Skip to main content

Kettering Health (ketteringhealth.org)

Continuing Med Ed

A- A A+ Text Size

Kettering Med Ed

Internal Medicine
Residency

Transitional Year
Residency

Medical Student Rotations

- Calendar of Events (opens in new tab)

- Event Applications /
Forms

- Policies & Procedures

- Presentations &
Recordings

- Obtain Event Credit (opens in new tab)

- Obtain CME Transcript (opens in new tab)

Advanced
Practice Providers (opens in new tab)

Observership Application (opens in new tab)

Institutional Policy for Vacation and Leave of Absence (opens in new tab)

Regularly Scheduled Series (RSS)
Activity CME Application

* Presentation Date:

* Presentation Time:

* Event Topic/Title:

* Planner Name:

Planner Phone:

Planner Email:

* Location:

In-person
Virtual
Hybrid (In-person & virtual)

Other - Please explain

* Coordinator / Liaison:

* Coordinator Phone:

* Coordinator Email:

* Speaker(s):

Speaker Phone:

Speaker Email:

Yes No Need Commercial Support? - If Yes, contact CME Coordinator below

Upload the Curriculum Vitae (CV) for each of your speakers and moderators

Upload a copy of each speaker's signed Disclosure Declaration Statement

* Professional Practice Gap

Gap: State which gap from the RSS planning document will be addressed, or design an event-specific topical gap:

* Educational needs that underlie the gap:
Medical Knowledge Competence Performance

* This activity will result in improved:
Competence Performance Patient Outcome

Evidence will need to be provided to show improved outcomes.

* Learning Objectives

Identify 1-3 specific steps to be experienced by participants designed to address the needs and close the gap. These statements will describe the learner actions required to achieve the educational needs - the outcomes. Begin each statement with a measurable, action-oriented verb.

Suggestions on Writing Objectives

* 1.

2.

3.

* Evaluation of Activity Outcomes

Please develop 2 Yes/No questions that can assess the participants' achievement of the event's educational objectives. They will be distributed 2 to 3 months post-event.

* 1.

* 2.

Contacts:

Kim Kremer, MS

Kim Kremer, MS
CME Coordinator
937-232-2476

Martin Jacobs, MD

Martin Jacobs, MD
CME Chair
937-395-8611

Kettering Med Ed CME Contact

* Your Name:

* Your Email:

Phone: (Optional)

* Message: