Frequently Asked Questions about CPD Accreditation

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1 General Questions Frequently Asked Questions about CPD Accreditation 1. Where should learning objectives be published? Overall and session-specific learning objectives for any CPD activity (face-to-face or webbased group learning, self-assessment programs, etc.) should be included within preliminary and final program materials. Learning objectives should be distributed prior to the activity to facilitate the participants ability to determine the relevance of the learning activity to their practice. It is essential that learning objectives be written from the learner's perspective. Objectives should clearly state what a participant will know or be able to do as a result of attending an event or session. 2. Can educational activities for other health professionals be included within an accredited group learning activity for physicians? There are many examples of physician organizations that include other health professions as members of their target audience. Educational activities that are targeted at a health care team or at physicians and other health professions must meet the educational and ethical standards expected for accredited group learning activities. If a specific activity is planned only for other health professionals it can be planned to achieve the same standards for physicians or the standards developed by that health profession, where applicable. Regardless, these types of activities can be included within an accredited group learning event for physicians. 3. How can attending a group learning activity contribute to the development of personal learning projects in Section 2 of the MOC Program? Simply attending a group learning activity does not equate with completing a personal learning project (PLP). However, attending a group learning activity could be the stimulus for the development of a PLP that may include some of the aspects of participating in the activity. Personal learning projects are self-planned learning activities, developed to answer a question, issue, or problem identified in professional practice. Before participating in a group learning activity, participants could review the learning objectives and description of each session and develop one or two questions the activity may be answer. The formal (plenary session, large and small group activities) and informal (collegial discussions at breaks or over lunch) activities are resources that can be leveraged to answer the question(s) developed. When the activity is complete, the intention is to reflect what was learned and document (in MAINPORT) the conclusions or learning outcomes. 1

2 4. What information should be included on a certificate of attendance? Providing a certificate of attendance is a key accreditation standard. The physician organization is always responsible for issuing certificates of attendance to all participants, regardless of their profession or specialty. Certificates of attendance must be issued for accredited group learning activities, accredited self-assessment programs and accredited simulation programs. A certificate of attendance should always include the following elements: 1. The title of the activity. 2. The name of the physician organization responsible for the activity. 3. The date(s) the activity took place. 4. The location of the activity (i.e. city, country, web-based). 5. The total number of hours for which the activity is accredited. 6. The number of hours the registrant attended the activity (or a blank space for the registrant to complete themselves). 7. All applicable accreditation statements and the co-development statement when necessary. For a complete list of statements, please visit our website. 5. What are the accreditation statements? Where should they be published? The accreditation statements should be placed on all promotional materials for the activity once accreditation approval has been received from an accredited CPD provider. These materials include conference programs, certificates of attendance, website advertisements, flyers etc. Please note that statements indicating that an activity is pending approval are strictly prohibited. Sample Section 1 Accreditation Statement "This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada, and approved by [accredited CPD provider's name]." Section 3: Self-Assessment Program Accreditation Statement "This activity is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of The Royal College of Physicians & Surgeons of Canada, and approved by [Accredited Providers' Name] on dd/mm/yy' Program expires mm/yy. Remember to visit MAINPORT to record your learning and outcomes. You may claim a maximum of # hours (credits are automatically calculated)." Section 3: Simulation-based Activity Accreditation Statement This activity is an Accredited Simulation Activity (Section 3) as defined by the Maintenance of Certification Program of The Royal College of Physicians & Surgeons of Canada, and approved by [Accredited Providers' Name] on dd/mm/yy' and expires mm/yy. Remember to visit MAINPORT to record your learning and outcomes. You may claim a maximum of # hours (credits are automatically calculated)." 2

