Accreditation Application Questions Preview

1. What type of accreditation are you applying for? (Checkboxes)

2. Is this a Faculty Development program? (Radio buttons)

3. Identify the faculty development domain for which this program is designed: (Checkboxes)

4. Program Title: (Text box)

5. Program Start Date: (Date chooser)

6. Program End Date: (Date chooser)

7. How many times will this program be delivered: (Radio buttons)

8. Estimated Number of Participants per session: (Text box)

9. Delivery Method of Program (select all that apply): (Checkboxes)

10. In what language(s) do you intend to deliver the program? (Radio buttons)

11. Where will this program be delivered? (Checkboxes)

20. Do you intend to deliver this program in Quebec? (Radio buttons)

21. Quebec Program Delivery (Agreement checkbox)

22. Is your target audience from a single province/territory? (Radio buttons)

23. Select all the provinces and/or territories in which the program will be marketed: (Checkboxes)

24. Would you like help promoting your program? (Radio buttons)

25. Please indicate where you would like to have your event advertised: (Checkboxes)

Venue Name (Text box)

This program will be of interest to: (Text box)

Registration URL or how to register (Text box)

Contact name (Text box)

Contact email (Text box)

Contact phone number (Text box)

30. Has this program been previously accredited? (Radio buttons)

31. Name of organization which accredited the program previously: (Text box)

40. Provider organization name: (Text box)

Applicant Contact Name: (Text box)

Name of Physician Organization Submitting the Application: (Text box)

Address: (Text box)

Email: (Text box)

Telephone: (Text box)

42. Will the physician organization maintain attendance records for 6 years? (Radio buttons)

43. Name and Contact Information for Scientific Planning Committee Chair: First Name (Text box)

Last Name: (Text box)

Address: (Text box)

Email: (Text box)

Telephone: (Text box)

44. Name and Contact Information of Schulich Faculty Member Requesting Application: Is it the same contact listed above? (Radio buttons)

Contact Info (Text box)

45. Is this program being co-developed with another organization? (Radio buttons)

46. Name and contact information for organization co-developing the program (Text box)

47. Is the co-developing organization a physician organization? (Radio buttons)

48. I have approval to run this activity through the organizations listed above. (Radio buttons)

60. Name of active CFPC member(s) on SPC: (Text box)

61. List the Scientific Planning Committee Members (SPC): A minimum of three members of the target audience are required (Text box)

62. Describe how the planning committee was selected and how they represent the target audience: (Text box)

63. Is the scientific planning committee independent and responsible for content development? (Radio buttons)

64. Confirm which of program elements the SPC maintained control over. (Checkboxes)

65. Does this activity include speakers and/or presenters/facilitators/coaches/peer reviewers/assessors? (Radio buttons)

66. Describe the scientific planning committee’s process for selecting speakers and/or presenters/facilitators/coaches/peer reviewers/assessors: (Text box)

67. We attest that there is a communication plan in place to make sure presenters and facilitators are aware of: (Checkboxes)

68. Describe how the SPC ensures the content for this program is scientifically valid, objective, and balanced across relevant therapeutic options. (Text box)

69. All accredited CPD activities must comply with the National Standard for support of accredited CPD activities. If the scientific planning committee identifies that the content of the CPD program does not comply with the ethical standards, what process would be followed? How would the issue be managed? (Text box)

70. The scientific planning committee, speakers, moderators, facilitators, and authors have completed conflict-of-interest disclosure forms and potential conflicts of interest will be disclosed to participants. (Radio buttons)

71. Describe the SPC's process for the review of conflict of interest disclosures and the mitigation of any potential for bias. (Text box)

72. How will the SPC, speakers, moderators, facilitators, and authors potential conflicts of interest be disclosed to participants? (Text box)

