Kettering Health (ketteringhealth.org)
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Kettering Med Ed
Internal Medicine
Residency
Transitional Year
Residency
Breast Imaging
Fellowship
Cardiovascular
Disease Fellowship
Hematology/
Oncology Fellowship
Interventional
Cardiology Fellowship
Medical Student Rotations
Research
CME
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Calendar of Events
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Cardiology Oncology
Colloquium
Presentations
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Grand Rounds
Presentations
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Obtain Event Credit
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Obtain CME Transcript
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Policies & Procedures
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Planners:
Forms/Applications
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Location
Advanced
Practice Providers
Observership Application
Institutional Policy for Vacation and Leave of Absence
Life in Dayton
Locations
Kettering Med Ed
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Internal Medicine Residency
Director's Welcome
Mission & Aims
Chief's Welcome
Our Residents
Recent Graduates
Fellowships
Academic Excellence
Curriculum
Lifestyle Medicine Track
Ambulatory
Our Team
Benefits & Salary
Post-Grad Opportunities
Accreditation
Hospital Areas
WE ROCK!
Application Process & FAQs
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Transitional Year Residency
Director's Welcome
Mission & Aims
Chief's Welcome
Our Residents
Recent Graduates
Curriculum
Our Team
Openings
Benefits & Salary
Accreditation
Hospital Areas
WE ROCK!
Application Process
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Breast Imaging Fellowship
Requirements
How to Apply
Accreditation
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Cardiovascular Disease Fellowship
Mission & Aims
Our Team
Curriculum
Benefits & Salary
Accreditation
Testimonials
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Hematology / Oncology Fellowship
Mission & Aims
Our Team
Curriculum
Benefits & Salary
Accreditation
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Interventional Cardiology Fellowship
Mission & Aims
Our Team
Benefits & Salary
Accreditation
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Medical Student Rotations
Research
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CME
Calendar of Events
Cardiology Oncology
Grand Rounds
Obtain Credit for Event
Obtain CME Transcript
Policies
Planners: Forms/Applications
Location
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Advanced Practice Providers
Observership Application
Institutional Policy for Vacation and Leave of Absence
Life in Dayton
Locations
CME Activity Application & Planning
Administrative Items
* Activity Title or Topic:
* Chief Planner:
Phone:
* Email:
* Planning Team -
Identify all individuals involved in planning this event:
Physician
Nurse
Administration
Faculty
Advanced Practice Provider
Student
Resident/Fellow
Other
Admin. Asst./Event Liaison:
Phone:
Email:
* Event Date:
(Must be at least 30 days from today's date, prior to the event)
* Start Time:
* End Time:
* Cat. 1 Credit Hours:
* Activity Type:
Single Event
Regularly Scheduled Series
Other -
Please explain
* Activity Frequency:
Daily
Weekly
Monthly
Quarterly
Other -
Please explain
Activity Specialty:
Estimated # of Attendees:
* Location:
Dean Amphitheater
Other -
Please explain
* Speaker(s):
Speaker's Title & Organization:
* Speaker's Location / Address:
Speaker's Phone:
Speaker's Email:
Speaker Admin Assistant:
Speaker Contact Info:
Yes
No
Financial Support?
If yes, explain, otherwise skip this section:
Financial Support Request for:
Honorarium
Travel and Housing
PowerPoint/Handout Preparation
Other - Please explain
From pharmaceutical or medical device industry:
From Foundation or other local sources:
Company I'm working with for finanical support:
Educational Detail
Identify the Practice Gap
The professional practice gap is the difference between the practice that actually occurs and what the ideal practice should be. In other words, what is the problem or issue in practice that needs to be addressed? For any topic proposed, how does that topic relate to a problem in practice?
(Only one is required)
* Gap # 1 - General Topic:
Gap (the difference between current and best practices):
* This gap is the result of a lack of or deficiency in:
Knowledge
Competence
Performance
Gap # 2 - General Topic:
Gap (the difference between current and best practices):
This gap is the result of a lack of or deficiency in:
Knowledge
Competence
Performance
Gap # 3 - General Topic:
Gap (the difference between current and best practices):
This gap is the result of a lack of or deficiency in:
Knowledge
Competence
Performance
* This activity will result in improved:
Competence
Performance
Patient Outcome
Activity Learning Objectives - Learner will be able to:
The objectives should directly state the desired outcomes of the activity in terms of improved knowledge, competence, performance and/or patient outcomes. The objectives should reflect the ultimate goal of CME, that is to improve the delivery of patient care.
Suggestions on Writing Objectives
* 1.
2.
3.
4.
5.
6.
Identify the Specifc Source of Your Topic/Practice Gap
New methods of diagnosis or treatment:
New medications or new indications for use:
New technology:
Clinical quality assurance/audit data:
Consensus of established experts:
Committee/Dept Meetings:
Quality Improvements:
Maintenance of Certification:
Peer-reviewed journals or literature:
Policy, legal or ethical considerations:
Practice management effect on patient care:
Professional Society guidelines, national practice standards:
Public health data:
Survey:
Other:
Identify your target audience:
Yes
No
* Does activity content match audience's scope of professional activities?
If no, explain, otherwise skip:
Please justify the mismatch:
Physician Competencies
(check all that apply)
Patient Care:
Provide care/treatment that is compassionate, appropriate and effective for health problems.
Medical Knowledge:
Demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences and their application in patient care.
Practice-Based Learning and Improvement:
Able to investigate and evaluate their patient care practice, appraise and assimilate scientific evidence, and improve their practice of medicine.
Interpersonal and Communication Skills:
Demonstrate skills that result in effective information exchange and teaming with patients, their families and professional associates.
Professionalism:
Responsibilities conducted adhering to ethical principles.
System-Based Practice:
Show awareness of responsibility to a larger context and system of healthcare.
Educational Format
(check all that apply)
Lecture-discussion presentation
Moderator directed panel discussion
Moderator directed group discussion
Case studies
Audience response system
Demonstration
Other:
What professional practice improvement issues will be incorporated in the activity?
(check all that apply)
Appropriate prescribing
Decrease in unnecessary expenses
Implementation of best professional practices
Patient safety
Reduction in medical errors
Other
Evaluation of Activity Outcomes
Two to 3 months after your activity we will send a questionnaire to the attendees to determine if the content of the activity was used in practice or otherwise made a difference in competence, performance or patient outcomes. Please develop 2 yes or no questions which would be relevant to this activity.
Example:
One question that would be asked for KMC Grand Rounds on 6/9 titled "Beyond LDL-Cholesterol: The Scientific Justification for Advanced Blood Risk Markers" is "Have you started checking Sd LDL in your patients?"
Other instruments planned for follow-up evaluation of the event:
(check all that apply)
Live data with Audience Response System
Survey of specific changes
Medical staff survey
Quality improvement data
Pre post test
Other:
* Advertisement
Event is to be advertised on KHN CME database
Please send out reminders with other weekly events
Event will be by invitation only by planners and not to be advertised by KHN CME
Contacts:
Email Us
Talena Trenum
CME Coordinator
O: (937) 395-6004
F: (937) 522-8930
Martin Jacobs, MD
CME Chair
(937) 395-8611
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Kettering Med Ed CME Contact
* Your Name:
* Your Email:
Phone:
(Optional)
* Message:
