APPLICATION FOR CONTINUING PHARMACY EDUCATION ACCREDITATION SERVICES LIVE PROGRAM

Transcription

1 APPLICATION FOR CONTINUING PHARMACY EDUCATION ACCREDITATION SERVICES LIVE PROGRAM University of Colorado School of Pharmacy Office of Continuing Pharmacy Education Date of Application (Please note that the School of Pharmacy requires at least 60 days advance notice to consider an application for continuing pharmacy education accreditation.) Applicant Department/Organization Contact Person Address City State Zip Phone Fax Proposed Activity Title Activity Date(s) Activity Times (start and end) Activity Location (You may submit a draft agenda, if it is available, with this application for review.) If a home study activity, note what type of activity, e.g., CD-ROM, web activity, workbook Anticipated attendance Estimated number of contact hours requested Target Pharmacist Audience Community Hospital Managed Care Consultant Home Care Other List of proposed Faculty How were the faculty selected? 1. How were the educational needs of the audience determined? (Please submit evidence of needs assessment for each item that you check as conducted.) Literature search Consultations with experts Advisory board/planning committee Evaluation summary comments from previous event Patient data, clinical or patient care indicators Requests from potential pharmacy participants Poll/questionnaire results of potential pharmacy audience Focus group or reviewer panel results Recent event or public-awareness, patient-driven necessity Data from outside source (Centers for Disease Control, FDA, Health Department) 2. What is the proposed overall goal(s) for the activity? 3. Proposed Learning Objectives with Demonstrable Outcomes: Please indicate how the identified needs cited above will be incorporated into the learning objectives of your activity. What are the objectives FOR THE LEARNER of the educational intervention? Please note that the content of the educational material and assessment of learning must be related directly to the learning objectives. What will the participant know or be able to do differently as a result of the learning? This type of objective gives potential participants clear information on what they can expect

2 to take away from the activity, communicates to the speaker what he/she is expected to convey to the learners, and provides a measurable basis for evaluation of whether the objectives have been met.. Examples: Differentiate acute (simple) pain from chronic (complicated) pain. Upon completion of this program, the participant should be able to: 1. Describe the pathophysiology of allergic rhinitis. 2. Recognize the drug mechanisms of pharmaceutical agents employed in the treatment of allergic rhinitis. 3. Evaluate the clinical efficacy of medications used to treat allergic rhinitis. 4. Distinguish between studies that evaluate cost-efficacy and cost-effectiveness. Specific verbs useful for learning objectives include: 1. Comprehension: assess, classify, compare, contrast, demonstrate, describe, differentiate, explain, interpret 2. Application: apply, calculate, develop, operate, practice, prescribe, select, solve, translate, use, utilize 3. Analysis: analyze, appraise, debate, deduce, diagram, distinguish, measure, question, summarize 4. Synthesis: arrange, collect, construct, create, design, detect, formulate, integrate, manage, specify, validate 5. Evaluation: critique, determine, estimate, evaluate, judge, rank, recommend, revise, score, test 6. Those that impart skills: administer, demonstrate, diagnose, diagram, employ, integrate, measure, operate, palpate, process, project, record 7. Those that convey attitudes: acquire, consider, encourage, exemplify, modify, plan, reflect, revise, transfer 8. Those that convey information: cite, define, identify, list, quote, repeat, state, tabulate, trace, update Do not use the following verbs: appreciate, have faith in, know, learn, understand, and believe as they are vague and open to many interpretations, and hard to evaluate. Please write a minimum of 4 objectives as learner outcomes, which must be listed in any promotional literature and in the enduring material. Upon completion of this program, the participant should be able to: How do you intend to make these objectives known to the prospective participants? Check all that apply. Brochure/promotional literature (pre-approval required) Learning objectives to be identified at the beginning of the activity (required) Other (please explain):

3 5. How do you plan to announce the activity? Save-the-date announcement Flyer Brochure announcement Web announcement 6. When do you plan to announce the activity? (The School of Pharmacy must approve all promotional materials regarding this activity prior to distribution.) 7. What instructional methods will be used? Lectures Slide presentations Panel discussion Q&A sessions Case studies Problem solving activities Short writes Think-pair-share exercises Small group discussions Real or simulated (actor) patients Workshops Hands-on participation Syllabus Audio-visual aids Audience Response System Pre-test and post-test questions Interim quizzes Brainstorming Role-playing 8. How will attendance be recorded? Sign-in sheet Evaluation form with participant information on it Statements of attendance Other 9. How will the activity be evaluated? Written evaluation form Trained observer Discussion group/focus group Audience response system Post-activity evaluation ( /mail) Random sampling evaluation 10. Do you anticipate receiving commercial support for this activity? Yes No List companies: 11. Will a registration fee be required of participants? Yes No 12. Who will be responsible for paying the fees for the School of Pharmacy accreditation services? Name of responsible party Phone number of responsible party 13. Preliminary Budget. Complete the following information or attach the budget (rough estimates are acceptable) indicating projected revenue and expenses for this activity. Please note the University of Colorado School of is not liable for expenses or losses associated with activities seeking CE accreditation. No state funds may be used to cover a financial loss for this activity.

