Step 1

First time applicants must request UHMS Sponsorship of CME by contacting:

Lisa Tidd / UHMS CME Coordinator

UHMS

21 W. Colony Place, Ste. 280

Durham, NC 27705

Phone: 919-490-5140 / Fax: 919-490-5149

Email: lisa@uhms.org / Website: www.uhms.org

You will receive:

1. UHMS Physician CME Guidebook (Application forms and samples are at Appendix D)

2. UHMS CME Activity Application

3. UHMS Guidelines for Commercial Support of CME GCS

4. UHMS Agreement with Joint Sponsor LOA CME 201. First time applications must complete a UHMS Agreement with Joint Sponsor LOA CME 201 and submit to the UHMS at the above address prior to application submittal. This document requires you to read the UHMS Guidelines for Commercial Support of CME to help plan your activity.

5. UHMS CME Representative. The Education Committee Chair appoints a CME Representative to participate in planning the CME activity with the Activity Director.

Re-applicants may start the application process at Step 2.

Step 2

Appoint a planning committee that includes the UHMS CME Representative. Each member of the planning committee must complete a Disclosure Form CME 110. An individual who refuses to disclose relevant financial relationships can not take part in the development, management, presentation, or evaluation of the CME activity.  Please review the UHMS Guidelines for Commercial Support of CME prior to planning your CME activity.

Step 3

Complete UHMS CME Activity Application Form CME 102

LIVE CME ACTIVITY APPLICATION

UHMS CME Activity Application Form CME 102, which must be completed and signed.

First time applicants should apply for 1-year approval only. Re-applicants may apply for 1, 2, or 3-year approvals.

The completed UHMS CME Activity Application Form CME 102 must include the following 13 attachments

Attachment 1

CME Mission Statement

The Responsible Organization must have a written statement of its CME mission. (A description is at Chapter 4 of UHMS Physician CME Guidebook.) The CME Mission Statement is a concise description of the organization’s role in CME. It:

• Describes the purpose of the overall CME program;

• Indicates the content areas for achieving the CME mission;

• Outlines the characteristics of the potential participants;

• Specifies the target audience for whom the CME activities are planned;

• Lists the general types of activities and services provided;

• States the expected results of the CME program.

Attachment 2

Needs Assessment

The Needs Assessment should be a statement of why this applying organization is providing this activity to this group of physicians. Consider answering the following questions: What is the need that this CME activity addresses for your target audience? Why is this activity being offered to physicians by your organization?

Include information sources that go beyond the activity director’s own perception of need. Examples of methods for identifying educational needs include consensus of experts, survey of target audience, self-assessment, faculty perception, quality assurance, and participant evaluation data from prior CME activities.

Activity Directors should refer to the UHMS CME Needs Assessment and UHMS Panel of Experts Opinion of Priority (at Appendix B) to determine where the proposed CME activity falls on the UHMS prioritized list.

Attachment 3

Expected Results (Goals and Objectives)

The Goals and Objects section is now referred to as Expected Results. It can be either an overall statement of goals, a list of goals, or specific hour-by-hour objectives. Expected results provide an understanding of the purpose of the CME activity. Instructors must know exactly what is expected of them and participants must be able to determine whether the activity will meet their needs. Goals answer the question: What is the purpose of the educational activity? Learning objectives should have measurable outcomes and answer the question: What will the participant gain or be able to do after the educational experience?

There must be a statement of Expected Results (goals or objectives) printed in the brochure or course announcement, and in the CME Activity Evaluation (critique sheet).

Specific hour-by-hour objects are only mandatory for the UHMS Designated Introductory Course in Hyperbaric Medicine.

Examples of Goals

The goals of the workshop are to:

• Help attendees to learn the methods for determining the fitness status of a diver;

• Provide attendees with the clinical rationale for the adjunctive use of hyperbaric oxygen therapy for treating problem wounds.

Examples of Objectives

At the conclusion of this seminar, the participant should be able to:

• Discuss newer methods for assessing the extent of brain injury resulting from cerebral arterial gas embolism;

• Describe the technology pertaining to monoplace and multiplace chamber operations and be able to use the equipment appropriately to manage UHMS-approved indications for hyperbaric oxygen therapy;

• Design and implement a Quality Assurance Program.

Where to Place Expected Results in the Document

• Expected results may be written into the document in one of two places: under the heading of Purpose, or as part of the description of each individual lecture.

• Irrespective of where they are placed, expected results must be written in sufficient detail to represent the educational component of each instructor.

Attachment 4

Academic Schedule

The Academic Schedule should list the start and stop time for each topic. The schedule is used to count CME hours. The number of hours is determined by counting the hours from start to adjournment and subtracting lunch (also subtract break-time if exhibitors are present). Breaks up to 10 minutes taken each hour are not subtracted. However, since CME is not authorized for breaks conducted in the exhibit area, we subtract break-time when exhibitors are at the activity. (For determining CME credit see chapter 11 of the UHMS Physician CME Guidebook)

Attachment 5

Faculty List

Faculty List must have speaker’s name, credentials, and organization including city and state.

Attachment 6

Program Planning Committee List

The Program Planning Committee List must have members’ name, credentials, and organization including city and state. The CME Representative should be listed as one of the Program Planning Committee members.

Attachment 7

CME Activity Evaluation

The CME Activity Evaluation Form CME 107 should evaluate each topic for Presentation and Objectives Met. In addition, the following items should be listed on every evaluation:

• The overall objective for the activity must be stated on the evaluation

• What is your impression of the overall effectiveness of this CME activity?

