: $250 applied to application fee for a rush review. Both the CME staff review and submission will be slotted at the beginning of the queue. There is no guaranteed timing for review, submission, or approval.

Late fee: A late fee of $250 may be assessed for each missed deadline. Please see above for pre-activity and post-activity documentation for deadlines.

Marketing your activity prior to CME approval is allowed; however, CME credit should not be mentioned. Marketing material may not state, "Category 1 CME credit is pending" or the "Category 1 CME credit has been requested" or has been "applied for." Marketing materials may not include statements such as "8-hour educational meeting," which may mislead the learner to think CME has been awarded.

All marketing materials must be approved by CME staff prior to distribution (including webpages, tweets, Facebook posts, etc.). WSMA staff will only need to approve a specific wording/method for an approved activity once; if you use that same marketing material again you do not need to resubmit for approval.

The application may be completed using WSMA's CME application portal at Foundant. The following must be completed prior to the start of the planning process.

WSMA staff is responsible for ensuring disclosure and training are completed prior to activity planning.

Agenda
CME credit can be awarded in 15-minute (0.25 increments). Round up or down to the nearest 15-minute increment. Breaks and meals where education is interrupted do not count toward the total activity credits. If rounding, ensure that the total credit does not exceed the length of actual time in the meeting (i.e. rounding by session equals 2.5 hours, however the meeting only lasts from 1 p.m. - 3:15 p.m. (2.25 hours). Total credits requested would be 2.25).

Credits	Start – End Time	Activity or Session Title
0.75	9:00-9:45	Session A
0.5	9:45-10:15	Session B
0.0	10:15-10:30	Break (does not count for CME)
1.0	10:30-11:30	Session C
0.5	11:30-11:55 (25 min)	Session D
0.0	11:55-12:50 (50 min)	Lunch (does not count for CME)
1.0	12:50-1:55 (55 min)	Session E
3.75	Total Credits Requested

Maintenance of Certification (MOC)
If you are interested in applying for Maintenance of Certification (MOC) credit for your activity, contact the CME department prior to submitting the application. Certain requirements change and will need to be implemented throughout the planning process. Failure to do so will disqualify you from awarding MOC credit.

Commercial Independence

Introduction

Commercial independence is the cornerstone of accredited continuing education. As an accredited provider, the WSMA is responsible for ensuring that healthcare professionals have access to learning and skill development activities that are trustworthy and are based on best practices and high-quality evidence. These activities must serve the needs of patients and not the interests of industry. The cooperation of activity planners is essential to ensuring that commercial bias does not enter any aspect of accredited continuing education.

Ineligible Company: any company producing, marketing, selling, re-selling, or distributing healthcare products used on or by patients. The WSMA refers to ineligible companies as commercial interests.

The ACCME does not consider providers of clinical service directly to patients to be ineligible companies - unless the provider of clinical service is owned, or controlled by, an ACCME-defined ineligible company.

Disclosure Forms

(Click here to download the disclosure form.)

Disclosure forms are the WSMA's first step in safeguarding against commercial bias. In addition to collecting participants' disclosure information, they relay WSMA's expectations about the education to activity planners and faculty (see ACCME's Clinical Content Validation Policy and Methods to Ensure Independence).

Everyone in control of an activity's educational content must complete a disclosure form and list all financial relationships they have with a commercial interest, except in limited circumstances. When the content of the activity is non-clinical, such as leadership training or communication skills, no disclosure forms are necessary. WSMA CME staff must approve this prior to the application's submission.

Email replies will be accepted so long as the inquiry email includes all content verbatim from the Disclosure of Financial Relationships form (e.g. attach the disclosure form to the email or copy/paste the text into the email).

This form is submitted at two stages:

Information for all planners is submitted with the application
Information for all speakers, faculty, content reviewers and others in control of content is submitted with pre-activity information

Individual(s) in control of content: anyone who has the opportunity to affect the content (e.g., topics or speakers) of a CME activity at any point in the planning or implementation process are considered to be in control of content. Examples of individuals in control of content include but are not limited to: the activity planning committee, content reviewers, panel moderators, CME coordinators, speakers/presenters, the WSMA CME program committee, or WSMA CME staff.

This form is submitted at two stages:

Information for all planners is submitted with the application
Information for all speakers, faculty, content reviewers and others in control of content is submitted with pre-activity information

Relevant financial relationship: Financial relationships are defined as relevant if:

A financial relationship, in any amount, exists between the person in control of content and an ineligible company;
The content of the education is related to the products of an ineligible company with whom the person has a financial relationship; and
The financial relationship existed during the past 24 months.

With respect to personal financial relationships, contracted research includes research funding where the institution gets the grant and manages the funds. When the person is the principal or named investigator on the grant, this relationship must be disclosed to the WSMA.

WSMA collects information about financial relationships, identifies relevant financial relationships, and selects an appropriate mitigation strategy for each relevant financial relationship from everyone in control of content. Each relevant financial relationship must be mitigated for before the person assumes their role. If a person has multiple roles in an activity, relevant financial relationships are mitigated appropriate to each role.

A disclosure is "not relevant" if the financial relationship is with a commercial interest that has products or services that are unrelated to the content of the CME activity (e.g., the activity is on cardiology and the financial relationship is with a company that only makes orthopedic devices) or if the financial relationship is with a non-commercial interest as defined by the ACCME (e.g., consultant for an insurance company).

