Content Review Form

Title of activity *

AKH Activity Number *

Collaborators (JP Name) *

Commercial Supporter(s): (If none, list N/A) *

Date of Activity

Month

Day

Year

Project Manager *

Are recommendations for patient care based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options? [Standards for Integrity and Independence 1.1] *

Yes

No

Comments:

Does all scientific research referred to, reported, or used in this educational activity in support or justification of a patient care recommendation conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation? [Standards for Integrity and Independence 1.2] *

Yes

No

Comments:

Are new and evolving topics for which there is a lower (or absent) evidence base, clearly identified as such within the education and individual presentations? [Standards for Integrity and Independence 1.3] *

Yes

No

Comments:

Does the educational activity avoid advocating for, or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning? [Standards for Integrity and Independence 1.3] *

Yes

No

Comments:

Does the activity exclude any advocacy for, or promotion of, unscientific approaches to diagnosis or therapy, or recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients? [Standards for Integrity and Independence 1.4] *

Yes

No

Comments:

Pharmacy Review

What does ‘applicable to the practice of pharmacy’ mean?

In general, for guidance in organizing and developing CPE activity content, providers should ensure that, as for all health care professionals, pharmacists should develop and maintain proficiency in five core areas*:

Delivering patient-centered care,
Working as part of interdisciplinary teams,
Practicing evidence-based medicine,
Focusing on quality improvement and
Using information technology.

Is this activity applicable to the practice of pharmacy? *

Yes

No

Target Audience (pharmacy) *

Pharmacists

Pharmacy Technicians

Select the content area(s) that your activity addresses. {Check all that apply} *

Does Not Apply

Child Abuse Prevention or Reporting

Collaborative Practice

ContraceptionCultural Competency

Diversity, Equity, Inclusion (including bias)Human Trafficking

Lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ)Mental Health Awareness

Nicotine Replacement

Non-Sterile Compounding

Nursing Home Consulting

Pharmacist Prescriptive Authority

Precepting

Sexual Harassment

Sterile Compounding

Suicide Prevention

Comments:

Pre/Post Test Questions

Are the questions related to the objectives? *

Any recommended modifications to questions? *

Yes

No

N/A

Provide recommendation:

Competencies

ABMS/ACGME - Please check the competencies that apply. *

Patient Care and Procedural Skills

Medical Knowledge

Practice-based Learning and Improvement

Interpersonal and Communication Skills

Professionalism

System-based Practice

N/A

Institute of Medicine - Please check the competencies that apply. *

Provide patient-centered care

Work in interdisciplinary teams

Employ evidence-based practice

Apply quality improvement

Utilize informatics

N/A

Interprofessional Education Collaborative - Please check the competencies that apply. *

Values/Ethics for Interprofessional Practice

Roles/Responsibilities

Interprofessional Communication

Teams and Teamwork

N/A

Other Competencies - Please list additional competencies that apply.

APA Review

Is activity at least one hour in length? *

Yes

No

Comments:

Is there at least one LO for each session (if multiple sessions)? *

Yes

No

Comments:

Does this activity meet the criteria for continuing education? *

Yes

No

Comments:

Is the content well balanced and free from bias? *

Yes

No

Comments:

Are the references current and reliable? *

Yes

No

Comments:

Is there discussion of unlabeled use of drugs? *

Yes

No

Comments:

Do you recommend this activity be monitored for potential bias? *

Comments:

Does this activity contain content for Interprofessional Continuing Education? *

Yes

No

Comments:

AANP Review

Please list the # of pharmacology credits. If none, list 0. *

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Content Review Form

Pharmacy Review

Pre/Post Test Questions

Competencies

APA Review

AANP Review