Complete this form to renew a regularly scheduled series such as grand rounds, case review conferences, and tumor boards.

Make sure you are logged into EthosCE before you begin. Your name should appear in the upper right corner if you are logged in.  Logging in before your start this form will allow you stop and return later with your work saved.  If you are not logged in, you will need to complete the form in its entirety and submit the form in order not to lose the data.

Activity Director Roles & Responsibilities:

As a condition of being the CE Activity Director of an accredited CE activity, you agree to fulfill these requirements in a timely manner: 

  • Read the MCW CE Policy Compendium 
  • Identify and articulate the educational need of healthcare professionals who have completed training 
  • Complete CE application form and submit to OCPD no less than 90 days prior to the start/launch of activity 
  • Ensure valid content and qualified speakers 
  • Provide CME Financial Disclosure and ensure all in control of content provide CME financial disclosure prior to the start of the CME activity 
  • Resolve any real or perceived financial conflicts of interests prior to the start of the CME activity 
  • Participate in the development of an effective evaluation strategy 
  • Participate in CME debrief with CPD Deans 

Failure to meet the accreditation requirements will result in loss of accreditation for your CE activity and puts MCW’s accreditation status in jeopardy 

 

Competencies Information

What we mean by competence, performance, or patient outcomes
 

 
1 Start 2 Complete
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Please provide the formal name of the series.
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If there is a planning committee, please provide the names and credentials for each planner. If the plan is to offer physician assistant credit, a PA must be an active member of the planning committee. Likewise if nurse practitioner credit is being offered, an NP must be an active member of the planning committee. Please contact the Office of Continuing Professional Development if you wish to provide credits beyond AMA PRA Category 1 credit as additional fees and requirements apply.
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Name of administrative staff support person (CE Coordinator)
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What day of the week will the series be held? (check all that apply)
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Provide the: Name of Institution Address Room Name or Number City State Postal Code Or state - Virtual until further notice.
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How you would describe the series to someone who may be interested in participating. What is the educational benefit of attending this series?
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Describe the overall learning objectives for the series.
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This series is designed to change: Note - competence here is defined as “Knowing how to do something”...is a combination of knowledge, skills and performance, the ability to apply knowledge, skills and judgment in practice…the simultaneous integration of knowledge, skills, and attitudes required for performance in a designated role and setting.”
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How will planners determine if the series effectively changed competence, performance, or patient outcomes. What data will be used?
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Describe how this series incorporates at least Three of the following:
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