CPD activity toolkit
Frequently asked questions
General questions about accreditation
Where should learning objectives be published?
Overall and session-specific learning objectives for any continuing professional development (CPD) activity (face-to-face or web-based group learning, self-assessment programs, etc.) should be included in preliminary and final program materials. Learning objectives should be distributed prior to the activity to facilitate the participants’ ability to determine the relevance of the learning activity to their practice. It is essential that learning objectives be written from the learner’s perspective and that they clearly state what a participant will know or be able to do as a result of attending an event or session.
Can educational activities for other health professionals be included in an accredited group learning activity for physicians?
There are many examples of physician organizations that include other health professions as members of their target audience. Educational activities that are targeted at a health care team or at physicians and other health professionals must meet the educational and ethical standards expected for accredited group learning activities. If a specific activity is planned for other health professionals it can also achieve the same standards for physicians or the standards developed by that health profession, where applicable. These types of activities can be included in an accredited group learning event for physicians.
How can attending a group learning activity contribute to the development of personal learning projects in Section 2 of the Maintenance of Certification (MOC) Program?
Simply attending a group learning activity is not the same as completing a personal learning project (PLP). However, attending a group learning activity could be the stimulus for the development of a PLP that may include some of the aspects of participating in the activity. Personal learning projects are self-planned learning activities, developed to answer a question, issue or problem identified in professional practice. Before participating in a group learning activity, participants could review the learning objectives and description of each session and develop one or two questions the activity may answer. The formal (plenary session, large and small group activities) and informal (collegial discussions at breaks or over lunch) activities are resources that can be leveraged to answer the question(s) developed. When the activity is complete, the intention is to reflect what was learned and document the conclusions or learning outcomes in MAINPORT ePortfolio.
What information should be included on a certificate of attendance?
The physician organization is always responsible for issuing certificates of attendance to all participants, (regardless of their profession or specialty) for accredited group learning activities, accredited self-assessment programs and accredited simulation programs. A certificate of attendance should always include the following elements:
- title of the activity
- name of the physician organization responsible for the activity
- date(s) the activity took place
- location of the activity (i.e. city, country, web-based)
- total number of hours for which the activity is accredited
- number of hours the registrant attended the activity (or a blank space for the registrant to complete themselves)
- all applicable accreditation statements and the co-development statement, when necessary (for sample statements, see the next question)
What are the accreditation statements and where should they be published?
The accreditation statements should be placed on all promotional materials for the activity once accreditation approval has been received from an accredited CPD provider. These materials include conference programs, certificates of attendance, website advertisements, flyers, etc. Please note that statements indicating that an activity is “pending approval” are strictly prohibited. Click here for sample CPD accreditation statements.
Is a program that is only 30 minutes in duration eligible for MOC accreditation?
Yes. There is no minimum time requirement for accredited activities. MAINPORT ePortfolio will allow Fellows and MOC Program participants to record quarter-credits (15 minutes). The previous MAINPORT ePortfolio system accepted only full credits (one hour), therefore activities either needed to be at least an hour in length or learners would round up to the nearest full credit.
Can accredited CPD providers review activities developed solely for residents?
Yes. Activities developed solely for residents can be reviewed for MOC credits. Of course, the same accreditation standards apply to these activities. Resident Affiliates of the Royal College may participate in the MOC Program and carry forward up to 75 credits from their Residency Affiliate cycle to their first Fellow cycle.
Does a Fellow have to sign the accreditation application form?
No. The chair of the planning committee must sign the accreditation application form, thus taking responsibility for the educational and ethical standards of the program.
Can accredited CPD providers review group learning activities held outside Canada for MOC credits?
Yes, but it may not be necessary. Group learning activities held outside of Canada developed by an international physician organization do not have to be accredited by a Royal College-accredited CPD provider in order for learners to record MOC credits. If the program developer wishes to have the program reviewed for MOC credits, they may do so but it is likely that the activity has already been reviewed for credits in another jurisdiction. Note: If a Canadian physician organization holds a learning activity outside of Canada, it should be reviewed by a Royal College-accredited CPD provider for MOC credits.
