Stanford CME offers services for traditional CE activities such as Regularly Scheduled Series (i.e. Grand Rounds, Morbidity & Mortality, Tumor Boards, Journal Clubs, etc.) and live conferences and workshops as well as immersive and simulation-based learning, hands-on workshops, Maintenance of Certification (MOC) activities, webinars, live event streaming, and online activities.

Stanford CME also provides a wide range of services for developing educational activities, these services include planning, consultation, and implementation in the following areas:

• Compliance (Disclosures, Conflict Resolution, Ensure that AMA, ACCME, and Stanford Medicine requirements are met and offer certification)
• Educational Design Consultation (Including Needs Assessment, Gap Analysis, Instructional Design)
• External Funding Management (Identify Grant, exhibit, Sponsorship Opportunities, Prepare Proposals and Budgets, Submit Grants, Secure Letter of Agreements, Present Outcomes and Reconciliation)
• Budget Management (Help with Budget Development, Monitoring, and Reconciliation)
• Management of Faculty (Copyright Release, Slide Decks, etc.)
• Audience Development / Marketing
• Project and Logistics Coordination
• Webinar and Online Activity Production
• Full-Service Meeting Planning (Including coordination with outside partners and vendors, budget and faculty management, logistics coordination, and marketing)
• Evaluation of Outcomes (Assessment planning and design, data collection, analysis and reporting)
   

The Stanford CME team is looking forward to collaborating with you on educational activities, sharing Stanford Medicine’s research, scholarship, and practice to enhance the knowledge/performance of healthcare professionals and teams, resulting in improvements in patient health outcomes.

Directly Provided: An activity that is planned, implemented, and evaluated by the accredited CE provider. This definition includes co-provided activities (offered by two accredited providers) reported by the accredited provider that awards the credit.

Jointly Provided: An activity that is planned, implemented, and evaluated by an accredited provider and one or more non-accredited entities.

Course: A live activity where the learner participates in person (examples: annual meeting, conference, seminar).

Regularly Scheduled Series (RSS): A course planned as a series with multiple, ongoing sessions, that may be offered weekly, monthly, or quarterly; and is primarily planned by and presented to the accredited organization's professional staff. (examples: grand rounds, tumor boards, morbidity and mortality conferences).

Internet Live: An online course only available at a certain time on a certain date in realtime (examples: webcast, webinar).

Enduring Materials Internet: An online course available when the learner chooses to complete it (examples: online interactive educational module, recorded presentation, podcast).

Performance Improvement: Activities based on a learner’s participation in a project established and/or guided by a provider in which a learner identifies an educational need through a measure of his/her performance in practice.

Enduring Materials: A printed, recorded, or computer-presented activity that may be used over time at various locations and which in itself constitutes a planned activity.

Journal CE: Activity that includes the reading of any article (or adapted formats for special needs).

Cultural and Linguistic Competency (CLC): The ability and readiness of health care providers and organizations to humbly and respectfully demonstrate, effectively communicate, and tailor delivery of care to patients with diverse values, beliefs, identities and behaviors, in order to meet social, cultural and linguistic needs as they relate to patient health.

Implicity Bias (IB): The attitudes, stereotypes and feelings, either positive or negative, that affect our understanding, actions and decisions without conscious knowledge or control. Implicit bias is a universal phenomenon. When negative, implicit bias often contributes to unequal treatment and disparities in diagnosis, treatment decisions, levels of care and health care outcomes of people based on race, ethnicity, gender identity, sexual orientation, age, disability and other characteristics.

Other: The activity format for blended, new, or other approaches that do not fall into one of the established format categories.

Example 1
The 2019 Updates on Esophageal Disease conference aims to enhance participants’ knowledge on recent research and clinical developments related to esophageal disorders. Participants will learn strategies and diagnostic approaches to common esophageal complaints, including dysphagia and reflux symptoms. Faculty experts will cover hot topics such as diagnostic and management approaches for achalasia, eosinophilic esophagitis, Barrett's esophagus, esophageal cancer and non-cardiac chest pain. Using an integrated educational approach that encompasses didactic lectures, Q&A panels, debates, and case presentations, speakers will discuss recent advances in technology, research, diagnosis, guidelines and treatment strategies.