3 Co-Development Statement "This [program, workshop or seminar] was co-developed with (name of organization) and was planned to achieve scientific integrity, objectivity and balance." (If the co-developed activity is included within a larger, group learning activity, this statement should be located within the program alongside the title/description of the session.) AMA PRA Category 1 Credit designation statement Through an agreement between the Royal College of Physicians and Surgeons of Canada and the American Medical Association, physicians may convert Royal College MOC credits to AMA PRA Category 1 Credits. Information on the process to convert Royal College MOC credit to AMA credit can be found at Click here to learn more about the Royal College agreement with the American Medical Association. UEMS ECMEC Credit designation statement "Live educational activities, occurring in Canada, recognized by the Royal College of Physicians and Surgeons of Canada as Accredited Group Learning Activities (Section 1) are deemed by the European Union of Medical Specialists (UEMS) eligible for ECMEC credits." (Click here to learn more about the Royal College agreement with the European Union of Medical Specialists). 6. Is a program that is only 30 minutes in duration eligible for MOC accreditation? Yes. There is no minimum time requirement for accredited activities. MAINPORT will allow Fellows and MOC Program participants to record quarter credits (15 minutes). The previous MAINPORT system accepted only full credits (1 hour) therefore activities either needed to be at least an hour in length or learners would round up to the nearest full credit. 7. Can accredited CPD providers review activities developed solely for residents? Yes. Activities developed solely for residents can be reviewed for MOC credits. Of course, the same accreditation standards apply to these activities. Resident Affiliates of the Royal College may participate in the MOC Program and carry forward up to 75 credits from their Residency Affiliate cycle to their first Fellow cycle. 8. Does a Fellow have to sign the accreditation application form? No. The Chair of the planning committee must sign the accreditation application form therefore taking responsibility for the educational and ethical standards of the program. 3

4 9. Can accredited CPD providers review group learning activities held outside of Canada for MOC credits? Yes, but it may not be necessary. Group learning activities held outside of Canada developed by an international physician organization do not have to be accredited by a Royal College accredited CPD provider in order for learners to record MOC credits. If the program developer wishes to have the program reviewed for MOC credits, they may do so but it is likely that the activity has already been reviewed for credits within another jurisdiction. Note: If a Canadian physician organization holds a learning activity outside of Canada, it should be reviewed by a Royal College accredited CPD provider for MOC credits. 10. At what point does an accredited activity have to be re-reviewed as a result of changes? All Section 1 group learning activities are accredited for a 1-year period. All Section 3 selfassessment programs and simulation-based activities are accredited for a 3-year period. If there are any significant changes to the content, learning objectives or desired learning outcomes, the program must be re-reviewed. This review process could be a partial review of the content or a complete review depending on how significant the changes are. This is up the discretion of the accredited CPD provider. 11. Is the accreditation of rounds a responsibility of an accredited CPD provider? No. The accreditation of rounds, journal clubs and small group learning follows a selfapproval process. Accredited CPD providers can be valuable resources for the planning committees of these activities by providing mentoring, coaching and sharing resources and tools but Royal College accredited CPD providers are not responsible for the accreditation of these activities. Some University offices of CME have taken on a leadership role within their faculty to provide oversight of these activities, however. 12. Do participants of accredited conferences need to sign in to each workshop/activity? No. The MOC Program operates on an honor system basis. We do not expect activity organizers to keep track of how many actual hours a learner participates in a learning activity. We do recognize that some CPD providers do track these hours but this is not the expectation of the Royal College. However, we do require activity organizers to maintain attendance records for a 5-year period. These records should indicate the names of the participants for any future credit validation purposes. 13. Is there a minimum amount of time I am required to retain the evaluation forms for an accredited activity? There is no Royal College accreditation policy for the retention of evaluation forms. Our recommendation is that activity planners retain a summary of the evaluation forms (which must be provided to each faculty member) for a period of time that will allow program 4

5 planners to reflect on the evaluation results to inform program change, needs assessment data, overall CPD program evaluation etc. Conflict of Interest 1. In addition to presenters and planning committee members, do moderators, session chairs, and/or facilitators need to submit a conflict of interest form? It is important that the audience be made aware of any potential conflicts of interest held by anyone with responsibility for the planning or content of an activity. Faculty and planning committee members are expected to complete and submit a conflict of interest declaration form. Faculty are expected to include a slide at the beginning of their presentation informing the audience of any declared conflicts of interest. Declared conflicts of interest from all planning committee members, session chairs, moderators and/or facilitators should be communicated to participants in some way (for example, printed in the final program). 2. What strategies would the Royal College recommend to manage identified conflicts of interest? When a conflict of interest is declared, the physician organization must have a process in place to manage identified conflicts of interest that, in the judgment of the physician organization, are of significant concern (for example, where the conflict and the content of the topic make balance and the minimization of bias very difficult). There are a number of strategies that can be considered to manage and resolve such identified conflicts: a) The speaker could be required to alter the focus of the talk to limit the areas where conflict of interest is significant. b) The topic selected could be changed, but the same speaker be used. c) The planning committee could ask for a peer review of the content to ensure that the principles of scientific integrity, objectivity and balance have been respected. d) Eliminating the topic and speaker. This is a very uncommon occurrence, but can be used as a last resort if a significant conflict of interest cannot be otherwise managed. Physician Organizations: 1. How does the Royal College define a physician organization? A physician organization a not-for-profit group of health professionals with a formal governance structure, accountable to and serving, among others, its specialist physician members through: Continuing professional development Provision of health care, and/or Research. This definition includes (but is not limited to) the following groups: Faculties of medicine Hospital departments or divisions Medical societies 5