4 Projected Revenue Projected Expenses Registration Fees Commercial Support Speaker Honoraria (list companies) Travel Food/Catering Meeting Room Rental A/V Charges Brochure Printing Department Support Syllabus Printing Postage Fax, phone, etc. Other Support (specify) Faculty Dinner Miscellaneous CME/CE Administrative & per person fees Total Revenue: Total Expenses: The School of Pharmacy will contact you regarding this application. Further information may be required. Roles and responsibilities of the co-sponsor and the School of Pharmacy will be discussed and outlined in a co-sponsorship agreement and accreditation fees will be determined. Please note that this program and all continuing pharmacy education programs must be produced in accordance with the Educational Standards of the Office of Continuing Pharmacy Education. If you have any questions, please contact the School of Pharmacy at Submitted by: Signature Date Name Title Return this application and attached documentation to: University of Colorado School of Pharmacy Office of Continuing Pharmacy Education C238-P15, Research Building E. 19 th Avenue, Room P Aurora, CO or return by to: Kathleen.McCartney@UCDenver.edu

5 UNIVERSITY OF COLORADO SCHOOL OF PHARMACY (SOP) OFFICE OF CONTINUING PHARMACY EDUCATION EDUCATIONAL STANDARDS Activity Purpose The educational activity is designed for scientific or educational purposes and not for promotion of any proprietary product, either directly or indirectly. Independence The SOP Office of Continuing Pharmacy Education, as the provider of continuing pharmacy education, is ultimately responsible for control of content and selection of presenters, moderators, and authors. All educational content will be developed and presented in accordance with ACPE (Accreditation Council for Pharmacy Education) Standards for Commercial Support; and as such, will be balanced and fair without commercial bias, and will be based on best evidence from established medical literature. The SOP will select presenters, moderators, and authors based on balance and independence. The provider will not permit any organization, corporate sponsor, or an agent thereof to script, emphasize or influence the content of the program. Financial Disclosure The SOP Office of Continuing Pharmacy Education will disclose to program participants the source(s) of funding for the programs, as well as any known relationships, financial or otherwise, between the organization or corporate sponsor and anyone in a position to influence the content of the activity. Independence of the Provider in Use of Contributed Funds Funding support for the program must be disbursed only to the University of Colorado School of Pharmacy. The SOP will make suitable arrangements for compensating presenters, moderators and authors. Promotional Activities No promotional activities (such as product advertisements or promotional literature) will be permitted in the same room or obligate path at the program. At the discretion of the SOP, exhibits may be associated with a program in a specially designated area. Objectivity and Balance The SOP will make every effort to ensure that data regarding commercial products are objectively selected and presented, with favorable and unfavorable information and balanced discussion of prevailing information on the product(s) and alternative treatments. Presenters, moderators and authors will be required to make proper disclosure when discussing the use of a drug or product that is not approved for use in the U.S. When the format of the program permits, a meaningful opportunity will exist for scientific debate, questioning and discussion. Scientific Rigor The SOP will ensure, to the extent possible, that clinical data is based on adequate and well-controlled studies and that the presentation of clinical data shall be sufficiently complete, and includes results and methodology to allow for critical analysis by the faculty and audience. Limitations on data will be disclosed. Evaluations Activity participants will be provided with an opportunity to evaluate the program and presenters (faculty). The procedure and methodology for this evaluation is at the discretion of the SOP. General evaluation results will be shared with any company or organization that provides full or partial funding support; however, use of evaluation results for any purpose other than internal review requires the consent of the SOP. Evaluations of speakers will be shared with the individual speaker, but will otherwise be kept confidential. Program Ownership If this program is offered in mediated form (i.e., non-live, print, audio, video, computer-assisted instruction) and has identified the SOP Office of Continuing Pharmacy Education as the accredited continuing education provider (including the ACPE Universal Activity Number), it may not be reprinted, redistributed or offered for continuing educational credit by anyone else without the express, written consent of University of Colorado School of Pharmacy. A company or organization, with prior agreement, may distribute an educational program developed by the SOP. However, distribution and use of the program must conform to standards outlined in the Letter of Agreement and the ACPE Standards for Continuing Pharmacy Education.