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)
• Grant Management (Identify Grant 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) Part 4 webpage at https://med.stanford.edu/cme/planning-services/moc4.html

This policy is intended to ensure that Stanford Center for Continuing Medical Education’s Accredited Continuing Education (CE) activities are fully compliant with both the Accreditation Council for Continuing Medical Education (ACCME) Standards for Integrity and Independence in Accredited Continuing Education and the Stanford School of Medicine Industry Interactions Policy (SIIP). The goal is to ensure Stanford Medicine CE is free from commercial influence, based upon the best scientific evidence available, and designed to change physician competence, performance-in-practice and/or patient outcomes.

This policy encompasses all forms of accredited education certified for CE by the Stanford School of Medicine or other certified medical professional continuing education developed by Stanford through the Stanford Center for Continuing Medical Education (Stanford CME), whether held on or off campus. This policy applies to all Standord CME-developed continuing education including live courses, regularly scheduled series (grand rounds, tumor boards, case conferences, M&Ms, journal clubs), live online activities, performance improvement activities, and enduring materials (online, print, DVD, etc.). Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team through November 2026.

What Constitutes Commercial Support?
Companies that are ineligible to be accredited in the ACCME System (ineligible companies) are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Commercial support is defined as financial or in-kind support from ineligible companies that are used to pay all or part of the costs of an educational activity. “In-kind” refers to the loan or donation of equipment and/or supplies from an ineligible company.

Commercial Funding for Specific CE Activities Is Permitted if the Activities Have Been Pre-Approved by the Strategic Advisory Committee (SAC)
This includes activities either on campus or at off-site venues and all functions that propose to use the Stanford name. Donations from companies which do not meet the definition of an eligible companies, individuals, foundations, and/or charitable organizations that are not ineligible companies may be used for support of a specific CE activity and do not need preapproval by the SAC.

Commercial Support Guidelines
Support from industry for CE may be accepted by Stanford CME or by an external educational partner approved by Stanford CME will only be accepted for activities in areas that have been designated by Stanford for curricular development.  These areas will be identified and proposed to the Stanford CME on a regular basis. The Stanford CME conducts a two-level review and approval process to ascertain that the activities have been independently developed without influence from ineligible companies, focus on identified practice gaps, and are congruent with Stanford Medicine’s identified needs and mission.  Commercial support can be accepted only in these pre-determined areas of curricular enhancement.  Acceptance of commercial support must not influence curriculum in any way.  Stanford and any Stanford CME identified educational partners must lead the identification of needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that control the content, selection of educational methods, and evaluation.  Commercial support may not be accepted for Regularly Scheduled Series (RSS).

Commercial Support Funding for Food and Beverages is Prohibited
All food and beverages served at CE activities must be paid for through tuition, funds supplied by a School of Medicine or hospital department, or other eligible companies.

Commercial Support Funds May Be Contributed to the Stanford Center for Continuing Medical Education
All commercial support for CE activities must be directed to the Stanford CME or to an approved educational partner with which Stanford CME is developing an activity. Commercial funds eligible for use in support of CE activities can be given either to the Stanford CME in support of a specific activity (except for RSS) or in support of the overall activity.

Applying for Commercial Support
On a regular basis, Course Directors can submit to the Stanford CME requests for permission to seek commercial support. These requests will be assessed by Stanford CME to verify the Request’s independence and fit within the missions of Stanford Medicine’s entities. If approved, the activity will be designated appropriate for curricular development and commercial support may be sought for it.

Stanford CME will submit the Request to a non-conflicted clinician reviewer. The review will check to ensure that no commercial bias exists. If commercial bias is present, the Request will be modified by the Course Director as needed to remove the bias.

If an ineligible company agrees to provide funding for an activity, both the ineligible company and Stanford are required to sign a Letter of Agreement (LOA) for Commercial Support that specifies the ineligible company providing the commercial support and terms and conditions of that support that comply with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. This instrument must be approved and signed by a responsible company official (who is authorized to make such commitments) and by the Associate Dean for Postgraduate Medical Education or the Director of Stanford CME. Stanford has developed a standard form for this purpose.