6 Medical associations Medical academies Physician research organizations Health authorities not linked to government agencies Canadian provincial medical regulatory authorities (MRAs) This definition excludes pharmaceutical companies or their advisory groups, medical supply and surgical supply companies, communication companies or other for-profit organizations and ventures/activities. Types of organizations that are not considered physician organizations: Disease-oriented patient advocacy organizations (e.g. Canadian Diabetes Association) Government departments or agencies (e.g. Health Canada, Public Health Agency of Canada) Industry (e.g. pharmaceutical companies, medical device companies, etc.) Medical education or communications (MEC) companies (e.g. CME Inc.) 'For-profit' on-line educators, publishing companies or simulation companies (e.g. Medscape, CAE) Small number of physicians working together to develop educational programming 2. Can three or more physicians from a faculty of medicine create a program and be considered a physician organization? If the three physicians are from the same department within the faculty of medicine and are developing the activity as members of the department, then yes, they would be considered a physician organization. If the three physicians are from different departments within a faculty of medicine, the individuals cannot be equated with a physician organization. This is because physician organizations must have a formal governance structure, accountable to and serving, among others, its specialist physician members. Since a small group of physicians often have a good idea for the development of a group learning activity, they may co-develop with a physician organization to develop an activity. Educational events developed independently by a group of doctors cannot be considered for MOC Section 1 credits. 3. Does a physician organization need to have a membership base? Almost invariably, a physician organization has a membership base that defines its accountability to the profession. Non-physician organizations are often accountable to the government, the public or shareholders. Accountability to the profession is a key element in what defines a physician organization. 4. For an activity to be approved for MOC Section 1 credits does there have to be at least one specialist physician who is a Fellow of the Royal College on the planning committee? If yes, should this individual sign the application form on behalf of the physician organization? The Royal College standards for CPD accreditation require planning committees to be reflective of their target audience therefore if specialist physicians are part of the target audience they must be represented on the planning committee. Whether or not a single 6

7 individual can represent the intended target audience of an activity is a matter of judgment. The application form for MOC Credits must be signed by a Fellow of the Royal College declaring that the program was planned in accordance with the organizational, educational and ethical standards as defined by the Royal College. This Fellow does not have to be the chair of the planning committee to sign the application form. Sponsorship 1. How can I acknowledge sponsors of educational activities approved for MOC credits? Sponsors providing an educational grant for an activity approved for MOC credits may be acknowledged on the general sponsorship page in the syllabus or program of the activity. The sponsorship page(s) should be located on a page separate from the educational content (for example, on the back page of the program). 2. Can higher-level sponsors (such as platinum) be specifically thanked apart from the other sponsors at a purely social event within an activity? Yes, this is ethically permissible. 3. Can there be written or verbal recognition of the sponsors during a social event? Yes, this is ethically permissible. It is important to ensure, however, there are no accredited educational components to the social event. 4. Can a sponsor fund a specific day within a multi-day conference? Yes, this is ethically permissible if the specific day is separated into a separately accredited activity. It is ethically preferable for the acknowledgement of the funding for a day within a multi-day meeting to not be included within the overall program. Can sponsorship recognition on a website include hyperlinks to the main pages of the sponsors websites? This is ethically permissible only on pages which do not contain e-cpd material, per the CMA Guidelines for Physicians in Interactions with Industry (2007) which state There should be no direct links to an industry or product website on any web page which contains e-cpd material (guideline 37). All e-cpd activities approved for MOC Program credits must be free of any promotional displays, infomercials and any form of industry advertisements including corporate logos. 5. Can a plaque be presented recognizing partnerships with sponsors at a social event or during a trade show without any educational components? Yes, this is ethically permissible assuming that there are no accredited educational components included within these types of social events. 7

8 6. Can a sponsor pay for the printing, publishing, and distribution of abstract books as a sponsorship opportunity and be acknowledged for doing so? Yes, this is ethically permissible. Payment for printing, publishing, and distribution costs of abstract books is a service provided to participants. Such practices do not have any influence on aspects of the planning process or scientific information, including the selection of the content or speakers that formed the basis of the abstracts. 7. What is tagging Tagging is defined as the linking or alignment of a sponsor s name to a specific educational session within an accredited group learning activity. Effective July 1, 2012, tagging is not permitted. 8. Does the tagging policy only apply to a pharmaceutical company or medical device company, or does it relate to any instance where funds changes hands? The application of the tagging policy is not restricted to members of the pharmaceutical/medical device industry, but to any sponsor including not-for-profit organizations. A sponsor is an individual, group, corporation or organization who contributes funds, goods or services to support accredited educational activities, learning resources or tools. The provision of an in-kind contribution does not allow the names of organization to be tagged to specific components, but should be acknowledged in a general way as a sponsor or collaborator of the entire activity. The sponsorship acknowledgement page(s) should be located on a page separate from the educational program (for example, on the back page of the program). 9. Are there any options where sponsorship funding can be linked to specific educational activities within an approved activity? Linking a sponsor to a specific educational session within an approved activity is permissible if the educational activity is unaccredited. Unaccredited sessions may not be advertised in the educational program and must occur at times that do not compete with accredited activities. These types of activities are referred to as satellite symposia. 10. Can an award that is named after an industry sponsor be presented at a President s Gala? Yes, this would be ethically permissible as the activity is an award presentation which is not considered an accredited group learning activity. 11. If an Internet café is sponsored and the kiosks are located inside the exhibit hall only within the sponsor s booth (an unaccredited venue), is tagging permissible? Linking a sponsor to a specific educational session within an approved activity is ethically permissible for all non-educational activities and items. It is ethically preferable for the internet café to be located in an exhibit hall (or similar) therefore separated from the space where the educational activities occur. 12. Are activity organizers permitted to distribute one page promotional items at the registration booth advertising satellite symposia? 8

9 Yes, this is ethically permissible, however, the activity organizer is not required to do so. Satellite symposia are unaccredited group learning activities which must occur at times that would not conflict with or compete with accredited group learning activities. Satellite symposia may not be listed or advertised within conference brochures or schedules (including preliminary and final programs). 13. If social activities can be tagged, such as a lunch, can there be a sponsor s sign in the room where lunch is being served? Sponsorship of non-educational events such as lunches within an accredited educational activity is ethically permissible. Therefore a sign may be placed in the room where lunch is being held indicating the sponsor s name. Co-Development 1. What is co-development? Co-development is the process by which two or more organizations, at least one of whom must be a physician organization, prospectively collaborate to develop and implement an accredited educational activity, learning resource or tool. 2. How is co-development different from sponsorship? Sponsorship is the process by which individuals, groups, corporations or organizations provide support (financial or in-kind contributions) to a CPD organizer to support an accredited educational activity, learning resource or tool. Co-development is the process by which two or more organizations, at least one of whom must be a physician organization, prospectively collaborate to develop and implement an accredited educational activity, learning resource or tool. Co-development may or may not include the provision of sponsorship. In a co-development relationship, the physician organization must assume control over all aspects of the planning process (needs assessment, learning objectives, content, evaluation, speaker selection) as if they were planning the event independently. If the co-development relationship is with a pharmaceutical/medical device company there are several additional important restrictions. Members of the pharmaceutical/medical device company cannot participate as members of the planning committee that determines the content, speakers, educational format, etc. Non-physician organizations can contribute their expertise to needs assessment strategies, evaluation strategies and logistical support for the activity. 3. With the understanding that in a co-development relationship an industry representative cannot sit on the planning committee, can the industry representative recommend a physician to sit on the planning committee with the approval of the physician organization? The membership of the planning committee is the sole responsibility of the physician organization. The co-developing organization is permitted to make recommendations to the physician organization regarding the planning committee membership, but the final decision is left to the physician organization. 9

