EDUCATION DESIGN I DOCUMENTATION FORMAT
MIDWEST MULTISTATE DIVISIONEDUCATIONAL PLANNING FORMV1.2021Instructions: For an educational activity/event with multiple sessions, please complete a planning form for each individual session for which contact hours will be awarded. Type directly into blank cells of the tables. Save the completed form to your computer.Educational Activity Title:Individual Session Title: (if different than activity title)Learning outcome(s)List learning outcome(s) in behavioral terms using a single measurable verb for each. Outcomes are evaluated to determine the impact of educational activities on patient care and professional development of the learner. Learning outcomes should fit into one of Miller’s zones1: ContentTime FramePRESENTER/Faculty/AUTHORProvide an outline of the content to be presented in sufficient detail to determine consistency with learning outcomes and selected learner engagement strategies. Use of objectives or restatement of learning outcomes do not meet the criteria.List the number of minutes2 for each topic/content area and/or active learner engagement strategies marked with an asterisk from the list below.List the presenter, faculty person or author for each content area. Evaluation Time3, if applicableX minutesLEARNER ENGAGEMENT STRATEGIESCheck the engagement strategies utilized in this activity. Engagement strategies should complement the delivery format of the educational activity. Engagement strategies marked with an asterisk (*) are active strategies that require time to complete. These strategies should be detailed in the Content column outline and the time frames for each indicated in the time frame column. ? Self-check or self-assessment? Audience response system? Return skill demonstration*? Role play*? Small group discussion*? Assignments/testing/practice*? Engaging learners in dialogue? Analyzing case studies*? Audience polling? Informal audience check-in ? Audience reactions – emojis, thumbs up or down? Audience reflection? Social media – hashtags, etc.? Videos, music, animations? Games*? Using the video function to show presenters face? Question/Answer – live or via chat/ Q&A feature ? Other: FORMTEXT ?????Live Activities: Total minutes for this activity/session: Total Minutes FORMTEXT ????? divided by 60 = FORMTEXT ????? contact hour(s)Enduring Activities:Method of calculating contact hours:? Pilot Study ? Mergener formula ? Historical Data? Complexity of Content? Other – Describe: FORMTEXT ?????List full citations for the evidence-based reference(s) used to develop the content of this educational activity/session next to the appropriate category: Information from organization/website:(current available evidence within past 5-7 years; may be published or unpublished content. Examples –Agency for Healthcare Research and Quality, Centers for Disease Control, National Institutes of Health). Provide full web page citations for material referenced, not “”.Peer –reviewed journal/resource:(reference should be within past 5-7 years)Clinical guidelines:(published or online. Example - )Expert resource:(individual, organization, or educational institution - book, article, website)Textbook reference:Other: ................
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