• Did this activity meet your educational needs?

• Did attendance at this activity enhance your medical practice?

• Were the references appropriate?

• Was there a perceived commercial bias?

• Was the overall objective for this activity met?

Attachment 8

CME Activity Budget

A CME Activity Budget Form CME 112 is required to show that the Responsible Organization is aware of the income and costs involved.

Attachment 9

Notes/Minutes showing CME Representative involvement in planning

The Notes should summarize the communication between the Responsible Organization and the UHMS CME Representative and/or UHMS Education Committee. It does not have to be an extensive list. The purpose of the notes is to show that the UHMS Education Committee was involved in the planning of the CME activity.

Attachment 10

CV for Faculty and Program Director (2 page max)

A 2-page max CV for each speaker and the Program Director should be submitted with the application. CVs of more than 2 pages should not be submitted.

Attachment 11

Disclosure

All speakers and planners of CME activities are required to submit a Disclosure Form CME 110 to disclose in writing to the UHMS, and verbally to their audiences, any real or apparent conflict of interest related to the content of their presentation. Disclosure must never include the use of a trade name or a product-group message.

Attachment 12

Draft Brochure

The draft brochure should include the following items:

• Expected Results (Goals or Objectives)

• Target Audience

• Topics

• Principle Faculty and Credentials

• Accreditation Statement. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Undersea & Hyperbaric Medical Society (UHMS) and (name of non-accredited provider). The UHMS is accredited by the ACCME to provide continuing medical education for physicians.

• The UHMS designates this educational activity for a maximum of [number of credits] AMA PRA Category 1 Credit(s)™.  Physicians should only claim credit commensurate with the extent of their participation in the activity. (NEW AS OF 1/1/2007)

• Full Disclosure Statement. All faculty members participating in continuing medical education activities sponsored by (name of responsible organization) are expected to disclose to the participants any real or apparent conflict of interest related to the content of their presentation. Full disclosure of faculty relationships will be made at the activity.

Attachment 13

Application Fee

The fee is determined by the UHMS fee schedule at Chapter 12 of the UHMS Physician CME Guidebook. Checks are submitted directly to the UHMS along with the signed copy of the application and the Disclosures. Please check the box with the number of years you wish to have approved. Credit card information should be mailed or faxed to the UHMS CME Coordinator at the UHMS home office.   Advance to Step 4

ENDURING MATERIALS CME APPLICATION

Those applying for Enduring Materials CME must submit the 3 attachments below in addition to UHMS CME Activity Application and its required 13 attachments.

Attachment 14

Enduring Materials Application Form CME 103

The Enduring Materials CME Academic content form is an addendum to the UHMS CME Activity Application. It contains a listing of the academic content and allocates the time allotted to complete each segment of enduring material. (See Chapter 11 for determining credit hours.) Time can be allotted for completing the post test.

Attachment 15

Post Test

Attach a multiple choice post-test that assesses participant knowledge. There should be a minimum of 5 questions per academic hour.

Attachment 16

Instructions to Participants

This replaces the Draft Brochure that is required in a live program

The following items are required in the Instructions to Participants:

• Expected results (objectives)

• Accreditation Statement

• Designation Statement

• Disclosures made by the faculty

• Target audience

• Topics and educational content

• Principle faculty and their credentials

• Medium used

• How to acquire CME

• Estimated time to complete education activity

• Date of original release, most recent review, update, or approval and expiration

Advance to Step 4

UHMS DESIGNATED INTRODUCTORY COURSE IN HYPERBARIC MEDICINE

Those applying for UHMS Designated Introductory Course in Hyperbaric Medicine must submit the attachments below in addition to Form CME 102 and its required 13 attachments.

A UHMS Designated Introductory Course in Hyperbaric Medicine must have at least 40 hours of instruction, formal assessment upon completion, some element of practical chamber-side instruction, and must be documented by a certificate of completion.

Attachment 17

UHMS Introductory Course in Hyperbaric Medicine Form CME 104

The UHMS Designated Introductory Course in Hyperbaric Medicine lists the required elements and the page number where the objective that meets that element is located on the attached Detailed Hourly Objectives. An example below.

Attachment 18

Detailed Hourly Objectives

This documents the hour-by-hour objectives for the course. Ensure that there is an objective for each required element on the application. An example is at Chapter 18 of the UHMS Physician CME Guidebook.

Attachment 19

Certificate of Attendance

An example of a Certificate of Attendance is at Form CME 111. The format or layout of the certificate is at the discretion of the Responsible Organization.  Advance to Step 4

Step 4

Email entire CME Activity Application to UHMS CME Coordinator, lisawasdin@uhms.org, for Education Committee review. Mail signed UHMS CME Activity Application Form CME 102 along with application fee. Submit signed documents electronically if possible.

Step 5

Obtain approved UHMS CME Activity Application Form CME 102 from UHMS Education Committee

Step 6

Publish course announcements / brochures. Providers shall not indicate in any brochure or announcement that “CME credit has been applied for”.

Step 7

Initiate Provider Agreement with Commercial Supporters LOA CME 202 if applicable. Form must be signed by Joint Sponsor Representative, Commercial Support Representative, and UHMS CME Representative.

Step 8

Conduct the CME activity. Announce all Disclosures and commercial supporters

Step 9

Award formal or informal Certificates of Attendance Form CME 111.

Step 10

Submit CME Activity Closing Report Form CME 105 to UHMS CME Coordinator (The UHMS will issue CME certificates to participants).

Step 11

Maintain records for six years

Step 12

Prepare for UHMS audit / site visit