Management of Commercially Derived Funds
All commercial support for CE certified by Stanford must be given with the full knowledge and approval of and be managed by either the Stanford Center for CME or its approved education partner.

Educational Partners
Stanford supports collaborative development of CE activities with other organizations.  It will work closely with non-ACCME/JA accredited entities to develop and offer jointly provided activities (as defined by the ACCME/JA), on a case-by-case basis. In these cases, commercial exhibits and advertisements are prohibited, regardless of which institution certifies the activity.

Co-providership with organizations that are ACCME/JA accredited CE providers will also be considered. Proposals should be discussed with the Associate Dean for Postgraduate Medical Education and/or the Director of CME.  Either institution may be the accrediting provider and control the process for commercial support as long as the CE activity is found to be free of commercial bias as determined by an independent (defined as an individual not associated with the activity) non-conflicted physician reviewer or the School of Medicine’s Conflict of Interest Review Program.

Potential collaborations must be based on a willingness to fully comply with Stanford policies.

Commercial Funds Contributed for Purposes Other Than CME May Not Be Used to Support CE
To ensure compliance with ACCME and Stanford Industry Interaction Policy requirements, commercial funds contributed for initial uses other than CE (such as unrestricted commercial donations to departments or other Stanford Medicine entities) may not be used to support Stanford CME activities.

No Additional Funds May Be Provided to Those in Positions to Influence Educational Content
Stanford School of Medicine policy prohibits commercial supporters from providing funds for CE other than through an agreement with the Stanford CME office. An ineligible company may not provide additional CE support funds to those in a position to control content of CE activities.

Disclosing Commercial Support to Learners
Stanford must disclose to the learners the name(s) of the ineligible company(ies) that gave the commercial support, and the nature of the support if it was in-kind, prior to the learners engaging in the education. Disclosure must not include the ineligible companies’ corporate or product logos, trade names, or product group messages.

“In-kind” Support – A Special Consideration
“In-kind” support refers to the loan and/or donation of equipment or supplies from an ineligible company. In-kind support may be donated for use in a specific activity upon prior approval by the Associate Dean of Postgraduate Medical Education or Executive Director of Stanford CME via an executed Letter of Agreement for in-kind commercial support. No marketing activity may be associated with the use of in-kind support. When multiple products are available, conscientious effort must be made to attract support from multiple vendors of similar and substitutive equipment and supplies. Stanford has developed a standard LOA for this purpose.

Utilization of Excess Commercial Funds
Funds contributed by companies in support of a Stanford CME activity will be expended on the designated CE activity. Once the contractual agreements from the company are met, if any funds remain available, these monies can be used amplify the reach of the designated Stanford CME activity i.e., the development of enduring materials from the recorded live session. Any excess funds will be returned to the funder.

Commercial Exhibits and Advertisements
Exhibits or advertisements by ineligible companies are not permitted at CE activities whether at Stanford or at offsite locations. The only exceptions are medical book vendors and non-profit organizations unrelated to ineligible company (such as societies and associations).

Ineligible Companies’ Employees as Instructors and Planners
Ineligible companies’ employees may not participate in the planning of CE activities. Ineligible companies may serve as an instructor in Stanford CME activities only under narrowly defined circumstances. An employee of an ineligible company may present on: the scientific or discovery process itself (the processes/methodologies of research), the results of basic (biologic, chemical, physical) research studies relevant to the clinical problem being addressed but not those specific to a product or its clinical testing, and CE topics other than those related to the products and business lines of his/her employer. Ineligible companies’ employees may neither teach about their products nor offer recommendations regarding patient care. Permission for an ineligible companies’ employee to act as instructor in a Stanford CME activity must be obtained in advance from the Associate Dean for Postgraduate Medical Education and the employees’ participation must be closely monitored by course leadership.