If this is the case, select the following option in the spreadsheet: "Relationship was disclosed, reviewed, and found not to be a relevant financial relationship."
Document the name and contact information of the reviewer(s), along with a brief explanation of why the financial relationship isn't relevant.

If the financial relationship is "relevant" to the CME activity, use one or more of the "Mitigation Methods" listed below to address each conflict of interest.

Document the mitigation method used for each conflict of interest in the spreadsheet and provide a brief explanation, as well as the name and contact information of the reviewer(s).

Note: Owners or employees of commercial interests may only participate in the planning or implementation of CME activities under very limited circumstances. If anyone in control of content is an owner or employee of a commercial interest, you must consult with WSMA CME staff prior to completing this portion of the application.

The activity chair is the primary person responsible for ensuring relevant financial relationships are mitigated. If the chair has a relevant financial relationship, then another content expert who does not have a relevant financial relationship should review everyone's disclosure(s) and take steps to mitigate any relevant financial relationships.

Mitigation Methods for Planners:

Peer review of CME planning decisions
Change in focus of the planner's contributions
Limit the scope of the planner's involvement
Sever relationship
Other (describe in notes)

Mitigation Methods for Faculty or Moderators:

Peer review of educational content
Attestation collected: clinical recommendations are evidence-based and free of commercial bias
Change in focus of presentation
Sever relationship
Other (describe in notes)
N/A

Please ask WSMA CME staff if you have any questions about mitigating relevant financial relationships.

Disclosure to audience

In order to inform the audience that the activity was planned independently and that the education they are about to receive will be disseminated free of commercial bias, we have to disclose to them what we discovered in our disclosure process. Once you have received the disclosure forms, reviewed for possible conflicts, and mitigated all relevant financial relationships, we then create the disclosure to the audience.

Disclosure of relevant relationships to commercial interests for everyone in control of content must be made to the audience prior to the beginning of the activity.

Disclosure can be made in one or more of the following ways:

Presented in the syllabus
Made verbally (include a written attestation of completion for the file)
Visually on activity slides
On the activity website

Use the wording as follows:

Nothing to Disclose:
If no one in control of content (including both planners and speakers) has anything to disclose, you may state the following:

No one in control of content has indicated a relevant financial relationship with an ACCME-defined ineligible company. All clinical content presented will be evidence-based and unbiased.

Something to Disclose:
If planners and/or faculty disclosed a relevant financial relationship(s), you may state the following:

Planners: The following planners have indicated (a) relevant financial relationship(s) with an ACCME-defined commercial interest:

Planner name(s), name(s) of commercial interest, type(s) of relationship(s).

All relevant financial relationships have been mitigated. All others in control of content have indicated no relevant financial relationship with an ACCME-defined commercial interest. All clinical content presented will be evidence-based and unbiased.

Faculty: The following faculty have indicated (a) relevant financial relationship(s) with an ACCME-defined commercial interest:

Faculty name, name of commercial interest, type of relationship.

Activity Not Related to Commercial Interests
When the content of the activity is non-clinical (e.g., leadership development or communication skills training), there is no potential for any relevant financial relationships. You may sate the following:

The content of this activity is not related to products or services of an ACCME-defined ineligible company; therefore no one in control of content has a relevant financial relationship to disclose.

WSMA CME staff must approve the use of this language prior to the activity.

Resources

WSMA CME Clinical Content Validation Policy

Accredited providers are responsible for ensuring that their education is fair and balanced and that any clinical content presented supports safe, effective patient care.

All recommendations for patient care in accredited continuing education must be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options.
All scientific research referred to, reported, or used in accredited education in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation.
Although accredited continuing education is an appropriate place to discuss, debate, and explore new and evolving topics, these areas need to be clearly identified as such within the program and individual presentations. It is the responsibility of accredited providers to facilitate engagement with these topics without advocating for, or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning.
Organizations cannot be accredited if they advocate for unscientific approaches to diagnosis or therapy, or if their education promotes recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients.

Fair and Unbiased Planning and Presentation

The following methods may be used to ensure fair and unbiased planning and presentation:

Use of generic names. If the CME educational material or content includes trade names, where available trade names from several companies should be used, not just trade names of single products.
Unless there is a product which has no comparable alternatives, the educational content should list all like products, including pros and cons.
Reference sources, ideally peer-reviewed journals, for any clinical recommendations.
All accredited continuing education will be free from marketing. No logos of commercial interests are allowed in any educational materials.

Educational Planning

In this section we will identify the reason for holding this educational activity, clarify our objectives, and determine what we want the end result to be for our learners. In addition, this section will give us the opportunity to think outside the box with regard to planning an activity - we can identify the best methods to transmit information and determine if there are any ways to engage in additional methods to create the most comprehensive educational activity for our learners.

Identifying Professional Practice Gaps

What is the problem that needs to be addressed? Identify gaps in physician learning. A "gap" is the difference between what is currently going on in practice compared to ideal or best practice. A gap in practice may be identified due to new guidelines, treatment, management, and prevention mechanisms. Additionally, a gap in practice may be identified due to failure to meet new guidelines, treatment, management, and prevention mechanisms.

