1. Title of activity ... - Kuwait Institute for Medical Specialization
1. Title of activity ... - Kuwait Institute for Medical Specialization
1. Title of activity ... - Kuwait Institute for Medical Specialization
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Form I<br />
CME Center<br />
<strong>Kuwait</strong> <strong>Institute</strong> <strong>for</strong> <strong>Medical</strong> <strong>Specialization</strong><br />
Application <strong>for</strong> Accreditation <strong>of</strong> CME/CPD Programs – Administration Details<br />
<strong>1.</strong> <strong>Title</strong> <strong>of</strong> <strong>activity</strong>: ………………………………………………………………..……<br />
2. Date(s):……………………………… Duration (in hours <strong>of</strong> <strong>activity</strong>): ……..............<br />
3. CME/CPD Provider: …………………………………………………………………<br />
4. Organizing institution: ……………………………………………………..….…......<br />
……………………………………………………………………………………......<br />
5. Name <strong>of</strong> coordinator/organizer <strong>of</strong> <strong>activity</strong>: ………………………….…..…….…….<br />
Contact address: ………………………………………………………..………….....<br />
……………………………………………………………………………………......<br />
Tel.: .......................…… Fax: …….…………. Email address: …………………..<br />
6. Type <strong>of</strong> organizing institution:<br />
Academic Hospital/Health Center Health pr<strong>of</strong>essions society<br />
Specialized organization <strong>for</strong> CME/CPD Other<br />
(specify) .........................................<br />
7. Type <strong>of</strong> <strong>activity</strong><br />
Symposium/seminar<br />
Conference<br />
Workshop<br />
Lecture series<br />
Other (specify) ……….………………….……..………………………....<br />
8. Field <strong>of</strong> specialty or subject area: ……………………………………………….…...<br />
……………………………<br />
Coordinator/organizer<br />
……………………………<br />
Date<br />
Note: To ensure that there is sufficient time <strong>for</strong> prospective participants to be in<strong>for</strong>med and <strong>for</strong> them<br />
to make appropriate arrangements to attend, the completed Application Form and all required<br />
details should be received by the CME Center 3 weeks be<strong>for</strong>e the start <strong>of</strong> the <strong>activity</strong>.<br />
General basis <strong>for</strong> calculating credit points (Check details at www.kims.org.kw/cme or in publications provided by CME Center):<br />
Category 1<br />
One contact hour in lecture equivalent to one credit point <strong>of</strong> CME/CPD<br />
One contact hour in clinical/practical session equivalent to 0.5 credit point <strong>of</strong> CME/CPD<br />
Category 2<br />
One contact hour <strong>of</strong> session equivalent to 0.5 credit point <strong>of</strong> CME/CPD<br />
Annex relevant in<strong>for</strong>mation on <strong>activity</strong>, using Form II, Application <strong>for</strong> Accreditation <strong>of</strong> CME/CPD Programs – Academic Details.<br />
On completion <strong>of</strong> <strong>activity</strong>,<br />
i. Prepare Evaluation report <strong>of</strong> the program <strong>for</strong> use by organizer, resource persons and CME Center.<br />
ii. Maintain List <strong>of</strong> Participants <strong>for</strong> future reference.<br />
For use by CME Center:<br />
Credit points: ...................................................................……….<br />
CME Registration No.: .......................................................……..<br />
Approved:.........................................................<br />
Date:.................................................................
Form II<br />
CME Center<br />
<strong>Kuwait</strong> <strong>Institute</strong> <strong>for</strong> <strong>Medical</strong> <strong>Specialization</strong><br />
Application <strong>for</strong> Accreditation <strong>of</strong> CME/CPD Programs – Academic Details<br />
Note: To ensure that there is sufficient time <strong>for</strong> prospective participants to be<br />
in<strong>for</strong>med and <strong>for</strong> them to make appropriate arrangements to attend, CME/CPD<br />
activities will be registered only if the completed Application Form and all required<br />
details are received by the CME Center 3 weeks be<strong>for</strong>e the start <strong>of</strong> the <strong>activity</strong>.<br />
CME/CPD organizers are requested to provide in<strong>for</strong>mation about the proposed <strong>activity</strong><br />
under the following headings, and to <strong>for</strong>ward it with the completed Application <strong>for</strong><br />
Accreditation <strong>of</strong> CME/CPD Programs – Administration Details to the CME Center <strong>of</strong> the<br />
<strong>Kuwait</strong> <strong>Institute</strong> <strong>for</strong> <strong>Medical</strong> <strong>Specialization</strong> (Use additional sheets, if necessary):<br />
<strong>Title</strong> <strong>of</strong> <strong>activity</strong>: …………………………………………………………………….<br />
Frequency <strong>of</strong> conducting <strong>activity</strong> (if to be repeated): …………………………………………<br />
Aims and objectives:<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
Content outline:<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
Scheduling <strong>of</strong> sessions (Annex copy <strong>of</strong> program schedule):…………………...………..<br />
Target audience: number and background: ……………………………………………<br />
…………………………………………………………………………………………<br />
Names <strong>of</strong> resource persons (Lecturers, tutors, demonstrators etc.):<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
…..…………………………………………………………………………………….<br />
Plans <strong>for</strong> program evaluation: …………………………………………………………..<br />
…..……………………………………………………………………………………….
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