73. We attest that: (Checkboxes)

80. Select the group(s) identified as the primary audience in the needs assessment? (Checkboxes)

81. For family medicine, this program targets family physicians with a community of practice in: (Checkboxes)

82. Who is the primary target audience of the program? Choose all that apply. (Checkboxes)

83. Select the needs assessment methods used to identify the perceived needs of the learners: (Checkboxes)

Select the needs assessment methods used to identify the unperceived needs of the learners: (Checkboxes)

84. Outline the needs identified from the data collected and, if Mainpro+ application, how this led to identifying knowledge, skills, or behaviour gaps in CanMEDS-FM competencies and/or how the Fundamental Teaching Activities Framework domains are relevant to the needs assessment results. (Text box)

85. What CanMEDS/CanMEDS-FM Role(s) are relevant to this program? (Checkboxes)

86. Describe how CanMEDS/CanMEDS-FM competencies were considered in the needs-assessment process. (Text box)

87. List the overall learning objectives derived from the needs assessment results and the most applicable CanMEDS/CanMEDS-FM competencies addressed by the learning objectives: (Text box)

88. State the sources of information selected by the planning committee to develop the content of this program (e.g. scientific literature, clinical practice guidelines, etc.) (Text box)

91. How were those responsible for developing or delivering content informed that any description of therapeutic options must utilize generic names (or both generic and trade names) and not reflect exclusivity and branding? (Text box)

100. Will this activity include discussion of off-label or unapproved treatments? (Radio buttons)

101. Explain the relevance of these off-label or unapproved treatments over approved options: (Text box)

102. Describe how speakers will be advised of the Quality Criteria requirements for the incorporation of evidence. (Text box)

103. Describe how barriers to practice/physician change will be addressed within the program. (Text box)

104. What learning methods/formats were selected to help the CPD program meet the stated learning objectives? (Text box)

105. Select the methods used to meet the 25 per cent interactivity requirement: (Checkboxes)

106. How will the overall group learning program and individual sessions be evaluated by participants? (Text box)

107. Program Key Words – In order to aid CFPC members searching for programs most suited to their individual learning needs, please select the key words most relevant to your program from the list below: (Checkboxes)

115. Does this program include teaching or demonstrating aesthetic medicine procedures? (Radio buttons)

116. Is this a modular program? (Radio buttons)

117. Explain how participation is tracked and how learners can ask questions and receive answers about the program content: (Text box)

120. Please select the type of program: (Checkboxes)

121. Describe how the activity design and format are appropriate for the content and allow the learner to achieve the learning objectives: (Text box)

123. Select the sources of evidence used to design and support the activity content: (Checkboxes)

124. Select the evidence source(s) used in the educational design this program: (Checkboxes)

125. Describe how the evidence was identified and selected: (Text box)

126. Select the evaluation formats used in this activity: (Checkboxes)

127. Describe how the evaluation strategy was selected and how it serves as a measure of learning objective effectiveness and learner competence: (Text box)

128. Describe how evaluation feedback is used, who receives it, how often , and how it is used for quality improvement: (Text box)

129. Include, if applicable, an explanation of how the diversity of patient populations was addressed/considered in the needs assessment process. If not, how this could be included in future programs? (Text box)

130. Explain how you considered information and perspectives from various cultural, social, and demographic backgrounds to enrich the learning experience: (Text box)

131. Explain the specific strategies used to make sure the program content reflects diverse perspectives relevant to the topic/content discussed. If you have not considered this, explain why not and how you might incorporate this in the future. (Text box)

132. Describe your approach to designing instructional and learning activities that accommodate diverse learning preferences, abilities, challenges, interests, and background knowledge. If you have not incorporated this approach, explain why not and how you might incorporate this in the future. (Text box)

133. Provide examples of how you created an inclusive learning environment that considers the accessibility needs of diverse participants: (Text box)

134. Does this activity included enhanced activities? (Radio buttons)

135. Providers who wish to create opportunities for participants to earn additional optional credits may choose to include any of the following elements in their program. Select the optional activities you wish to include and respond to the additional questions. (Checkboxes)