How do I know if a conference held in Canada qualifies for Section 1 of the MOC Program?
In Canada, conferences, courses, workshops and seminars must be approved by a Royal College accredited CPD provider. Section 1 approval will be recognized by a Royal College accreditation statement on program materials. (Please refer to the next question regarding the exception.)
I participated in a group learning activity in Canada approved for AMA PRA Category 1 credits. Are these credits approved for MOC Section 1?
Group learning activities held in Canada but developed by Accreditation Council for Continuing Medical Education (ACCME)-accredited physician organizations (university, academy, specialty society, hospital department etc.) can be recorded as accredited activities under Section 1 of the MOC Program.
If the activity was developed by a physician organization, the following statement can be placed on program materials to indicate to learners that they may record MOC Section 1 credits for the group learning activity:
- “Activities held outside of Canada developed by a university, academy, specialty society or other physician organization can be recorded as accredited group learning activities under Section 1 of the Royal College of Physician and Surgeons of Canada’s Maintenance of Certification (MOC) Program.”
Where can a participant report their attendance at a conference held outside of Canada or a conference held overseas?
All live conferences or live courses held outside of Canada can be reported as accredited group learning activities under Section 1 of the MOC Program if they are developed by a university, academy, college, academic institution or physician organization.
A participant completed an online group learning course approved for AMA PRA Category 1 credits. Are these credits approved for MOC Section 1?
Online group learning courses do not automatically qualify for Section 1 credits in the MOC Program. All web-based group learning activities must be reviewed and approved directly by a Royal College Accredited CPD Provider and if approved, would contain the Royal College accreditation statement.
At what point does an accredited activity have to be re-reviewed as a result of changes?
All Section 1 group learning activities are accredited for a one-year period. All Section 3 self-assessment programs and simulation-based activities are accredited for a three-year period. If there are any significant changes to the content, learning objectives or desired learning outcomes, the program must be re-reviewed. This review process could be a partial review of the content or a complete review, depending on how significant the changes are. This is up the discretion of the accredited CPD provider.
Is the accreditation of rounds a responsibility of an accredited CPD provider?
No. The accreditation of rounds, journal clubs and small group learning follows a self-approval process. Accredited CPD providers can be valuable resources for the planning committees of these activities by providing mentoring, coaching and sharing resources and tools but Royal College-accredited CPD providers are not responsible for the accreditation of these activities. However, some university offices of CME have taken on a leadership role within their faculty to provide oversight of these activities.
Do participants of accredited conferences need to “sign in” to each workshop/activity?
No. The MOC Program operates on the honour system. We do not expect activity organizers to keep track of how many actual hours a learner participates in a learning activity. However, we do require activity organizers to maintain attendance records for a five-year period. These records should indicate the names of the participants for any future credit validation purposes.
Is there a minimum amount of time I am required to retain the evaluation forms for an accredited activity?
There is no Royal College accreditation policy for the retention of evaluation forms. Our recommendation is that activity planners retain a summary of the evaluation forms (which must be provided to each faculty member) for a period of time that will allow program planners to reflect on the evaluation results to inform program change, needs assessment data, overall CPD program evaluation, etc.
On conflict of interest
In addition to presenters and planning committee members, do moderators, session chairs and/or facilitators need to submit a conflict of interest form?
It is important that the audience be made aware of any potential conflicts of interest held by anyone with responsibility for the planning or content of an activity. Faculty and planning committee members are expected to complete and submit a conflict of interest declaration form. Faculty members are also expected to include a slide at the beginning of their presentation informing the audience of any declared conflicts of interest. Declared conflicts of interest from all planning committee members, session chairs, moderators and/or facilitators should be communicated to participants in some form (for example, printed in the final program).
What strategies would the Royal College recommend for managing identified conflicts of interest?
