WSMA CME Application Process Guide

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

Minimum deadline: 30 days prior to activity date. Applications will not be submitted for review past that time.

2-Week Fulfillment Documentation late fee

$250 fee assessed after 2-week (14-day) deadline

Post-Activity late fee

$250 fee assessed for post-activity materials submitted after 60 days

*Submission date is based on the date which the application is finalized and available for committee approval.

Pre-Activity Approval Marketing

Marketing your activity prior to CME approval is allowed; however, CME credit should not be mentioned.
Marketing material may include the agenda, faculty, name, date, and location.
Advertising a course stating “Category 1 CME credit is pending” or the “Category 1 CME credit has been requested”, or has been “applied for” is not allowed. Marketing materials may not include statements such as "8-hour educational meeting," which may mislead the learner to think CME has been awarded.

All marketing materials must be approved by CME staff prior to distribution (including web-blasts, tweets, Facebook posts, etc.).

WSMA CME Application

General Information

Important

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

The following must be completed prior to the start of the planning process

At least one planning committee member must watch the ACCME's short 3 minute video with Dion Richetti, ACCME Vice President for Accreditation and Recognition. The video explores our expectation for alignment between educational activities and the professional competencies as defined by CME stakeholders and healthcare leaders.
Disclosure forms for the planners and, if applicable, resolution. This requirement is covered in detail in the Commercial Independence section below.
The activity chair and coordinator must complete the free NFEI training on appropriate CME content versus promotional activities. The online activity clarifies the roles and responsibilities of those in control of content and helps learners to understand current CME guidelines. The NFEI initiative maintains high standards in CME as well as protects the credibility of our CME activities. The training is between 30 – 45 minutes. Participants can start and stop and complete it in parts.

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

Activity Details

Activity Chair
The activity chair is the individual most in control of content; including gap and need identification, speaker selection, agenda formatting, etc. The chair does not need to be a physician.

CME credit
CME credit can be awarded in 15 minute (.25 increments). Time increments to round up to the nearest 0:15 minute include: 0:10, 0:25, 0:40, 0:55. Time increments to round down to the nearest 0:15 include: 0:05, 0:20, 0:35, 0:50. Breaks and meals where education is interrupted do not count toward the total activity credits. If rounding, ensure that the total time does not exceed the length of actual time in the meeting (i.e. rounding by session equals 2.5 hours, however the meeting only lasts from 1:00pm - 3:15pm [2.25 hours]. Total credits requested would be 2.25 hours.).

Agenda

Amount of time	Time	Activity or session title
.75	9:00-9:45	Session A
.5	9:45-10:15	Session B
.25	10:15-10:30	Break (does not count for CME)
1.0	10:30-11:30	Session C
.5	11:30-11:55 (25 min)	Session D
.75	11:55-12:50 (50 min)	Lunch (does not count for CME)
1.0	12:50-1:55 (55 min)	Session E
3.75	Total Credits Requested

Commercial Independence

Disclosures and Resolution of Conflict of Interest

The disclosure and resolution process is imperative to ensure that accredited CME is independent, fair and non-biased. Accredited CME is accountable to the public for presenting clinical content that supports safe, effective patient care and does not promote the goods or services of a commercial interest.

One of the methods the WSMA safeguards against bias is through the use of disclosure forms. The disclosure form is completed by everyone in control* of the content of an educational activity to identify all relevant financial relationships with any commercial interest to determine whether a conflict of interest exists. Disclosures are reviewed and, should a conflict of interest be identified, the conflict is resolved according to policy.
*except in those rare instances when content is not related to a commercial interest.

Everyone in control of content must submit a signed disclosure form. Attach the forms to the application.

Timeline

For planners: All conflicts of interest must be identified and resolved in advance of any activity planning.
For speakers: All conflicts of interest must be identified and resolved in time for the 2-week Fulfillment Documentation.

Definitions:

Commercial interest: any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients.