For example

: The American Academy of Pediatrics recommends screening all children for diabetes at 5 years of age. It has been identified that primary care physicians in Washington state are not screening all children for diabetes at the 5-year mark. Therefore, children are not receiving the care they need in a timely manner.

Please note: a new guideline in itself does not describe a gap. A gap would exist between the information contained in new clinical practice guideline, treatment, management, or prevention mechanism and the knowledge and information necessary to implement it.

Does the reason for this activity relate to any of the following? The following expressions may help you describe your educational gap.

•   New or updated approaches in technology/ treatment/ services
•   New regulatory, organizational, legal requirements/ changes
•   Updates in education or training
•   Not applying current clinical algorithms
•   Inappropriate clinical management
•   Rapid advances in the field
•   New or updated processes of care
•   Appropriate referrals to specialist
•   Condition is poorly understood
•   Coordinating care
•   New or changes in scope of practice/guidelines for care/evidence-based medicine
•   Experience in managing or treating
•   Condition is difficult or challenging to diagnosis or treat
•   Applying wrong or incorrect technique

Gaps can be between populations of patients:

• Health outcomes for African American women with breast cancer compared to health outcomes for Caucasian women
• The differences in health outcomes between patients in various parts of the country

Gaps can be in the outcomes of patient care:

• Only 75% of patients receive care according to certain clinical guidelines

Gaps can be in physician performance:

• Only 60% of physicians in our clinic prescribe a particular drug appropriately
• Dr. Smith prescribes the drug appropriately 80% of the time

There are many ways that quality gaps and/or physician gaps can be identified. One way to think about the myriad of sources that could point to gaps is to think about the sources being at different levels:

1. Individual physician level – for CME activities such as point-of-care or performance in practice
2. Group level (e.g., physician group)
3. Health care provider level
4. Local community level
5. State and regional level
6. National level

Ways to identify gaps
At each of these levels there are several areas that could be reviewed to identify gaps. WSMA's Provider Education menu on the public CME page has links to many sources for gaps.
1. Individual physician level: Performance gaps could be identified by asking physicians about their performance (how often do you do X) and/or by auditing patient charts. One downside of asking physicians to subjectively assess and report their performance is that they may not be able to give an accurate self-assessment. This type of gap assessment is best used for individualized CME, such as performance improvement CME and point-of-care.
2. Group level: Chart audits could also help identify gaps at a group level. More and more physician groups now report their performance and patient outcomes to outside sources. These sources can be tapped to look at performance and quality gaps.
3. Health care provider level: Physician group, hospital, and healthcare system quality and performance data are available publicly from a variety of sources. A few of the sources are provided here:

Hospital Compare
Leapfrog Group
Washington Hospital Quality

4. Local community level: Public health departments have data about the communities they serve. These data can point to quality gaps. Local newspapers often report on health conditions, quality of care, and problems in health delivery services in areas affecting their readers. These data often directly relate to local, community level quality care gaps. In addition, sources such as the following can be accessed to review quality data at a local, community level:

County Health Rankings
Washington Health Alliance Community Checkup

5. State and regional level: Government agencies, in addition to other groups, publish data at the state and regional levels:

Washington State Department of Health
Centers for Disease Control Prevention
State Health Facts

6. National level: National health data are available from a variety of sources, including:

Agency for Healthcare Research Quality
Institute for Health Metrics Evaluation

Each activity will have its own sources for identifying performance and/or quality gaps.

Identifying Educational Needs

What type of educational needs do the learners have?

Learning needs can contribute to the gap (i.e. due to the needs there is a gap in practice). Identifying the educational need helps identify how we can close the gap. In other words, to solve the problem (gap), the learner "needs" to... In order to identify what the learner needs to learn in the educational session, it is helpful to explore if the learner:

Has a knowledge deficit For example: The learner doesn't know or understand the new guidelines.
Has a competence [strategy] deficit For example: The learner knows the guidelines but lacks the ability or strategy necessary to apply them in practice.
Has a performance deficit For example: The learner knows the guidelines and has a strategy in place to perform them but has not put their abilities into practice.

For example: If a gap were detected in prescribing a new drug for a certain indication, asking why the gap exists could help identify if learners need:

- knowledge on the use of the drug (knowledge need),
- strategies for identifying when to prescribe the drug (competence need), or
- support to ensure they are indeed prescribing the drug appropriately (performance need).

Identifying Sources:

How did you recognize this opportunity for change?
What sources did you use to identify the gap (above)? Remember, all activities may have different sources. Is the gap based on a quality gap at the hospital level? Is there a public health gap identified through the local public health department? Were there new clinical guidelines issued by your specialty society's national organization?
Check the box(es) that apply.

Expected Outcomes

What are you trying to change? This section will help formulate what type of evaluation tool to use later in the application process.

Competence: The learner now has a strategy in place to improve patient outcomes
Performance: The learner is now able to perform strategy in their professional practice.
Patient Outcomes: The learner had an opportunity to perform their strategy in practice and as a result, patient outcomes were affected.

State what the CME activity is designed to change in terms of competence, performance, and/or patient outcomes (max 50 words).