Example 2
In order for Stanford University School of Medicine (SoM) and Stanford Healthcare (SHC) to cultivate effective leadership, the two organizations have committed to the professional development of their faculty physicians and staff. The Leadership Development Program provides leaders at Stanford Medicine an educational foundation based on identifying, applying, and fostering the knowledge, skills, and strategies necessary for physicians to enhance efficiency and collaboration within their professional spheres. In its 14th year of the program, the course aims to improve the leadership approaches of current and high potential individuals nominated by the deans, department chairs, and senior leadership of SHC. The program was designed to gather a diverse and inclusive group of Stanford Medicine’s most qualified individuals for an enriching learning experience that uses the SoM and SHC’s mission statement, vision, and strategic goals as a basis. The curriculum includes topics directly connected to leadership effectiveness. Participants will engage in active learning experiences including formulation of leadership development goals, case studies, simulation, role-play, breakout discussion groups, video vignettes, writing assignments, reflection, and contemplation. The number of participants is limited to allow for direct interactions between them and faculty. Participants will apply what they learned from the course by carrying out an action-learning project leading a multidisciplinary team.

Example 3
Facial paralysis affects thousands of children and adults each year and can have a significant impact on patient quality of life. This CME symposium seeks to increase knowledge about the options for treatment for facial paralysis by using a broad, multidisciplinary approach to describe the role of surgical reanimation, rehabilitation, mental health, ophthalmology, neurodiagnostic assessment, and skull base surgery in the care of patients with facial paralysis. Faculty experts will review current evidencebased practices, incorporate case-based discussions to facilitate discussion on the optimal surgical and nonsurgical options for patients with facial paralysis, as well as present best practices for developing and utilizing a multidisciplinary care team to optimize health outcomes.

Example 4
The Stanford Sports Concussion Summit aims to increase participants’ knowledge and enhance clinical integration of the best practices and evidence-based advances in the diagnosis and management of concussion and mild traumatic brain injury. The clinical track focuses on developments in sports concussion while the demonstration track exhibits innovative technology in the field. The Summit will feature expert physicians, patients, and a multidisciplinary group of practitioners committed to advancing concussion research, including a former professional athlete and Pac-12 Brain Trauma Task Force Collaborators. The sessions integrate clinical knowledge, patient experience, and public outreach to provide global insight into the management of concussion in adults and children.

Definition
Interprofessional Continuing Education (IPCE): When members from two or more professions learn with, from, and about each other to enable effective collaboration and improve health outcomes (ACCME, ACPE, ANCC 2015).

Planning Team for Interprofessional Activities: Joint Accreditation criteria require that Interprofessional Continuing Education activities are planned by and for the healthcare team. For activities that are focused on multiple professions, the planning team should reflect the professions and credit types being targeted by the activity.

Video Resource
Defining Interprofessional Continuing Education

Practice Gap: The difference between health care processes or outcomes observed in practice and those potentially achievable on the basis of current professional knowledge. The difference between the ACTUAL and the IDEAL. (What is the problem/ issue?)

Educational Need: The knowledge and training which will address the identified practice gap. (What education is needed to address the problem? Why does the gap exist?)

Knowledge:  A learner’s information on a particular subject, process or skill.  (The learner needs new or additional information.)

Skills/Strategy: The ability to utilize new knowledge, processes, strategies or skills. (The learner needs new abilities or skills.)

Performance: Putting into practice a change in behavior and measure the outcome/impact. (The learner needs to take a new action or make a change in practice behavior.)