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

Relevant financial relationship: a financial relationship with a commercial interest in any amount occurring within the past 12 months that creates a conflict of interest

Conflict of interest: circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

The ACCME considers “content of CME about the products or services of that commercial interest” to include content about specific agents/devices, but not necessarily about the classification of agents/devices or about the whole disease class in which those agents/devices are used.

What to do with your disclosure review:

If the disclosure has nothing to disclose mark "no" and move to Educational Planning.

If the disclosure has something indicated, mark "yes" and use this flow chart to identify if you need to resolve a potential conflict of interest.

List the names of planning committee members under the checkbox for the process of identification or resolution.

If a relationship is disclosed that is not a commercial interest you can indicate that in the 3rd checkbox of the green section "Relationship disclosed, reviewed and is not a commercial interest".
If a relationship is disclosed that is not relevant or related to the activity or topic you can indicate that in the 4th checkbox of the green section "Relationship disclosed, reviewed and found to be not related to activity".
If the activity content is in no way related to an ACCME-defined commercial interest there cannot be any relevant financial relationships nor any potential conflicts of interest and you do not need to collect disclosure forms. If this is the case, mark the 4th checkbox "The content of this activity is in no way related to products or services of an ACCME-defined commercial interest, therefore there are no relevant financial relationship to disclose and not potential conflicts of interest". Always check with WSMA staff before checking this box.

List the names of faculty under the checkbox for the process of identification or resolution

If a relationship is disclosed that is not a commercial interest you can indicate that in the 3rd checkbox of the green section " Relationship disclosed, reviewed and is not a commercial interest".
If a relationship is disclosed that is not relevant or related to the activity or topic you can indicate that in the 4th checkbox of the green section "Relationship disclosed, reviewed and found to be not related to activity".
If the activity content is in no way related to an ACCME-defined commercial interest there cannot be any relevant financial relationships nor any potential conflicts of interest and you do not need to collect disclosure forms. If this is the case, mark the 4th checkbox "The content of this activity is in no way related to products or services of an ACCME-defined commercial interest, therefore there are no relevant financial relationship to disclose and not potential conflicts of interest." Always check with WSMA staff before checking this box.

Methods to resolve conflict(s) of interest include:

Check the box on the application and include documentation (see below for examples) of the resolution process applied.

Peer review of CME content conducted at another oversight level to assure balance and non-bias.
Change in focus of course so the activity does not include information related to products or services about which the planning committee member has a conflict.
Sever relationship(s) between member and any related commercial interest.

Documenting the resolution process:
The documentation for your resolution process should be a written attestation describing the process taken to resolve conflicts of interest.

For example:

The chair reviews the presentation PowerPoint and found that it was fair and non biased. Nothing further needs to be done to "resolve" the bias. The chair's review and findings are documented and attested to in a letter to the CME Program Committee.
The chair reviews the presentation PowerPoint and found a slide with commercial interest names and logos. The chair reviews the Clinical Content Validation Policy with the speaker and asks the speaker to remove the bias using the methods to ensure independent activities. The speaker removes the conflict from the slides. This process is documented in a memo to the CME Program Committee and the chair attests.

In addition to disclosure of commercial interests; the disclosure form is also the WSMA's method to relay the expectations for planners and faculty. Specifically, the form includes the Content Validation Policy, which states:

Content Validation Policy
Accredited CME activities are accountable to the WSMA, participants and the public for presenting clinical content that supports safe and effective patient care. This policy intends to ensure that patient care recommendations made during CME activities are accurate, reliable and based on current scientific evidence. Clinical care recommendations must be supported by data, scientific evidence or information that is accepted within the profession of medicine. Specifically,

All the recommendations for care, medications or diagnostic procedures involving clinical medicine in a CME activity must be based on the best evidence available that meets accepted standards within the profession of medicine. Presenters are expected to provide adequate justification for their indications and contraindications in the care of patients.
All scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis. Any variation from or incompleteness of the research is to be identified, relayed and explained to the audience to allow assessment of its validity and usefulness.
No activity may award credit for CME if it intends to promote recommendations, treatments, or manners of practicing medicine that are not within the generally accepted standards of medical care, known to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients. Activities that are devoted to advocacy of unscientific modalities of diagnosis or therapy are not eligible for CME credit.

