CME Application Part 1

The purpose of the INTEGRIS HEALTH Medical Education office is to plan and execute exemplary educational activities based on the practice gaps of our participants with the result being to enhance the participants knowledge of evidence based medical information and skills to apply that knowledge, resulting in an influence on their behavior leading to better patient outcomes. It is our hope that you use this form as more than an application for credit: It should serve as a tool to structure the design, implementation, and evaluation of your activities.

Continuing Medical Education Diagram

There are two parts of the INTEGRIS Health CME Application. The Medical Education Department will provide access to Part 2 of the application after verifying Part 1 meets the Accreditation Council for Continuing Medical Education (ACCME) requirements.

Please read this document in its entirety, and then complete. If you have questions, or difficulty in filling out the form, please contact Jill Mayes, System Director of Continuing Medical Education at 405-317-5845.

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Section 1 - Activity Information
Section 2 - Program Purpose

Please describe the desired outcome of this program (what will the learner be able to do following completion of the program).

Section 3 - Professional Practice Gaps and Educational Needs

This section asks you to describe the practice problem to be addressed through education, why the problem exists, and how you identified the need for education. The planning committee should identify professional practice gaps. The gap is the difference between what is actually happening in practice and what should be happening in practice. Answers the question: Why do they need a learning activity on this topic? Gaps can exist at the individual, group, or community level of providers. Sources to identify gaps may include: national data, peer-reviewed published literature, registries such as, practice guidelines, national data, professional society/college data, chart audits, standardized assessment exercises, focus groups, reflection in/on practice, computerized tools, office visit diary and/or, learning portfolios. Click here for additional guidance.

Supporting documentation provides evidence to validate the professional practice gap. This is the information that helped identify the need for education. Please provide the information used to identify the professional practice gaps based on your needs assessment (e-mail) via email to Jill Mayes at
Section 4 - Activity Design and Objectives

The gaps will drive both the development of the instructional activity design and the learning objectives of the CME activity. Develop the CME activity to address the needs identified above in order to change competence, performance and/or patient outcomes. (See Example)


The objectives are the solution to address the need and help close the practice gap. Objectives should be measurable and define what the learners will be able to do as a result of this activity.

Activity Competencies

Please indicate which desirable physician attributes are associated with this activity content.

Enduring Materials

Enduring Material CME is an activity that is printed or recorded and does not have a specific time or location designated for participation. The participant determines when to complete the activity.

If this activity is planned for enduring material, please complete information below.
Section 5 - Activity Evaluation and Outcomes

Activity Competencies Identifying learners’ practice gaps is a key component to providing meaningful CME as part of the continued professional development process. The gaps can be used as part of the outcomes evaluation process to determine how effective the educational activity was.

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