Learner Objectives

What do you want the learner to do after this activity? While the need indicated a behavior that wasn't being done in practice, the objective states what we want them to be able to accomplish after the educational session.
In order to evaluate our activity later to see if we accomplished our goals, the objectives must be stated in behavioral, measurable terms. For example, you can measure if they can "apply" a concept; however, measuring if they "understand" would be less straightforward.
For example:

Designed To Change	Learner Objective(s)
☒ Competence (now has strategy to implement in practice to improve patient outcomes)	What strategy or ability will the learner gain? Use clear and consistent messaging and strategies to engage patients in managing healthy weight status.
☒ Performance (can perform strategy in practice to improve patient outcomes)	What strategy or skill will the learner put into practice? Implement the maternal early warning sign tool to detect impending critical illness.
☐ Patient Outcomes (performed strategy in practice and patient outcomes were affected; method to record outcome measures required)	What impact will the education have on patient outcomes?

Going beyond "understand"
The ultimate goal of CME is to change behavior and outcomes. We expect that change in knowledge is implicit in our educational opportunities. Through implementation of the knowledge, we will change a competence, performance, and patient outcomes.

To facilitate the transfer of learning into practice, learning objectives need to go beyond helping physicians "know" or "comprehend" something. Rather than "understand newly released clinical guidelines," we want our learners to "apply the guidelines," or at a minimum, be able to "describe the guidelines and how they should be applied."

By thinking of the end result (what we want the learner to do in practice) we can write behavioral objectives that can be applied in practice. Start with the end in mind.

The Bloom's Taxonomy chart below provides some helpful prompts for writing learner objectives. The rows of verbs become progressively action-oriented as you read them left to right. Please see the AAFP Guide for Writing Learner Objectives for more information.

Target Audience

Who needs to receive this information? Identifying the appropriate target audience will help you identify the specific gap and create an agenda.

If the activity is focused on neurology for primary care physicians, the agenda should not be at a neurologist level, it should be presented at a primary care level. If the target audience includes rural physicians that have a more general practice, the activity should focus on how to disseminate specialized updates to generalized practices.

For example: Practicing clinicians involved in obstetric care and other healthcare providers and maternity leaders in Washington state.

Educational Format

"Liberating education consists in acts of cognition, not transferals of information." – Paolo Freire

Studies show that within one hour learners will have forgotten an average of 50 percent of the new information presented. Within 24 hours they have forgotten an average of 70 percent and within one week they will have forgotten 90 percent of information. But you can do something about that learning curve!

Use a variety of learning methods: Studies also show that learners are able to retain information better (more quickly and accurately) in activities that include a variety of modalities besides didactic and PowerPoint presentations. Explore with your planning committee alternate learning methods, such as hands-on training, role-playing, and games. Think about ways in which you as an adult learner learn.
Repeat, repeat, repeat: Stop forgetfulness in its tracks. Reinforcing your message throughout the learning process will help decrease the percentage of forgotten information. Repeat your message early and often.

To achieve the optimum educational environment for your learner, consider your gap, educational need and learning objectives. What are you trying to accomplish with your activity? Different educational formats can be used in different ways to help learners achieve the educational outcome.

For example: An activity which is designed to give the physician the resources to identify situations in practice in which new guidelines are applicable, may benefit from education which re-creates these situations using role-playing, i.e. an actor "patient" describes symptoms to see if the physician is able to accurately diagnose and apply the guidelines.

Learning experiences are broken into three tiers.

Tier 1: Education is interactive. The learner is actively engaged and has an opportunity to perform skills learned.
Tier 2: Education is interactive. The learner is actively engaged and participates in learning experience.
Tier 3: Education is lecture-based. The learner is passive.

Please select all relevant educational formats.

Why is this educational format appropriate?

How is the choice of educational format going to help your learner achieve the optimal learning outcome?

For example: Learners are invited to participate in small group discussion after a brief didactic session to process concepts and describe how they will implement them in their own practices. Additionally, it will give learners an opportunity to hear how colleagues will implement new concepts.

Please provide a brief explanation of why the educational formats were selected.

Desirable Physician Attributes

Accredited CME looks to align itself with "competencies," or values, as identified by recognized medical organizations and boards to guide educational efforts. Aligning our education with these competencies is a further step in legitimizing the scope of CME.

Check all that apply.

Commercial Support and Exhibits

Indicate here if the educational activity will receive commercial support, if vendors or exhibitors will be allowed, or if there will be advertisements of commercial interests.

Commercial support is financial or in-kind grants or donations from a Commercial Interest such as a pharmaceutical or medical device manufacturer. All commercial support must have a signed letter of agreement.

Exhibit fees are not considered commercial support, even if they are from a Commercial Interest. When representatives from a commercial interest will be present at a CME event, they must sign an agreement outlining expected behavior.

If a supporter would like to purchase an exhibit space and would like to fund a portion of the meeting (either financially or in-kind), the funding portion is considered commercial support and must have a signed letter of agreement.

You do not need to have all grants and agreements signed at the time of the application submission; they will be due with the pre-activity documentation prior to your activity.

Budget

Please complete an estimate of the budget for this CME activity. Enter income and expense revenue estimates for each relevant line. More lines may be entered as needed.

Please note that if there will be more than 1 speaker, the honoraria should be broken out by individual speaker.

Budget Definitions
Government grants: monetary grants received from federal, state or local governmental agencies in support of your activity.

Advertising/vendors/exhibitors: money received for advertising or exhibiting; not commercial support. Please use the exhibitor agreement for each exhibitor or vendor.