Addressing Practice Gaps
Closing Practice Gaps: Educational Needs
Educational Terms: Knowledge, Strategy/Skills, Performance, and Patient Outcomes

Example 1
State the problem or gap in practice (difference between current state and desired state or opportunity for improvement) that this activity is designed to address?
Critical gaps in medical knowledge of facial paralysis exist primarily in two areas:

1. the selection of surgical methods of treatment for chronic, non-resolving facial paralysis, and
2. the surgical and non-surgical management of synkinesis. Synkinesis is often the result of misdirected facial nerve fibers after partial recovery and has a high incidence after significant facial nerve injury. The under-treatment of both chronic, non-resolving facial paralysis and synkinesis may be due to a lack of access to specialists, and/or an incomplete fund of knowledge regarding the treatment algorithms for patients with facial paralysis.

State the educational need(s) that you determined to be the cause of the professional practice
gap(s) (check all that apply):
☒ Knowledge Need and/or
☒ Strategy/Skills Need and/or
Add more detail based on the Knowledge and Strategy/Skills needs (50 words max): Physicians lack both knowledge and strategy/skills regarding the surgical and non-surgical management of patients with Bell’s Palsy who do not recover or patients with an irreversible cause of facial paralysis (i.e., facial nerve tumor). As most cases of facial paralysis are due to Bell's Palsy, which has a favorable complete recovery rate of approximately 71% [Holland2014], physicians are familiar with the management of this patient group but need education on the care and strategies for management of patients with facial paralysis with less-common etiologies.

Example 2
State the problem or gap in practice (difference between current state and desired state or opportunity for improvement) that this activity is designed to address?
Physicians who hold key positions in academic medical centers often lack sufficient leadership & management skills. Physician leadership is essential for the survival of teaching hospitals. Despite challenges in quality, safety, patient centeredness and cost, healthcare in the past has been slow to adopt leadership practices of highly effective organizations. Collaborating with non-physician leaders is required to address the complex challenges academic medicine faces. Importantly, physicians must take a proactive role in healthcare delivery system innovation, which will require further leadership preparation.

State the educational need(s) that you determined to be the cause of the professional practice gap(s) (check all that apply):
☒ Knowledge Need and/or
Add more detail based on the Knowledge need (50 words max): Undergraduate medical education and post-graduate training does not provide opportunities for physicians to enhance their knowledge and understanding and development of leadership skills, as it focuses primarily on the study of medicine, health, and patient care.

☒ Strategy/Skills Need and/or
Add more detail based on the Strategy/Skills need (50 words max): Similarly, undergraduate medical education and post-graduate training does not offer programs that enable physicians to improve their strategy/skills around leadership skills, nor do these schools and academic hospitals train and educate physicians on the unique culture that emerges in a healthcare setting.

☒ Performance Need and/or
Add more detail based on the Performance need (50 words max): Because physicians typically do not receive formal education or training in leadership, their performance in leadership/management roles may be less effective than others, which may result in issues and challenges with collaboration, problem solving, and leading their healthcare teams.

Example 3
State the problem or gap in practice (difference between current state and desired state or opportunity for improvement) that this activity is designed to address?
Concussion is a public health concern with approximately 1.74 million cases of mild traumatic brain injury (MTBI) annually. As concussion research grown exponentially, it is critical for healthcare providers, as well as families and members of local sports communities, to remain abreast of evidence-based best practices, resources, and new guidelines for care of those who have experienced MTBI.
State the educational need(s) that you determined to be the cause of the professional practice gap(s) (check all that apply):
☒ Knowledge Need and/or
☒ Strategy/Skills Need and/or
Add more detail based on the Knowledge and Strategy/Skills needs (50 words max): Issues regarding a lack of knowledge and strategy/skills exist due to overwhelming literature and media surrounding concussion, which often lacks a focus on clinical translation of research and technology as well as evidence-based practice.

Definition
Learning Objective: The description of what the participant will be able to do at the conclusion of the activity.