Methods to ensure independent activities

Use of generic names. If the CME educational material or content includes trade names, where available trade names from several companies should be used, not just trade names of single products.
Unless this is a product which has no comparable alternatives, the educational content should list all like products, including pros and cons.
Reference sources, ideally peer-reviewed journals, for any clinical recommendations.

Disclosure to Audience

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

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

Disclosure can be made in any of the following ways:

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

Use the wording as follows:

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

No one in control of content has indicated a relevant financial relationship with an ACCME-defined commercial interest. All clinical content presented is evidence-based and unbiased.

Otherwise, please use the following disclosure statements:

Planning Committee Disclosure

The planning committee for this activity, (list names), have indicated no relevant financial relationships with an ACCME-defined commercial interest. Their planning contributions were evidence-based and unbiased.

Faculty Disclosure

______ has indicated no relevant financial relationships with an ACCME-defined commercial interest. Their presentation will be evidence-based and unbiased.

Something to disclose

_______ has indicated a relevant financial relationship(s) with an ACCME-defined commercial interest [name of commercial interest, type of relationship]. Their [planning contribution was/presentation will be] evidence-based and unbiased.

Activity Not Related to Commercial Interests

The content of this activity is not related to products or services of an ACCME-defined commercial interest; therefore no one in control of content has a relevant financial relationship to disclose and there is no potential for conflicts of interest.

Educational Planning

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

Identifying Gaps:

What is the problem that needs to be addressed?

Identifying Gaps in Physician Learning
A “gap” is the difference between what is currently going on in practice compared to ideal or best practice. A gap in practice may be identified due to new guidelines, treatment, management, and prevention mechanisms. Additionally, a gap in practice may be identified due to failure to meet new guidelines, treatment, management, and prevention mechanisms.

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

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

Does the reason for this activity relate to any of the following? The following statements may help you describe your educational gap.
New or updated approaches in technology/ treatment/ services	Rapid advances in the field	New or changes in scope of practice/guidelines for care/evidence based medicine
New regulatory, organizational, legal requirements/ changes	New or updated processes of care	Experience in managing or treating
Updates in education or training	Appropriate referrals to specialist	Condition is difficult or challenging to diagnosis or treat
Not applying current clinical algorithms	Condition is poorly understood	Applying wrong or incorrect technique
	Inappropriate clinical management	Coordinating care

Gaps can be between populations of patients:

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

Gaps can be in the outcomes of patient care:

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

Gaps can be in physician performance:

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

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

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

Ways to Identify Gaps
At each of these levels there are several areas that could be reviewed to identify gaps. WSMA’s Provider Education page Provider Education page has links to many sources for gaps.

Individual physician level: Performance gaps could be identified by asking physicians about their performance (how often do you do X) and/or by auditing patient charts. One downside of asking physicians to subjectively assess and report their performance is that they may not be able to give an accurate self-assessment. (This type of gap assessment is best used for individualized CME, such as performance improvement CME and point-of-care.)
Group level: Chart audits could also help identify gaps at a group level. More and more physician groups now report their performance and patient outcomes to outside sources. These sources can be tapped to look at performance and quality gaps.
Health care provider level: Physician group, hospital, and healthcare system quality and performance data are available publicly from a variety of sources. A few of the sources are provided here:
Local community level: Public health departments have data about the communities they serve. These data can point to quality gaps. Local newspapers often report on health conditions, quality of care, and problems in health delivery services in areas affecting their readers. These data often directly relate to local, community level quality care gaps. In addition, sources such as the following can be accessed to review quality data at a local, community level:
- County Health Rankings
- Washington Health Alliance Community Checkup
State and regional level: Government agencies, in addition to other groups, publish data at the state and regional levels:
National level: National health data are available from a variety of sources, including:
- Agency for Healthcare Research Quality
- Institute for Health Metrics Evaluation

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

Identifying Sources:

How did you recognize this opportunity for change?