Ineligible Companies’ Employees as Technical Assistants
As a general rule, ineligible companies’ employees are not permitted to assist in CE. Exception may be made if the ineligible company employee is needed for technical assistance essential to operating a piece of equipment in a demonstration critical to the educational mission of the activity. In such a circumstance, an employee may demonstrate use of the product but may not discuss the indications for use of the product or its merit relative to competing products. This participation of an ineligible company employee must be approved in advance by the Executive/Managing Director of CME or Associate Dean of Postgraduate Medical Education. Commercial employees who provide technical assistance are required to sign Stanford’s attestation/disclosure form. It is the responsibility of course leadership to appropriately monitor the employee’s participation in the CE activity for compliance with these guidelines.

Ineligible Companies’ Employees as Learners
Ineligible company employees may attend CE activities for their own education. They must pay full tuition, wear a conference name badge, wear no commercial identifiers (e.g. corporate logos), and engage in no sales or promotional activity.

Ineligible Companies’ Employees as Commercial Funder Representatives
If an activity receives financial commercial support, one or two members of the funder’s continuing education/independent education team will be allowed to attend the activity to observe how the company’s commercial support was expended. The names of these individuals must be provided in advance to the Stanford CME. As attendees, these commercial employees will wear a conference name badge, wear no commercial identifiers (e.g. corporate logos), and engage in no sales or promotional activity.

Commercial Marketing and Product Messaging Is Forbidden
All Stanford medical education syllabi, brochures, course websites, lecture slides, etc. must be entirely free of commercial marketing and product messaging such as logos, slogans, etc.

Use of Brand Names
Descriptive terminology rather than brand names for pharmaceuticals (i.e. generic or chemical names) and medical technologies and devices should be employed. To avoid learner confusion, a brand name may be used in conjunction with its generic equivalent if this promotes learning.

Assuring Fairness and Balance
When a commercial product and/or device is discussed, every effort must be made to ensure fairness and balance. A thorough discussion of the alternatives (e.g. other treatments, drugs, or technologies) should be included.

Promotion of Stanford CME by Commercial Interests Is Not Permitted
Stanford CME activities may not be marketed by an ineligible company (e.g. on their websites, by their representatives) lest this suggest a relationship that does not exist.

Separation of Education from Promotion
Stanford CME activities must not promote the interests of product manufacturers. The following safeguards monitor this separation:

ACTIVITIES LINKED TO ANALYSES OF LEARNER GAPS AND EDUCATIONAL NEEDS
CE activities are planned based on the identified professional practice gaps of the learners and the educational needs arising from those gaps.

CONTENT VALIDATION PRACTICES
Content planners and course faculty are required to attest that commercial bias is not present and that the educational material is scientifically accurate, based on evidence acceptable to the profession, and that treatments discussed are appropriate. Stanford has developed a standard form for this purpose, used in the planning stages for all activities.

RETROSPECTIVE LEARNER FEEDBACK
Evaluation mechanisms contain questions that serve to demonstrate that learners did not perceive commercial bias in the materials from a specific teacher/author. If a bias is perceived, this information is provided to the Course Director(s), planners, faculty and others so that an improvement plan can be initiated, and outcomes of the improvements monitored.

Provision of Funds to Learners
Stanford CME does not provide funds to offset the costs of attending CE activities (i.e. travel, lodging, personal expenses). Honoraria and expense support may be provided to the faculty of the activity.

Stanford Develops CE Activities Independent of Any Ineligible Company
Ineligible companies are never allowed to be involved in the following:

• Identification of practice gaps and needs that become the foundation for the activity
• Preparation of or input into the learning objectives
• Selection and presentation of content
• Recommendation of persons to serve as faculty for the activity or any other persons that will be in the position to control the content of CE
• Influence over the selection of the educational design for the activity
• Selection of vendors or methods for the evaluation of the activity
• Requests for “technical review” of the content of the CE activity

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credential Center (ANCC). Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education. As such, please follow these guidelines to help us create high quality education that is independent of industry influence.