Example 1
At the conclusion of this activity, learners will be able to:

• Recognize the main symptoms and signs of PH and right heart failure
• Classify patients with suspected PH into one or more of the major five World Health Organization groups
• Utilize basic right heart catheterization data to develop initial treatment plans
• Employ the ventilation-perfusion scan as the gold standard test in the diagnosis of chronic thromboembolic pulmonary hypertension
• Recognize the three main classes of FDA-approved drug therapy for pulmonary arterial hypertension as well as their major associated risks to patient safety

Example 2
At the conclusion of this activity, participants should be able to:

• Implement into practice recent updates and recommendations from the American College of Cardiology (ACC)/ American Heart Association (AHA)/ American Association of Clinical Endocrinologists (AACE) guidelines on dyslipidemia management and cardiovascular disease (CVD) prevention
• Develop treatment or referral plans for patients presenting with signs of mitral valve regurgitation
• Evaluate the available clinical evidence for recommendations for the management of cardiovascular disease during pregnancy
• Assess recommendations for post-procedure management of patients who have undergone transcatheter aortic valve replacement (TAVR)

Example 3
At the conclusion of this activity, participants should be able to:

• Critically study, review, and integrate specific leadership models, strategies, and skills into practice
• Cultivate communication skills for productive collaboration with other leaders, members of the healthcare team, and patients
• Devise and strategically implement plans to engage others effectively in actions and behaviors aimed to achieved leadership objectives and goals
• Demonstrate leadership skills when managing project, operational, research, or clinical teams in order to facilitate successful execution of tasks, processes, and projects
• Align leadership principles discussed in this course with organizational objectives in order to manage the business of medicine and drive success and achieve outcomes

Case studies: Provides an actual problem or situation an individual or group has experienced. An effective method of provoking controversy and debate on issues for which definite conclusions do not exist.

Audience response/interaction: Provides a simultaneous large audience response to faculty questions, allowing the faculty to interact with their audience.

Debate or Panel discussion: Provides an opportunity for experts or a group of learners to present differing viewpoints on a topic, issue, or problem to other panelists and the audience.

Question/Answer: Provides an opportunity for faculty to answer specific participant questions.

Small group work/discussion: Provides a less formal setting for peer interaction, discussion and problem solving.

Simulation or Standardized Patients/Medical Actors: Provides a standardized method for physicians to assess their individual skills of diagnosis, treatment and management of a patient.

Technical skills/hands-on workshops, Communication skills workshops, or Role play: Experiential learning allows learning through reflection on doing.

Project-based learning (e.g. quality improvement project): Provides a dynamic approach in which learners acquire a deeper knowledge through active exploration of real-world challenges and problems.

Patient perspective (e.g. live patient and patient advocate): Sharing of the patient experience helps meet patients’ needs and their priorities thus impacting the relevance and meaning of the education.

Knowledge/Competence
Evaluation/Self-Assessment: A survey/questionnaire in which the learner evaluates or assesses aspects of the CE activity, such as the speakers, design, and implementation.

Audience Response System: Designed to improve audience engagement, an audience response system (ARS), is a mechanism or platform in which learners use a handheld or mobile device to respond to multiple choice questions, open-ended questions, and other types of polling questions.

Knowledge/Competence pre/posttest: A series of questions aimed to examine a learner’s level of knowledge or competence before (pre-) and after (post-) the CE activity.

Physician or patient surveys and evaluations: Data derived from physician/patient surveys (identifiers redacted) that illustrates an acquisition of knowledge due to the CE activity.

Performance in Practice
Follow-Up Survey: A survey/questionnaire, disseminated approximately 60-days post-activity, in which the leaners are asked to provide feedback on whether they have implemented the skills learned during the CE activity into their professional practice.

Commitment to Change with Follow-Up: A survey/questionnaire, disseminated approximately 60-days post-activity, in which the leaners are asked to provide feedback on whether they have followed through with their intent/commitment to change, which was asked of them in the evaluation disseminated immediately after the CE activity.

