CME Activity Application

CME Activity Application
Please have all individuals listed in the box complete a Disclosure Form at the following link:

Professional Practice Gap (PPG)

Criteria 2: The provider incorporates into CME activities the educational needs that underlie the professional practice gaps of their own learners.

Knowledge - A gap in learner knowledge.

Competence - A gap in the ability to apply knowledge.

Performance - A gap in the actual application of knowledge to practice.

Design to Change

Criteria 3: The provider generates activities/educational interventions that are designed to change competence, performance, or patient outcomes as described in its mission statement.

Educational Format

Criteria 5: The provider chooses educational formats for activities/interventions that are appropriate for the setting, objectives, and desired results of the activity.


Criteria 11: The provider analyzes changes in learners (competence, performance, or patient outcomes) achieved as a result of the overall program's activities/educational interventions. Criteria 12: The provider gathers data or information and conducts a program-based analysis on the degree to which the CME mission of the provider has been met through the conduct of CME activities/educational interventions. All CME activities must be evaluated to assess the extent to which the program has achieved the change in competence, performance, or patient outcomes. Your method of evaluation will depend upon the PPG you selected. Examples: Competence - Physician self-report of intended application of new knowledge to their practice. Performance - Physician self-report on the application of the new knowledge to their practice. Patient Outcomes - Data, such as re-admittance rates, compared prior to the activity and 6 months later.

Physician Competencies & Attributes

Criteria 6: The provider develops activities/educational interventions in the context of desirable physician attributes [eg, Institute of Medicine (IOM) competencies, Accreditation Council for Graduate Medical Education (ACGME) Competencies].

MOC Part II Only

Click here to view Evaluation/Assessment Examples.
Learner Assessment Tool: Please select one of the following:
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB
Download from Survey Monkey form


Criteria 7: The provider develops activities/educational interventions independent of commercial interests. (SCS 1, 2, and 6). It is the policy of the Rochester Academy of Medicine (RAM) to ensure balance, independence, objectivity, and scientific rigor in all educational activities.

Barriers to Change

Criteria 18: The provider identifies factors outside the provider's control that impact on patient outcomes. Criteria 19: The provider implements educational strategies to remove, overcome or address barriers to physician change.

Building Bridges with Stakeholders

Criteria 20: The provider builds bridges with other stakeholders through collaboration and cooperation.