10 4. How far along in the program planning process can a co-development relationship begin? For a physician organization to assume responsibility and control all aspects of the activity, the co-development process must begin early in the planning process. Although it is ethically preferable for the physician organization to identify a need to develop an activity, it is ethically permissible for a non-physician organization to approach a physician organization with needs assessment data. In this circumstance, the physician organization must validate the relevance of the needs assessment data and determine what educational response is appropriate to meet the needs of the defined target audience. 5. When activities are co-developed with a non-physician organization, any speaker expenses such as honoraria, travel and accommodation expenses must be by the physician organization. Can other expenses related to the activity (such as food, AV, room rental) be billed to and paid by the nonphysician organization? The standards established by the CPD Accreditation Committee separates the responsibility for speaker expenses from other logistical expenses. The payment of speaker expenses such as honoraria, travel and accommodation expenses must be paid by the physician organization. The responsibility to pay other logistical expenses such as food, AV, room rentals, etc. can be delegated to a non-physician organization. These expenses may also be paid by a third party as long as this process has been approved by the physician organization. It is ethically permissible for any organization (including industry) to serve as a third party. 6. How can industry s participation in a co-developed event be acknowledged? All accredited co-developed programs should be acknowledged as such within program brochures or materials. It is ethically permissible to include an acknowledgement of the codeveloped activity within the outline of the program. All co-developed relationships should be acknowledged using the following statement. This [program, workshop or seminar] was co-developed with (name of the organization) and was planned to achieve scientific integrity, objectivity and balance. It is ethically permissible to include the non-physician organization s logo in the codevelopment statement that is published in the meeting materials. Web-Based Activities 1. Can online group learning activities developed by a Royal College Accredited CPD Provider be designated for AMA PRA Category1 Credits? All web-based group learning activities approved for MOC Section 1 credits by either an accredited National Specialty Society or Simulation Program are eligible for conversion to AMA PRA Category 1 Credits. Click here to learn more about the Royal College agreement with the American Medical Association. 10

11 2. Are there additional criteria for web-based group learning activities to be approved for Section 1 MOC Credits? In addition to the organizational, educational and ethical standards established for accredited group learning activities, there are four requirements applicable to all asynchronous web-based group learning activities. 1. Asynchronous group learning activities delivered via the web must provide an opportunity for interaction between participants and faculty/facilitators and enable participants to observe the interaction of other participants with the course faculty/facilitator. 2. Acceptable options to incorporate interactivity for accredited group learning activities delivered in an electronic format include but are not limited to; Discussion forums / Chat groups Teleconference / Videoconferencing / Webinars Twitter 3. Participants must log on to the interactive component. Fellows can claim the time spent only reviewing posted materials under MOC Section 2 (scanning). 4. Certificates of participation should only be given to participants after they have logged on to the interactive component. 3. Can sponsorship recognition on a website include hyperlinks to the main pages of the sponsors websites? This is ethically permissible only on pages which do not contain e-cpd material, per the CMA Guidelines for Physicians in Interactions with Industry (2007) which state There should be no direct links to an industry or product website on any web page which contains e-cpd material (guideline 37). All e-cpd activities approved for MOC Program credits must be free of any promotional displays, infomercials and any form of industry advertisements including corporate logos. Self-Assessment Programs 1. I am reviewing a self-assessment program (SAP) that has a minimum passing grade which must be met in order for participants to receive credit and a certificate of participation. Does this make this program ineligible for MOC Section 3 credits? Not necessarily. In order for an SAP to be approved for MOC Section 3 credits, all accreditation standards must be met. This includes the standard requiring that self- Assessment Programs must provide detailed feedback to participants on their performance to enable the identification of any area(s) requiring improvement through the development of a future learning plan. Providing specific feedback on which answers were correct and incorrect with references enables learners to determine if there are important aspects of their knowledge, skills, clinical judgment or attitudes that need to be addressed through engaging in further learning activities. The Royal College standards for self-assessment programs do not require a minimum passing grade for credit. Therefore, if all learners receive the level of feedback that meets the standard outlined above, regardless of the grade achieved, the passing grade would not be considered a barrier to accreditation. If learners receive feedback on their performance only once a 11