Customized Interview/Focus Group about actual change in practice at specified intervals: Semistructured one-on-one interviews or focus groups facilitated by either a member of the course planning team or a CME staff member in which learners are asked a series of questions on the application of the knowledge or skills learned from the CE activity into their professional practice. These interviews/focus groups can be scheduled at various time intervals 90-days post-activity.

Physician or patient feedback, surveys and evaluations: Data derived from physician/patient surveys (identifiers redacted) that illustrates an application of skills in professional practice due to the CE activity.

Compliance Process & Requirements
The Stanford CME team is skilled at ensuring our CE activities are independent and free of commercial bias.  Our team will help ensure that AMA, Joint Accreditation, and Stanford Medicine requirements are met and offer certification.

Please visit Maintenance of Certification (MOC) webpage at https://med.stanford.edu/cme/planning-services/moc.html

Please visit Maintenance of Certification (MOC) Part 4 webpage at https://med.stanford.edu/cme/planning-services/moc4.html

Please visit External Funding (Commercial and Foundation) Support of Accredited Continuing Education Policy.

Please visit Promotional Support of Accredited Continuing Education Policy.

Evaluation Menu #1: A template of Stanford CME’s standard layout, which includes foundational questions that need to be asked of our learners to report to ACCME or for use in future activity planning.

Evaluation Menu #2: A template of Stanford CME’s more robust evaluation option, which includes foundational questions that are used in the standard template (Evaluation Menu #1) as well as probing questions (both quantitative and qualitative) to dig deeper into learners’ satisfaction of the activity and knowledge, competence, and skill acquisition.

Faculty Ratings: Likert rating scale item that requests the learners to rate the speaker/presentation on four categories: (1) quality of presentation content, (2) delivery and effectiveness of the speaker, (3) value of the topic, and (4) overall rating.

Additional Insights: A mix of Likert rating scale items, Yes/No questions, and Multiple-Choice Questions related to marketing, logistics, and supplemental educational materials.

Pre- and Post-Tests: A method of assessing the knowledge acquisition of learners after completing an educational intervention. 

Poll Everywhere: An audience response system (ARS) that lets you embed interactive polls and questions directly into your presentation. The learners respond using mobile devices.

Formative Feedback: Ongoing feedback provided to learners to help them better understand the limits of their knowledge and how to improve.  This can be done by providing them written feedback using a rubric or verbal feedback or instruction during simulation exercises.

Debriefing: Debriefing is the process of facilitated or guided reflection in the cycle of experiential learning. Analysis and discussion of scenarios and events after the simulation’s conclusion allows participants to solidify clinical knowledge and improve future performance.

Moore’s Level 5, Performance: A follow-up survey/questionnaire, disseminated approximately 60-days post-activity, in which the leaners are asked to provide feedback on whether they have implemented the skills learned during the CE activity into their professional practice.

Moore’s Level 6, Patient Health Outcomes: Data provided to Stanford CME 180-365 post-activity that demonstrates a change in patient health outcomes due to the delivery of the content from CE activity. Course planners will need to provide Stanford CME with data reports illustrating the comparison of baseline data with post-activity data, date range of the data collection, data analysis process, and a brief summary of the changes.

Moore’s Level 7, Population Health Outcomes: Data provided to Stanford CME 180-365 post-activity that demonstrates a change in population health outcomes due to the delivery of the content from CE activity. Course planners will need to provide Stanford CME with data reports illustrating the comparison of baseline data with post-activity data, date range of the data collection, data analysis process, and a brief summary of the changes.

Alternative Data Collection Options: Additional methods of data collection including the use of an audience response system; conducting focus groups, in-person interviews, phone interviews; offering a self-reflection assessment; or allowing the course planning team to use their own mature evaluation instrument in lieu of one of the Stanford CME’s menu options. For this last option, the Stanford CME office will need to review and approve it to ensure data can be used for comparison analysis.