136. Describe how these additional activities serve the program learning objectives. (Text box)

140. What type of assessment is taking place? (Checkboxes)

151. Select the needs assessment methods used to identify the need for the assessment activity: (Checkboxes)

152. Outline the needs identified from the data collected and how this led to the assessment chosen: (Text box)

153. Describe how assessors, if they are used, are selected and trained: (Text box)

154. Select the practice data sources that participants used: (Checkboxes)

155. Describe how you determined that the activity time frame is feasible for meeting the learning objectives: (Text box)

156. Describe the sources of evidence used to design and validate this assessment activity: (Text box)

157. Select the objective measurements of change used for this activity: (Checkboxes)

158. Describe how the evaluation strategy was selected and how it serves as a measure of learning objective effectiveness and learner competence: (Text box)

159. Explain, if applicable, how the diverse patient populations were addressed/considered in the needs assessment process. If not, how this could be included in future programs? (Text box)

160. Explain how information and perspectives from various cultural, social, and demographic backgrounds were incorporated to enrich the assessment experience: (Text box)

161. How did you design this assessment activity to accommodate diverse learning preferences, abilities, challenges, interests, and background knowledge? Specify the strategies used to make certain the assessment activity reflects the diverse perspectives relevant to the activity’s focus: (Text box)

162. How did you make sure this assessment activity considered the accessibility needs of diverse participants? (Text box)

163. Does this activity included enhanced activities? (Radio buttons)

164. Providers who wish to create opportunities for participants to earn additional optional credits may choose to include the following elements in their program. Select the optional activities you wish to include and respond to the additional questions. (Checkboxes)

165. Describe how these additional activities serve the program learning objectives: (Text box)

Certified Activity (hours and minutes) (Text box)

Certified Activity - Enhanced Activities (hours and minutes) (Text box)

Certified Assessment Activity (hours and minutes): (Text box)

Certified Assessment Activity - Enhanced Activities (hours and minutes): (Text box)

Are you seeking accreditation for this program with any other organization or group (e.g. Royal College of Physicians and Surgeons)? (Radio buttons)

Organization Name (Text box)

Number of credits: (Text box)

Type of credits: (Text box)

180. Describe the key knowledge areas or themes assessed by this self-assessment program. (Text box)

181. What learning methods were selected to help the CPD program meet the stated learning objectives? Describe the rationale for the selected format (e.g. multiple-choice questions, short answer questions, etc.) to enable participants to review their current knowledge or skills in relation to current scientific evidence. (Text box)

182. Describe the process that allows participants to demonstrate or apply knowledge, skills, clinical judgment or attitudes (e.g. through the creation of an answer sheet and scoring or web based assessment tools). In the Documentation section, submit a copy of the answer sheet for the assessment tool that allows participants to demonstrate knowledge, skills, clinical judgement or attitudes and shows how feedback will be provided to the participants. (Text box)

183. How will feedback be provided to participants on their performance to enable the identification of any areas requiring improvement through the development of a future learning plan? (Text box)

184. Does the program provide participants with references justifying the appropriate answer? (Radio buttons)

185. Describe how the references are provided to participants. (Text box)

190. How will the overall learning program and each individual module (if applicable) be evaluated by participants? (Text box)

191. Describe the key knowledge areas or themes assessed by this simulation program. (Text box)

192. What simulation methods were selected to enable participants to demonstrate their abilities, skills, clinical judgment or attitudes? e.g. Role playing, standardized patients, theatre-based simulation, task trainers, virtual patients etc. (Text box)

193. How will learners participate in the simulation? (Text box)

194. How will learners provide responses to online simulation? (e.g. Through an online response sheet or web based assessment tools) (Text box)

195. How will learners receive feedback after the completion of an online simulation? (Text box)

196. How will learners receive feedback (debrief) after the completion of a live simulation? (Text box)

197. How will feedback (debrief) be provided to learners on their performance to enable the identification of any areas requiring improvement through the development of a future learning plan? (Text box)