Unrestricted Educational Grants from Commercial Interests: Financial support from a Commercial Interest. Must have signed letter of agreement at time of activity. WSMA has a letter of agreement you may use, or you may use the commercial interest's letter of agreement, so long as it meets the WSMA's expectations for independence (WSMA staff can help you determine if this is the case).

Tuition/Registration: Income expected from learner tuition or registration fees.

Other (private monetary donations): money received from the private sector, including foundation or direct organizational support, in support of your activity. Organizational support would be actual money exchange (i.e. Medical Staff Services paying the CME department; it does not include "internal allocations" or generalized overhead for CME services).

Marketing

You are required to submit all marketing materials for approval prior to publication, distribution, broadcasting, or going live. Marketing may be submitted prior to submission of the activity application.

Check the box to attest that all marketing materials will be submitted for review. This may be an ongoing review if you plan to market your activity in a variety of formats and at different times.

WSMA staff will only need to approve a specific wording/method for an approved activity once; if you use that same marketing material again you do not need to resubmit for approval.

Additional Items

In the WSMA's efforts to seek ACCME Accreditation with Commendation through high-quality education, this section helps to assess activities which meet Commendation criteria, and is strongly encouraged. Please check all that apply and provide information where indicated. WSMA staff will be in contact for follow-up information after the activity (if applicable). See links to ACCME for more information.

Interprofessional Teams (C23)

ACCME Rationale: Interprofessional continuing education (IPCE) occurs when members from two or more professions learn with, from, and about each other to enable effective interprofessional collaborative practice and improve health outcomes. This criterion recognizes accredited providers that work collaboratively with multiple health professions to develop IPCE.

Please note that this criterion requires that there be both planners and faculty from interprofessional disciplines.

Strategies Beyond Clinical Care (C27)

ACCME Rationale: This criterion recognizes providers for expanding their CME programs beyond clinical care education to address factors affecting the health of populations. Some examples of these factors include health behaviors; economic, social, and environmental conditions; healthcare and payer systems; access to care; health disparities; or the population's physical environment.

Please submit a brief description of strategies beyond clinical care which will be taught to learners.

Collaboration (C28)

ACCME Rationale: Collaboration among people and organizations builds stronger, more empowered systems. This criterion recognizes providers that apply this principle by building collaborations with other organizations that enhance the effectiveness of the CME program in addressing community/population health issues.

Collaborators must be from outside organizations. Furthermore, collaborators are purposefully chosen and not necessarily a joint provider or educational partner who has been contracted to assist in managing the activity.

Please provide a list of collaborators (spelling out acronyms) and a brief description of how this will impact the WSMA's ability to address population health issues.

Communication (C29)

ACCME Rationale: Communication skills are essential for professional practice. Communication skills include verbal, nonverbal, listening, and writing skills. Some examples are communications with patients, families, and teams; and presentation, leadership, teaching, and organizational skills. This criterion recognizes providers that help learners become more self-aware of their communication skills and offer CME to improve those skills. In the application, please provide a brief description of how communication skills will be observed and how feedback will be given to the learners.

When submitting post-activity documentation, please submit evidence of the observation and evaluation of learners' communication skills. The summarized evaluations may fulfill this requirement. Please ask the CME department to be sure.

Individual Learning Plans (C31)

ACCME Rationale: This criterion recognizes providers that develop individualized educational planning for the learner; customize an existing curriculum for the learner; track learners through a curriculum; or work with learners to create a self-directed learning plan where the learner assesses their own gaps and selects content to address those gaps. The personalized education needs to be designed to close the individual's professional practice gaps over time. In the application, please provide a brief description of the individualized learning plan and feedback to the learner.

When submitting post-activity documentation, please submit evidence of feedback given to the learner regarding their individualized learning plan. The summarized evaluations may fulfill this requirement. Please ask the CME department to be sure.

Support Strategies Adjunct to CME (C32)

ACCME Rationale: This criterion recognizes providers that create, customize, or make available supplemental services (e.g., reminders) and/or resources (e.g., online instructional material, apps) that are designed to reinforce or sustain change.

Support strategies used must be adjunct to the CME activity. Examples include but are not limited to: post activity email reminder of educational points; post activity discussion; or online resources or toolkits. Please note that to fulfill this criterion, there must be some kind of follow-up ("periodic analysis") to determine the effectiveness of the support strategy. "Periodic analysis" may include: analyzing the rate of opened emailed reminders and usage of links therein; tracking participation of post activity discussion; or monitoring data related to educational topics. Furthermore, planned improvements of future educational activities as a result of this analysis must be demonstrated.

When submitting post-activity documentation, please include a copy of the support strategy along with a brief explanation of the "periodic analysis" and planned improvements to future activities. If analysis and planned improvements have not happened within the allotted time frame, please indicate when these will happen. The CME department will follow up for more information at that time.

Chair Attestation(s)

The chair is responsible for reading and abiding by all WSMA and ACCME criteria and Standards for Commercial Support. Have the chair review and initial the attestation and sign when completed. The signature must be the actual, faxed or verified digital signature (using a trusted verified signature program). Plain text or inserted digital signature will not be accepted.

If your activity plans to provide Maintenance of Certification (MOC) points, your chair is responsible for reading and abiding by all relevant Board and ACCME requirements. Have the chair review and initial the attestation and sign when completed. The signature must be the actual, faxed or verified digital signature. Plain text or inserted digital signature will not be accepted.

Maintenance of Certification (MOC)

In an effort to assist physicians who are required to obtain Maintenance of Certification (MOC) points, the ACCME has aligned with various specialty boards. This means that activities accredited for CME may also be certified for MOC points from one or more qualifying specialty board.

While they are similar, each specialty board has its own requirements for an activity to be eligible for MOC points, and it is the Chair's responsibility to ensure that the CME activity will meets these standards.

Please note: the activity Chair must submit an addendum for each board from which they would like MOC points at the time of the CME application submission.

The boards currently aligned with the ACCME are:

- American Board of Anesthesiologists (ABA)
- American Board of Internal Medicine (ABIM)
- American Board of Ophthalmology (ABO)
- American Board of Otolaryngology (Head and Neck) (ABOHNS)
- American Board of Pathology (ABPath)
- American Board of Pediatrics (ABP)

If your activity has been approved for Maintenance of Certification points, the relevant Board MOC statement must be used. CME staff will provide you with the current MOC statement for each board, as applicable.

Please refer to the most current Board Program Guides on the ACCME website for more information.

Finally, please add the following information to alert the learners that participation in MOC activities is not a condition of receiving AMA PRA Category 1 Credit™:

NOTE: WSMA offers (relevant board) MOC points for this activity for learners choosing to participate in the MOC program. Learners are NOT required to participate in any MOC activities in order to claim AMA PRA Category 1 Credits™ for this activity.

Submitting your Application for Approval

Once you have completed your CME application it is ready to be reviewed for submission to the CME Program Committee. Applicants will submit their materials to the CME department.

CME staff will review your materials and may respond with edits to help ensure a positive review once the application in submitted to the CME Program Committee. Please be advised: CME rules, regulations, and implementation processes are constantly evolving; CME staff is your source to make sure that your CME application meets current requirements.

It may be necessary for the CME application to be edited several times before the application is ready for submission to the CME Program Committee. For this reason, please make sure to budget adequate time into your planning process.

CME staff will submit the application on your behalf. Should the committee require any edits to the application, these changes will need to be completed before the application can be approved. If there are no changes, the committee will return a finding of approval or non-approval. Approval occurs when 3 or more committee members reviews and approves the CME application.

If your activity receives approval, congratulations! You can now move to the next section.

Accreditation Statement

The accreditation statement must appear on all CME activity materials and brochures distributed by accredited organizations, except that the accreditation statement does not need to be included on initial, save-the-date type activity announcements. Such announcements contain only general, preliminary information about the activity such as the date, location, and title. If more specific information is included, such as faculty and objectives, the accreditation statement must be included.

Save-the-date announcement wording: "This activity has been approved for AMA PRA Category 1 Credit™."

All accredited CME activities being advertised as Category 1 are required to use the following statement, verbatim, on all program brochures or announcements, and on all certificates of attendance:

Directly provided accreditation statement
The WSMA is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The WSMA designates this [type of educational activity*] activity for a maximum of ____ AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for up to ___ hour(s) of Category I CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission.

Jointly provided accreditation statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Washington State Medical Association and (name of non-accredited provider). The WSMA is accredited by the ACCME to provide continuing medical education for physicians.

The WSMA designates this [type of educational activity*] activity for a maximum of ____ AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for up to ___ hour(s) of Category I CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission.

*AMA Designation Statement Type of Activities
The AMA designation statement may include the following types of activities:

Live
Enduring material
Journal-based CME
Performance Improvement (or PI) CME
Test item writing
Internet point-of-care
Manuscript review
Other (provide brief description)

Maintenance of Certification (MOC)
If your activity has been approved for Maintenance of Certification points, the relevant Board MOC statement(s) must be used. The CME department will supply you with the most current statement(s) to be used. Please refer to the most current Board Program Guides on the ACCME website for more information. Please add the relevant Board statement together with the following:

NOTE: WSMA offers [relevant board(s)] MOC points for this activity for learners choosing to participate in the MOC program. Learners are NOT required to participate in any MOC activities in order to claim AMA PRA Category 1 Credits™ for this activity.

Pre-Activity Documentation

The CME Pre-activity Documentation form contains space for all speakers and faculty to be listed. Please list everyone involved, as well as their credentials. There should be a disclosure form for every person listed.

Please complete the pre-activity documentation form and include all attachments. These documents must be submitted and approved a minimum of two weeks prior to the CME activity, or a $250 late fee will be incurred.

Commercial Independence

In the pre-activity documentation attach the disclosure forms for those in control of content. At this stage, the form should only include presenters, moderators, reviewers, and other faculty, as planner disclosure forms were included with the CME application.

Resolution of Conflict of Interest

If applicable, attach the documentation of your resolution process for those in control of content that disclosed a relevant financial relationship, as described above.

Pre-Activity Documentation Checklist

Please use the pre-activity documentation checklist. Items which constitute the pre-activity documentation for a CME activity are:

All presentation slides
Disclosure forms
Disclosures to learners for:
Planning committee
Speaker/faculty
Commercial interests (if any)
Evaluation to be used
Final activity objectives, if different form the application
Method of recording CME credit
Commercial support
All letters of agreement
Method of disclosure of commercial support
Other commercial promotion
All exhibitor agreements for commercial promotion

Please make sure everything in the checklist has been submitted no later than two weeks prior to the event, or a $250 late fee will be incurred.