12 passing grade is achieved, the program would not meet the standard. Upon completing an accredited learning activity, all participants must receive a certificate of participation. 2. Can a learning activity with a pre and post-test be accredited as a selfassessment program? The answer is maybe. If the pre/post-test strategy is designed to provide learners with an assessment opportunity to assess their knowledge and use the data and feedback to identify gaps and develop an appropriate educational response, then it is possible that the program would meet the accreditation standards. Self-assessment programs use a gap analysis strategy which must: be based on an identified learning need enable a learner to demonstrate their knowledge, competence or performance provide the participant with their performance in relation to the current evidence meet all of the ethical standards established by the Royal College The gap analysis strategy must be designed to ensure that the key knowledge areas for a specific topic or condition are assessed in both a comprehensive (breadth) and complete (depth) manner. If the pre/post-test strategy is designed to evaluate the effectiveness of the learning activity in enhancing knowledge or skills and not to support a gap analysis strategy, it would likely not meet the accreditation standards. Therefore, it must be determined whether the program is designed to enable learners to assess the extent or depth of their knowledge or if it an assessment strategy is being is being incorporated into a learning activity evaluation process. 3. How can an audience response system be integrated into a group learning activity so that participants can receive MOC Section 3 credits? An audience response system (ARS) can be a useful learning tool. Not only can an ARS be used to enhance the interactivity opportunities in a group learning setting, but it can also be used to assess learners gaps in knowledge. If designed in such a way where it meets the standards, a group learning activity which integrates an ARS into the learning environment can be accredited as a self-assessment program. To determine whether the accreditation standards will be met, consider the following: 1. How will learners record their answers? The standard: Accredited self-assessment programs must provide learners with a process to record their answers. 2. How will participants receive feedback on their knowledge? The standard: Accredited self-assessment programs must provide learners with feedback on the answers they provided (which questions were answered correctly/incorrectly). 3. Has appropriate depth and breadth of the specific topic been assessed? The standard: Accredited self-assessment programs must be developed to provide a thorough review of all key knowledge areas. 4. How will the references for the correct answers be provided to learners? The standard: Accredited self-assessment programs must provide references to facilitate a review of the evidence for incorrectly answered questions. Integrating accredited self-assessment strategies into group learning is possible, but program developers must ensure that the standards outlined above as well as the other educational and ethical standards are met. 12

13 4. I have just reviewed and approved a self-assessment program for MOC Section 3 credits. Do I have to submit any paperwork to the Royal College? Yes. In order for MOC Program participants to record SAP activities in MAINPORT, they must select from a drop-down menu of approved programs. Our office populates this drop-down menu after receiving the notification of review forms submitted by accredited CPD providers. Please visit our website to access the up-to-date notification forms. Please ensure that notification forms are submitted as soon as the program is approved to ensure that the program is added to MAINPORT before the program start date. If you have approved an SAP for MOC credit, please visit our website to ensure that we have received and processed your notification of review. 5. What is the maximum accreditation period for self-assessment programs? The maximum accreditation period for self-assessment programs is 3 years, assuming the content has not changed. If the content changes significantly, it must be re-submitted at least for a partial review at the time any changes are made. Want to learn more? Please visit our website to access the SAP toolkit. Simulation 1. Now that simulation programs may apply to become Royal College accredited CPD providers, can other accredited CPD providers still review simulation activities for MOC Section 3 credits? A: All accredited CPD providers may continue to accept and review accreditation applications for simulation-based learning activities. The accredited simulation programs may only assign MOC Section 3 credits for activities they develop or co-develop and are not permitted to review applications from outside organizations. 2. How can observers of a simulation activity record MOC credits? A: As an observer of a simulation based activity, one does not receive feedback on their own performance and are therefore not able to record MOC Section 3 credits. Observers may record their participation under Section 1 accredited group learning or they may use the knowledge gained as a stimulus to create a personal learning project under Section 2 of the MOC Program. 3. What are the feedback requirements of a simulation activity? A: Organisers of simulation-based learning activities must include a strategy for instructors to provide feedback to participants on their performance. Feedback will enable the learner to develop a learning plan that will address areas that require improvement. Feedback must be based on an assessment of performance measured against the learning objectives, competencies, and practice standards as supported by published evidence. The feedback can be provided immediately or subsequent to the simulation, either verbally and/or in writing. 4. How do I count the number of hours eligible for MOC credit when reviewing a simulation activity that includes a group learning component? A: Quite often, simulation-based activities include group learning component(s). Often a facilitator will spend some time briefing learners about what they are about to experience, what is expected of them, what the simulator can and cannot do etc. When estimating the total credit time for MOC credits, all time spent providing instructions and/or a short lecture on the simulation topic, providing the rationale and instructions for the activity the simulation scenario itself, and debrief time is eligible for MOC Section 3 credits. When a 13

14 learning component is essential to the simulation activity, it should be considered part of the accredited Section 3 activity. 14

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