Why do I need to complete this disclosure?
In order to participate as an individual who will be able to control the educational content of this accredited CE activity, you must disclose all financial relationships with any ineligible companies that you have had over the past 24 months. The ACCME defines ineligible companies as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. There is no minimum financial threshold; you must disclose all financial relationships, regardless of the amount, with ineligible companies. All relationships are to be disclosed regardless of whether you view the financial relationships as relevant to the education. For more information on the Standards for Integrity and Independence in Accredited Continuing Education, please visit accme.org/standards.

Why do we collect this information?
By identifying and mitigating relevant financial relationships, we work together to create a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.

What are the next steps in this process?
After we receive your disclosure information, we will review it to determine whether your financial relationships are relevant to the education. Please note: the identification of relevant financial relationships does not necessarily mean that you are unable to participate in the planning and implementation of this educational activity. Rather, the accreditation standards require that relevant financial relationships are mitigated before you assume your role in this activity.

INSTRUCTIONS: Complete this form to share all financial relationships that you have had in the past 24 months with ineligible companies. This information is necessary in order for us to be able to move to the next steps in planning this continuing education activity. If an individual refuses to disclose relevant financial relationships to Stanford CME, s/he will be disqualified from participating in the accredited activity.

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect CE content about products or services of a commercial interest with which he/she has a financial relationship. The ACCME considers financial relationships to create actual conflicts of interest in CE when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CE about the products or services of that commercial interest.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients with the exemption of non‐profit or government organizations and non‐health care related companies. The ACCME does not consider providers of clinical services directly to patients to be commercial interests (e.g. liability/health insurance providers, group medical practices, hospitals, nursing homes, rehabilitation centers). 
Financial Relationships: Those relationships you currently have or had during the last 12 months in which you benefit by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research which also includes funding where the institution gets the grants and manages the funds and you are the principal or named investigator for the grant), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME ® considers relationships of the person involved in the CE activity to include financial relationships of a spouse or partner. The ACCME deems employment by a commercial interest to be a non-resolvable conflict for the employee unless the course content is unrelated to products or services provided by the commercial entity.

The purpose of this policy is to establish guidelines for interactions with Industry representatives throughout Stanford Medicine, which is composed of the Stanford School of Medicine, Stanford Health Care and the Lucile Packard Children’s Hospital Stanford. Interactions with Industry occur in a variety of contexts, including marketing of new pharmaceutical products, medical devices, and hospital and research equipment and supplies on-site, on-site training of newly purchased devices, the development of new devices, educational support of medical students and trainees, and continuing medical education. Faculty and trainees also participate in interactions with Industry off campus and in scholarly publications in a variety of circumstances including consulting activities of various sorts. Many aspects of these interactions are very positive and important for promoting the educational, clinical and research missions of Stanford Medicine and for translating knowledge and expertise from the faculty to society. However, these interactions must be ethical and cannot create conflicts of interest (COI) that could endanger patient safety, data integrity, the integrity of our education and training programs, or the reputation of either the faculty member or the institution. Individuals must consciously and actively divorce clinical care decisions from any perceived or actual benefits expected from any company. It is unacceptable for patient care decisions to be influenced by the possibility of personal financial gain. See policy for Conflicts of Interest in Clinical Care.

It is the policy of the Stanford School of Medicine, Stanford Health Care and the Lucile Packard Children’s Hospital Stanford that interactions with Industry should be conducted so as to avoid or minimize conflicts of interest. When conflicts of interest do arise they must be addressed appropriately, as described herein.

This policy incorporates the following types of interactions with Industry.

• Gifts and compensation
• Site access by sales and marketing representatives
• Provision of scholarships and other educational funds to students and trainees
• Support for educational and other professional activities
• Disclosure of relationships with industry
• Training of students, trainees, and staff regarding potential conflict of interest in industry interactions

For latest Stanford Industry Interactions Policy visit https://med.stanford.edu/siip/home.html  

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.