More information about the checklist items is below.

Commercial Support

In the application section you may have indicated your activity will receive Commercial Support. If you received Commercial Support attach the signed Letters of Agreement.

Jointly provided activities must have 3 signatures:

Your organization's representative
WSMA CME department representative
Commercial supporter representative

Directly provided activities must have 2 signatures:

WSMA CME department representative
Commercial supporter representative

Disclosure of Commercial Support

If you received a grant you are responsible for disclosing this information to the audience.

The commercial support disclosure cannot list a commercial interest as a "sponsor" or "provider" of the educational event.

Commercial support disclosure may include the commercial interest's name, mission statement and areas of clinical involvement, but may not include a corporate logo and/or slogan. Attach or link to your acknowledgement of commercial support.

The signed Letter(s) of Agreement and the commercial support disclosure(s) are due with the pre-activity documentation

Commercial Interest Promotion: Exhibitors and Vendors

In the application section you may have indicated your activity will receive money from a Commercial Interest for accepting exhibitors or vendors at your CME activity. If you will receive money for exhibitors, vendors, or accept representatives from commercial interests, attach a signed Agreement for every Commercial Interest that will be present.

Jointly provided activities must have 3 signatures:

Your organization's representative
WSMA CME department representative
Commercial Interest representative

Directly provided activities must have 2 signatures:

WSMA CME department representative
Commercial Interest representative

The signed Agreements are due with the pre-activity documentation.

Evaluation

Evaluation is an attempt to measure "Did we do what we said we were going to do?" Take a moment to look back at your activity application. When asked to identify outcomes, what did you design your objectives to change? By designing your objectives to change behavior, you can now structure your evaluation to measure if you were successful in transferring both knowledge and the ability to apply that knowledge to your learner.

For example:
A course on communication may best be assessed with a role-playing situation, where the learner has an opportunity to use the skills learned.

A course on new techniques may be best assessed using a case presentation, where the learner reads a medical case and answers how they would treat the patient using the new skills learned.
Below are options for assessing your learner. They are broken out by intended outcomes (competence, performance, patient outcomes). Using the knowledge of your learners and what the activity intends to change, identify the evaluation method that will best measure that change.

Assessing Competence (subjective)

If you plan to measure your learners immediately after the activity, you can measure for competence (strategies that will be implemented once the learner is back at their practice). Use the following list as options for your evaluation. You may also create your own. Make sure your method is approved by WSMA staff first.

Tool/Measure

Definition

Likert (global) rating scales

A series of statements expressing values, or beliefs, with which the clinician may indicate strong agreement – strong disagreement, or neutral; or if ability to implement a process or procedure has significantly increased – significantly decreased or neutral.

Written Examination

Some questions to help you measure objectives which support the application of new knowledge include:

Factual: How would you use…?
Conceptual: What approach would you use…?
Procedural: What would result if…?
Meta-cognitive: How would you apply what you learned…?

If you choose to use an online evaluation tool, such as Survey Monkey, to subjectively assess competence using a Likert scale, WSMA has a sample template you may use.

Assessing Performance (subjective)

If you plan to measure performance, you may need to wait until the learner has had a chance to implement (perform) the skill in practice. You may choose the timeline, but typically learners are evaluated 3, 6, or 9 months post-activity to see if they implemented change.

Tool/Measure	Definition
Observed Performance
Direct Observation	Scrutiny of a clinical encounter by a trained individual, generally with a checklist based on appropriate clinical guidelines.
Standardized Patients	Present a scenario/case, ask how the learner would diagnose and manage it (open-ended).
Recorded Performance
Chart Review/Audit	Analysis of data recorded in patient record by another physician (peer review) or by another trained individual (abstractor) often clinically trained.
Critical Incident Technique	A patient record is reviewed with the clinician by a trained evaluator. Probing questions may elicit elements of knowledge, problem solving skills, and attitudes to patient care.
Comparison of diagnostic and laboratory findings	Matching chart recording of diagnosis (e.g. appendicitis) with objective data obtained later (e.g., pathology report).
Control Charts	A method of presenting performance data to physicians in a way which allows peer comparison.
Indirect Measures
Lab Data	Use of lab test data to reflect physician ordering behaviors, of a diagnostic (e.g., HIV testing), monitoring (e.g., HBA1C), or preventive nature (e.g., cholesterol, or Pap smears).
Radiology Data	Use of x-ray, radiology or diagnostic imaging ordering data to reflect physician performance, either in the diagnostic realm (Lumbosacral spine X-rays for low back pain) or in preventive care (e.g., mammography).
Drug Utilization Review	Analysis of antibiotic and other drug prescribing behaviors by clinicians.
Insurance Claims	Use of insurance claim data (diagnosis, rehabilitation and other recommendations) to monitor physician performance.

Assessing Patient Outcomes

Measuring patient outcomes is a long-term goal. Ideally you would look at your same needs assessment material (e.g. hospital quality data) after a specific amount of time and see if that same data has changed.

For example:

Assessing the county health records you see that your county has lower than average vaccination rates. Using this data you create an activity to help physicians appropriately administer vaccinations. After 1 year you return to the county health record data to see if the vaccination rates in your county have changed. You submit this data to WSMA as your evaluation.

