Activity Planning Form

Activity Planning Form

This form must be submitted for each presentation.

Resources:

Activity Planning Guide

Full Name*

Email Address*

Which organization is planning this activity?*

Select

Session Title*

Is this session part of a conference or series?*

yes

Full Conference or Series Title

List all additional speakers

Each speaker must complete the Speaker Information and Disclosure Form

Plan Your Session

Refer to the Activity Planning Guide for support in planning an effective session.

Identify Practice Gaps:*

What problem is happening? Where can we do better to reach optimal practice?

Find Underlying Educational Needs:*

Why is the problem happening? What are the underlying factors contributing to this issue?

Write Objectives:*

What are our core objectives for this activity? At the end of this activity, the learner will be able to:

Use Bloom's Taxonomy to identify knowledge domain verbs. Focus on choosing verbs from understanding up the scale, e.g. interpret, explain, apply, evaluate, assess, facilitate. Refer to the Activity Planning Guide for more information on formulating objectives.

What areas is this session designed to drive change in?*

Knowledge - provides updated knowledge - can be self-reported by learners

Competence - provides strategies for applying knowledge in practice - can be self-reported by learners

Performance - Applied knowledge to professional practice - must be measurable

Patient Outcomes - Improved results from applied knowledge - must be measurable

Knowledge

Competence

Performance

Patient Outcomes

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