ࡱ> %k +(bjbjȚ  B,j,j+  =====QQQQQT6!!!TTTTTTTXZT=! @!!!T==T^#^#^#!==T^#!T^#^#yNXR^k$!^O(kTT0TO[!<[PRR"[=R!!^#!!!!!TT"!!!T!!!![!!!!!!!!! Y :  APPLICATION FOR CPD APPROVAL DO NOT SUBMIT THE COMPLETED FORM TO MORE THAN ONE OFFICE. RETURN OF THIS FORM WITH SIGNATURE, DATE AND CREDITS WILL INDICATE CPD APPROVAL BY ALL COLLEGES. The completed application form should be returned, no later than 14 days leading up to the event*, with a copy of the event programme and a copy of the proposed evaluation. CPD COURSE APPROVAL FEES ActivityNot for profitFor profitCourse/Event for local audience50100Course/event for national and/or international audience100`250* Ƶ takes up to 14 days to review each CPD application. Submissions received less than 14 days prior to the date of the event will incur an additional 50% late submission fee charge. Payment options (Payment will be made following approval) 1.Payment can be made via a payment link which will be sent to you following approval. Please note that you will be required to register and create an account. You will then be sent an email with proof of payment. 2.You can ask for an invoice to be raised. We will need a Purchase Order number, contact name and address for the invoice. Please provide the following information EVENT TITLE: Event date: Name and address of providing organisation: Venue: Nominated contact: Email: Phone number:Number of hours (not including breaks): Will the audience be (please tick): Local Regional National International Name of sponsors (if applicable): Participant fee(s):  Discipline of intended participants (tick as many as relevant):A&E MedicineAnaesthesiaDental SurgeryGeneral PracticeMedicineObstetrics & GynaecologyOphthalmologyOff-shore MedicinePaediatrics & Child HealthPathologyPre-hospital CareRadiologySports & Exercise MedicineSurgerySurgical Care PractitionersOther (please specify) Specialty (within discipline): Level/Grade of intended participants (please specify): Educational objectives of the event (please list): - - - -What specific skills/knowledge will participants gain during the event? (please list): - - - -What teaching methods will be used? (please tick) Lectures/tutorials Practical Workshops MCQs Synthetic Models Projection Quizzes Live demonstrations Discussion groups Individual performance review Other (please specify): How will this event be evaluated? Please submit either a blank copy of the proposed evaluation form or, if feedback is being collected online, a list of the questions that will be asked. You can use the sample evaluation at the end of this form should you not have your own. Please amend it to fit your event. Please note that organisers of CPD approved events are required to: Keep a record of the names of those who attended. This record should be kept for a minimum of eight years. Provide attendance certificates to participants who require them, including the CPD reference. Please note that individual participants can only record the number of hours they attend.  Guidance for Approval of CPD Events In order to qualify for CPD approval an event should: be aimed at a defined target group(s) set out clear and relevant aims and objectives include a mechanism for evaluation - so that the organisers and presenters can obtain feedback on the relevance, quality and effectiveness of the activity have an appropriate programme - which reflects the needs of the intended participants reflect a broad consensus of current expert opinion not be overtly promotional where there is a commercial sponsor have a nominated organiser who will keep records of attendance and evaluation The type of events which may require CPD approval are: Educational Conferences Educational Courses Distance learning programmes The AoMRC expects hospital-based CPD activities to be of good quality and well monitored. Such activities do not require approval unless they are aimed mainly at surgeons outside the hospital. However, local mechanisms must be set in place to accredit, monitor and record participation in local activities. Award of CPD If an event is approved for CME/CPD, it will be awarded a number of CPD hours, based on the duration of the activity as follows: one hour of educational content = one hour of CPD Please note that further guidelines and information on CPD can be found on the College website at  HYPERLINK "/professional-support-development-resources" /professional-support-development-resources Application procedure for approval 1. The completed application form should be returned, no later than 14 days leading up to the event, with a copy of the event programme and a copy of the proposed evaluation. Meeting organisers are advised that it is in their interest to forward forms at the earliest possible stage to ensure that CPD approval can be included on any pre-course material. 2. The form must be returned to only one office. Where appropriate the College or faculty will seek advice from the relevant specialist association, unless the meeting is of a general nature. 3. Appeals against a decision not to grant approval of an event will be referred to the Chairman of the Royal Colleges and the Federations of Surgical Specialty Associations (FSSA). If an event is approved someone from the approving body may ask to attend. In the case of distance learning programmes, the organiser may be called upon to show the programme materials to the approving body. After a CME/CPD approved event has taken place, the organiser would be expected to retain a list of participants for eight-years and a copy of the completed event evaluation for two years and to make these documents available to the JCCPD and the relevant College, Faculty or specialist association if required. * Specialist association refers to the SAC defined specialities. Sub-speciality groups should submit forms to the parent body within the speciality. If there is doubt or the meeting is of cross speciality interest, send the form to one of the Colleges. SAMPLE EVALUATION / FEEDBACK FORM As a result of attending this course, I have improved in my ability to:Strongly DisagreeDisagreeNeither Agree nor DisagreeAgreeStrongly AgreeList learning outcomes (but reword to fit with above)  Please rate the quality of each session in terms of clarity, relevance, and delivery on a scale of 1 to 5 (1 = Very Poor, 2 = Poor, 3 = Adequate, 4 = Good, 5 = Very Good) Sessions:Clarity of informationRelevance of sessionDelivery (materials/ style)List lectures and workshops What is the most important thing you have learnt from this Event?  Will you make any changes to your working practices as a result of attending this Event?  After having attended the Event, do you have any unanswered questions? *  In the future, I'd like to see other courses offered on the following topics: *  *If you would like to be emailed re either of the above please enter you email address here:  Please comment on up to three aspects of the Event that you LIKED:1.2.3. Please comment on up to three aspects of the Event that you DISLIKED (suggestions for improvement are welcome):1.2.3. Please rate the following:Very PoorPoorSatisfactoryGoodExcellentLocationVenueAudio Visual QualityCateringRegistration FeeExperience when contacting the College Online booking system, if usedOverall rating of the course Other YES NODid this course meet your expectations?Would you recommend this course to a friend / colleague? How did you hear about this course? (Please tick)Website ( Flyer/Poster ( Colleague ( Mailshot / e-mailshot ( Event (state which) _______________________________ Advertisement (state where) _______________________________ Other (please specify) _______________________________ Do you have any suggestions on where we should have advertised this course?  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