NOTE: There does not have to be change for you to report this data (e.g. the vaccination rates do not change). We want to see the data which was reported.

Mandatory questions

Please include the following questions in your evaluation method:

An "ineligible company," also known as a "commercial interest," is defined as any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients. Among the exemptions to this definition are government organizations, non-health care related companies and non-profit organizations that do not advocate for commercial interests. Did you perceive any bias toward a "commercial interest" in this activity?
No
Yes
If yes, please explain:
What barriers do you face in implementing what you learned at the activity?

Recording Credit

It is your responsibility to make sure you not only record that the learner attended, but for how much time. The WSMA's method of verification is to have the learner self-report their participation time. If you have a suggestion or would like to use another method, contact WSMA CME staff to see if your idea meets the requirement.

For example:

OR

The WSMA has a sample online template you may use.

To help attendees understand how much credit to claim, the following language may be used:

Physicians: The number of credits claimed equals the number of AMA PRA Category 1 Credits™ awarded, with one hour of participation equaling one AMA PRA Category 1 Credit™. Physicians should claim credit in 15-minute (i.e. 0.25) increments. This (activity type) was designated for (number) AMA PRA Category 1 Credit(s)™.

All other attendees: Please complete this form so that we may verify your participation in this activity, which was designated for AMA PRA Category 1 Credit(s)™.

You may consider attaching the credit claim form to the end of your evaluation as an easy way to ensure physician completion.

Certificate of Attendance

A PDF of the official, signed CME attendance certificates will be distributed once all material for the pre-activity documentation has been finalized, submitted and approved by the CME department. CME attendance certificates are not considered valid without an official CME department representative signature.

Post Activity Documentation

Please use the post activity documentation checklist. Items which constitute the post activity documentation are:

Website documentation
Attendance records
MD/DO/Resident learners and Other learners
Credit claimed
Evidence of accreditation statement, including marketing
Disclosure to learners for:
Planners
Speakers/faculty
Commercial interests (if applicable)
Additional Items
Evidence of observation and evaluation of learners' communication skills
Evidence of feedback to the learner regarding individualized learning plan
Copy of support strategies used to reinforce the education objectives and:
Analysis of reinforcing strategies
Planned improvements to this activity as a result of the analysis
OR
analysis and planned improvements will be provided at a later date (please specify)
Final Budget

Please make sure everything in the checklist has been submitted no later than 30 days after the event, or a $250 late fee will be incurred.

More information about the checklist items is below.

Website documentation

Create full-sized PDFs of your CME activity's website. Examples of items to include are:

Evidence of accreditation statement
Evidence of disclosure to learners
Agenda
List of exhibitors, if applicable

You do not need to include presentations.

NOTE: If the documents requested below are already included in the website materials (i.e. Accreditation Statement and Disclosure to Audience) you do not need to attach a duplicate document.

Attendance record and credit claimed

Attach a copy of your attendance record (sign-in sheet, electronic record) and credit claimed. Please make sure all names, credentials and credit claimed are legible.

Please submit summarized totals for MD/DO/Resident learners and Other learners.

For example:

Name	Credentials	Credit Claimed
Harry Potter	MD	4.5
Hermione Granger	MD, PhD, MPH	5
Severus Snape	ARNP	0
Ron Weasley	DO	3.75

Total MD/DO/Resident Members:	30
Total MD/DO/Resident Non-Members:	25
Total Other Learners:	15

Summarized evaluation

Attach a copy of your summarized evaluation. If you had open-ended questions or a comments section and used an online method, please make sure to include comments.

Accreditation statement

Attach all materials which included the accreditation statement (including marketing materials).

Disclosure to audience

Attach a copy of your disclosure to audience for both those in control of content (planners and speakers) and Commercial Support, if applicable.

Additional Items (if applicable)

Interprofessional Teams (C23)

Check the box if there were both planners and faculty involved with this CME activity.

Strategies Beyond Clinical Care (C27)

Please submit a brief description of strategies beyond clinical care which were taught to learners. The summarized evaluations may fulfill this requirement. Please ask the CME department to be sure.

Collaboration (C28)

Please provide a list of collaborators (spelling out acronyms) and a brief description of how this will impact the WSMA's ability to address population health issues. The summarized evaluations may fulfill this requirement. Please ask the CME department to be sure.

Communication (C29)

Please submit evidence of the observation and evaluation of learners' communication skills. The summarized evaluations may fulfill this requirement. Please ask the CME department to be sure.

Individual Learning Plans (C31)

Please submit evidence of feedback given to the learner regarding their individualized learning plan. The summarized evaluations may fulfill this requirement. Please ask the CME department to be sure.

Support Strategies Adjunct to CME (C32)

Please include a copy of the support strategy along with a brief explanation of the "periodic analysis" and planned improvements to future activities. If analysis and planned improvements have not happened within the allotted time frame, please indicate when these will happen. The CME department will follow up for more information at that time.

Final budget

Complete the final budget form, including income and expenses. Under expenses you may add lines for additional items as necessary. See the Budget section for more information. For commercially supported activities, please document receipt(s) and expenditure(s) of the commercial support.

Final Review

CME staff will review your post-activity documentation.

CONGRATULATIONS!

You have now completed your CME activity. WSMA CME staff welcome any feedback you would like to share.

WSMA CME Program Policies

View the complete WSMA CME program policies here .