198. How will the simulation program be evaluated by the learners? (Text box)

199. Will the program use any evaluation strategies, other than self-report, to assess the degree to which the intended outcomes were achieved? (Radio buttons)

200. Please describe the evaluation method. (Text box)

215. Registration Fees (Text box)

216. Additional costs, if any, to participants (describe in detail): (Text box)

217. Is this program self-funded by a for-profit organization? (Radio buttons)

218. Has the program been sponsored by one or more external organizations? (Radio buttons)

219. Check all sources of sponsorship that apply (Checkboxes)

220. Has this program received financial support? (Radio buttons)

221. Please list the name of the sponsor(s) providing financial support below (Text box)

222. Has this program received in-kind support? (Radio buttons)

223. Please list the name of the sponsor(s) providing in-kind support below (Text box)

224. Has the CPD provider organization made sure that all sponsorship funds are paid directly to the CPD provider organization/scientific planning committee or third-party non-commercial interest designated by the CPD provider organization? (Radio buttons)

225. Does the physician organization have written agreements with sponsors outlining the terms, conditions and purposes by which sponsorship is provided? (Radio buttons)

226. Will this activity have an exhibit hall/exhibitor? (Radio buttons)

227. Describe how the exhibit hall will be arranged and how the scientific planning committee has reviewed any incentives offered by exhibitors. If the event is virtual describe how participants will access the virtual exhibit hall. (Text box)

228. Is the physician organization responsible for paying speaker and scientific planning committee honoraria and travel? (required for activities delivered in Quebec) (Radio buttons)

240. How are payments of travel, lodging, out-of-pocket expenses, and honoraria made to members of the scientific planning committee, speakers, moderators, facilitators and/or authors? (Text box)

241. If the responsibility for these payments is delegated to a third party, please describe how the CPD provider organization or SPC retains overall accountability for these payments. (Text box)

242. How has the physician organization ensured that their interactions with sponsors have met professional and legal standards including the protection of privacy, confidentiality, copyright and contractual law regulations? (Text box)

243. How has the physician organization ensured that product specific advertising, promotional materials or other branding strategies have not been included on, appear within, or be adjacent to any educational materials, activity agendas, programs or calendars of events, and/or any webpages or electronic media containing educational material? (Text box)

244. What arrangements were used to separate commercial exhibits or advertisements in a location that is clearly and completely separated from the accredited CPD program? (Text box)

245. If incentives are to be provided to participants associated with an accredited CPD program, how will they be reviewed and approved by the physician organization? (Text box)

246. Are there any social events or activities associated with this program? (Radio buttons)

247. Describe in detail the social activities related to this program including when these activities take place in relation to the certified learning. What strategies were used to prevent the scheduling of unaccredited CPD activities occurring at same times and locations of accredited activities? (Text box)

Signed SPC Chair Agreement (File Upload)

Summarized Needs Assessment Results (File Upload)

Budget for this activity that details the receipt and expenditure of all sources of revenue (File Upload)

Final Program/Agenda (File Upload)

Mainpro+ Certified Activity - Enhanced Activities (File Upload)

Mainpro+ Certified Assessment Activity (File Upload)

Mainpro+ Certified Assessment Activity - Enhanced Activities (File Upload)

Promotional material (File Upload)

Participant evaluation form (File Upload)

Copy of the signed certificate of attendance (File Upload)

Speaker communication letter sent to one speaker (File Upload)

Sponsorship and/or exhibitor prospectus developed to solicit sponsorship/exhibitors for the activity (File Upload)

Written agreement that is signed by the CPD provider organization and one sponsor (File Upload)

CFPC Disclosure Slides (File Upload)

Signed CFPC Representative Confirmation (File Upload)

SPC Meeting Minutes (File Upload)

Other Documentation (File Upload)

Notify by Email (Text box)

User Experience - Do you have any feedback about this application form? (Text box)