What sources did you use to identify the gap (above)? Remember, all activities may have different sources; is the gap based on a quality gap at the hospital level? Is there a public health gap identified through the local public health department? Were there new clinical guidelines issued by your specialty society’s national organization?

Factors Outside the Provider's Control

What factors contributed to the problem (gap), but aren’t due to the learner (i.e. something the physician has to deal with, but doesn’t necessarily control) that you can address in the activity? Include how you will attempt to address the factors.

For example:
The planning committee identified that patients are not complying with the recommended treatment plan. Therefore, the course will provide learners with examples of brief 2 minute explanations on the importance of compliance with treatment.

Barriers to Physician Change

What potential barriers do you anticipate learners may have in incorporating new knowledge, competency, and/or performance objectives into practice? Include how you will attempt to address the factors.

For example:
The planning committee identifies that physicians are hesitant to discuss end of life options with patients of different cultural backgrounds. Therefore, the course will address cultural best practices and offer strategies to approach, ask, and listen to their patients.

Identifying Needs

What type of educational needs to the learner have?

Learning needs can contribute to the gap (i.e. due to the needs there is a gap in practice). Identifying the educational need helps identify how we can close the gap. In other words, to solve the problem (gap), the learner "needs" to...

In order to identify what the learner needs to learn in the educational session, it is helpful to explore if the learner:

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

For example:
If a gap were detected in prescribing a particular drug for a certain indication, asking why the gap exists could help identify if learners need knowledge on the use of the drug (knowledge need), strategies for identifying when to prescribe the drug (competence need), or support to ensure they are indeed prescribing the drug appropriately (performance need).

Learner Objectives

What do you want the learner to do after this activity? While the need indicated a behavior that wasn’t being done in practice, the objective states what we want them to be able to accomplish after the educational session. Likely, the objectives will be more detailed than the needs.

In order to evaluate our activity later to see if we accomplished our goals, the objectives must be stated in behavioral, measurable terms. For example, you can measure if they can “apply” a concept; however measuring if they “understand” would be less straightforward.

For example:

Use clear and consistent messaging and strategies to engage patients in managing healthy weight status.
Implement the maternal early warning sign tool to detect impending critical illness.

Going Beyond Describe
Accredited CME is tasked with changing behavior. We expect that change in knowledge is implicit in our educational opportunities and through implementation of the knowledge, we will change a behavior (competence, performance or patient outcomes).

If you are designing activities to change competence, performance, or patient outcomes and you want to facilitate the transfer of learning into practice, your learning objectives will need to go beyond helping physicians “know” or “comprehend” something. Rather than “describe guidelines and explain situations,” we want our learners to “apply” the guidelines, or at a minimum be able to “interpret” the situation to know if the guidelines are applicable.

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

Identifying Outcomes

Looking at the objectives above, what are you trying to change? This section will help formulate what type of evaluation tool to use later in the application process.

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

Target Audience

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

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

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

Learning Experience

“Tell me and I forget, teach me and I may remember, involve me and I learn.” – Benjamin Franklin

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

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

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

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

Learning experiences are broken into three tiers.

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

Why is this educational format appropriate?

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

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

Desirable Learning Attributes

Accredited CME looks to align itself with "competencies" identified by recognized medical organizations and boards as important values that should guide our educational efforts. Aligining our education with these competencies is a futher step in legitimizing the scope of CME.

Budget

Commercial Support and Exhibits
Will you receive commercial support for this activity?

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

Exhibit fees are not considered commercial support, even if they are from a Commercial Interest.

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

You do not need to have all your grants at the time of the application submission; they will be due with the fulfillment documentation 2 weeks prior to your activity. At this point we want to know if you plan to receive commercial support.

Income Definitions

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

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

Advertising/vendors/exhibitors: money received for advertising or exhibiting; not commercial support.

Educational grants: Financial support from a Commercial Interest paying for any part of the activity (e.g. breakfast, badges, coffee breaks, etc.) Must have signed letter of agreement at time of activity. WSMA has a letter of agreement you may use, or you may use the commercial interest's letter of agreement, so long as it meets the WSMA's expectations for independence (WSMA staff can help you determine if this is the case).

Marketing

You are required to submit all marketing materials for approval prior to publication, distribution, broadcasting, or going live.

Indicate using the check boxes how you plan to market this activity. Include copies for review.

This section can be completed prior to submission of the activity application. This may be an ongoing review if you plan to market your activity in a variety of formats and at different times.

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

Engagement with the Environment

This section is optional, but strongly encouraged. This section is designed for you to identify methods to maximize the impact of your activity, such as reinforcing tools, working with organizations to support your message and aligning your activity with quality metrics.

Reinforcing Strategies

Reinforcing (repeating) your message helps learners retain a greater percentage of new information learned. What tools or methods can you use (not including the marketing or educational content of the activity) to reinforce the objectives of your activity.

Include a copy of the strategy in post-activity materials, or once the strategy has been implemented.

For example: Learners can access an online toolkit to access patient forms, pamphlets and informational videos.

Your organization distributes a monthly newsletter where you highlight key takeaway's from your CME activity.

Additional Stakeholders

Are there any organizations that you can partner with to make sure your activity has the most impact? A collaborator is an organization with special expertise in the subject matter or influence over the targeted learners.

Collaborators are purposefully chosen and not necessarily a joint provider or educational partner with which you have contracted to assist in managing the activity.

For example: The applicant partnered with King County Public Health and Seattle Police Department on the topic of gun violence.

Framework for Quality

Did you identify the gap as a part of a quality improvement issue or could your gap be related to quality data? If so, identify the method you used to identify the gap and describe how your activity is contributing to overall healthcare quality or patient safety.

For example: The applicant's hospital quality performance indicators showed an above average variation for properly identifying stage 1 cervical cancer. The report is instrumental in raising awareness of the need to improve practice and patient outcomes. The report will be run 6 months after the activity to demonstrate change.

Chair Attestation(s)

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

Chair Attestation: Maintenance of Certification (optional)

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

Submitting your Application for Approval

Once you have completed your CME application it is ready to be reviewed for submission to the CME Program Committee. Applicants will upload materials to the corresponding folder in SharePoint.

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

The CME staff review and subsequent applicant edits cycle may take a few tries before the application is ready for submission to the CME Program Committee. For this reason, please make sure to budget adequate time into your planning process.

Once the CME application has been finalized it is ready to be reviewed by the CME Program Committee. CME staff will submit the application on your behalf. Should the committee require any edits to the application, these changes will need to be completed before the application can be approved. If there are no changes, the committee will return a finding of approval or non-approval. If your activity receives approval, congratulations! You can now move to the next section.

Accreditation Statement

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

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

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

Directly Provided Accreditation Statement

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

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

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

Jointly Provided Accreditation Statement

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

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

Maintenance of Certification Statement

If your activity has been approved for ABIM Maintenance of Certification points, add the following statement to the end of the accreditation statement:

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to ___ MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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

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

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

2-Week Fulfillment Documentation

Speaker Disclosure Forms

In the 2-week fulfillment documentation attach the disclosures for those in control of content. At the two-week mark this should only include speakers, as planner disclosure forms were included with the CME application.

Speaker Conflict of Interest Resolution Documentation

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

Disclosure to Audience

In the 2-week fulfillment documentation attach or link to your disclosure to audience for those in control of content (planners and speakers)

Commercial Support

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

Jointly provided activities must have 3 signatures:

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

Directly provided activities must have 2 signatures:

WSMA CME department representative
Commercial supporter representative

Method of Commercial Support Disclosure to Audience

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

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

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

In the 2-week fulfillment documentation attach or link to your acknowledgement of commercial support.

Evaluation

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

For example:

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

A course on new techniques may be best assessed using a case presentation, where the learner reads a medical case and answers how they would treat the patient using the new skills learned.

Below are options for assessing your learner. They are broken out by intended outcomes (competence, performance, patient outcomes). Using the knowledge of your learners and what the activity is indending to change; identify the evaluation method that will best measure change.

Assessing Competence (subjective)

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

Tool/Measure	Definition
Likert (global) rating scales	A series of statements expressing values, or beliefs, with which the clinician may indicate strong agreement – strong disagreement, or neutral; or if ability to implement a process or procedure has significantly increased – significantly decreased or neutral.
Written Examination	Some questions to help you measure objectives which support the application of new knowledge include: Factual: How would you use…? Conceptual: What approach would you use…? Procedural: What would result if…? Meta-cognitive: How would you apply what you learned…?

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

Assessing Performance (subjective)

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

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

Assessing Patient Outcomes

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

For example:

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

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

Mandatory Questions

Please include the following questions in your evaluation method:

A "commercial interest" is defined as any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients. Among the exemptions to this definition are government organizations, non-health care related companies and non-profit organizations that do not advocate for commercial interests.
Did you perceive any bias toward a "commercial interest" in this activity?

No

Yes

If yes, please explain:
What problems or challenges do you feel that you’re not able to address appropriately or to your satisfaction?
What potential barriers do you anticipate encountering as you incorporate what you learned at this activity?

Recording Credit

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

For example:

The WSMA has a sample online template you may use.

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

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

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

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

Certificate of Attendance

A PDF of the official, signed CME attendance certificates will be distributed once all material for the 2-week fulfillment documentation has been finalized, submitted and approved by the CME department. CME attendance certificates are not considered valid without an official CME department representative signature.

Post Activity Documentation

Website Documentation

Create full-sized PDF's of your CME activity's website. You do not need to include presentations. AMD: Ask Ben to send CME staff the website folder.

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

Summarized Evaluation

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

Attendance Record and Credit Claimed

Attach a copy of your attendance record (sign-in sheet, electronic record) and credit claimed.

For example:

Name	Credentials	Credit Claimed
Harry Potter	MD	4.5
Hermoine Granger	MD, PhD, MPH	5
Ron Weasley	DO	3.75

CME Certificate Verification

Based on your attendance records your organization will be charged a CME certificate fee based on WSMA-membership.

Disclosure to Audience

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

Final Budget

Complete the final budget form, including income and expenses. Under expenses you may add lines for additional items as necessary. See the Budget section for more information.

Accreditation Statement

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

Reinforcing Strategies

Attach any tools used to support the content (e.g. online resources, publications, handouts, etc.).

Final Review

CME staff will review your post-activity documentation. Once complete, you will receive an invoice for your CME activity. Payment is due 30 days from receipt of invoice.

CONGRATULATIONS!

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

WSMA CME Program Policies

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WSMA CME Application Process Guide

Table of Contents

CME Application Due Dates

CME Fees

Pre-Activity Approval Marketing

Important

Activity Details

Disclosures and Resolution of Conflict of Interest

Timeline

Definitions:

What to do with your disclosure review:

List the names of planning committee members under the checkbox for the process of identification or resolution.

Methods to resolve conflict(s) of interest include:

Disclosure to Audience

Identifying Gaps:

Identifying Sources:

Factors Outside the Provider's Control

Barriers to Physician Change

Identifying Needs

Learner Objectives

Identifying Outcomes

Target Audience

Learning Experience

Desirable Learning Attributes

Income Definitions

Reinforcing Strategies

Additional Stakeholders

Framework for Quality

Chair Attestation: Maintenance of Certification (optional)

Maintenance of Certification Statement

Method of Commercial Support Disclosure to Audience

Assessing Competence (subjective)

Assessing Performance (subjective)

Assessing Patient Outcomes

Mandatory Questions

Website Documentation

Summarized Evaluation

Attendance Record and Credit Claimed

CME Certificate Verification

Disclosure to Audience

Final Budget

Accreditation Statement

Reinforcing Strategies

CONGRATULATIONS!