When a conflict of interest is declared, the physician organization must have a process in place to manage identified conflicts of interest that, in the judgment of the physician organization, are of significant concern (for example, where the conflict and the content of the topic make balance and the minimization of bias very difficult).
There are a number of strategies that can be considered to manage and resolve such identified conflicts:
- The speaker could be required to alter the focus of the talk to limit the areas where conflict of interest is significant.
- The topic selected could be changed, but the same speaker be used.
- The planning committee could ask for a peer review of the content to ensure that the principles of scientific integrity, objectivity and balance have been respected.
- Both topic and speaker could be eliminated. This is a very uncommon occurrence, but it can be a last resort if a significant conflict of interest cannot be otherwise managed.
On “physician organizations”
How does the Royal College define a “physician organization”?
Can three or more physicians from a faculty of medicine create a program and be considered a physician organization?
Yes, if the three physicians are from the same department within the faculty of medicine and are developing the activity as members of the department. If the three physicians are from different departments within a faculty of medicine, the individuals cannot be equated with a physician organization because physician organizations must have “a formal governance structure, accountable to and serving, among others, its specialist physician members”. Since a small group of physicians often have a good idea for the development of a group learning activity, they may co-develop it with a physician organization. Educational events developed independently by a group of doctors cannot be considered for MOC Section 1 credits.
Does a physician organization need to have a membership base?
Almost invariably, a physician organization has a membership base that defines its accountability to the profession. Non-physician organizations are often accountable to the government, the public or shareholders. Accountability to the profession is a key element in what defines a physician organization.
For an activity to be approved for MOC Section 1 credits, does there have to be at least one specialist physician who is a Fellow of the Royal College on the planning committee? If yes, should this individual sign the application form on behalf of the physician organization?
The Royal College standards for CPD accreditation require planning committees to reflect their target audience. So if specialist physicians are part of the target audience, they must be represented on the planning committee. Whether or not a single individual can represent the intended target audience of an activity is a matter of judgment.
How can I acknowledge sponsors of educational activities approved for MOC credits?
Sponsors providing an educational grant for an activity approved for MOC credits may be acknowledged on the general sponsorship page in the syllabus or program of the activity. Sponsorship acknowledgements should be located on a page separate from the educational content (for example, on the back page of the program).
Can higher-level sponsors (such as platinum) be specifically thanked apart from the other sponsors at a purely social event within an activity?
Yes, this is ethically permissible.
Can there be written or verbal recognition of the sponsors during a social event?
Yes, but is important to ensure there are no accredited educational components to the social event.
Can a sponsor fund a specific day of a multi-day conference?
Yes, this is ethically permissible if the specific day is separated into a separately accredited activity. It is ethically preferable that the acknowledgement of the funding not be included in the overall program.
Can sponsorship recognition on a website include hyperlinks to the main pages of the sponsors’ websites?
This is ethically permissible only on pages that do not contain e-CPD material, per the CMA Guidelines for Physicians in Interactions with Industry (2007), which states: “There should be no direct links to an industry or product website on any web page which contains e-CPD material” (guideline 37). All e-CPD activities approved for MOC Program credits must be free of any promotional displays, infomercials or any form of industry advertisements including corporate logos.
Can a plaque be presented recognizing partnerships with sponsors at a social event or during a trade show without any educational components?
Yes, this is ethically permissible assuming that there are no accredited educational components included within these types of social events.
Can a sponsor pay for the printing, publishing and distribution of abstract books as a sponsorship opportunity and be acknowledged for doing so?
Yes, this is ethically permissible if such practices do not have any influence on aspects of the planning process or scientific information, including the selection of the content or speakers that formed the basis of the abstracts.
What is “tagging”?
Tagging is defined as the linking or alignment of a sponsor’s name to a specific educational session within an accredited group learning activity. Effective July 1, 2012, tagging is not permitted.
Does the tagging policy only apply to a pharmaceutical company or medical device company, or does it relate to any instance where funds change hands?
The application of the tagging policy is not restricted to members of the pharmaceutical/medical device industry, but to any sponsor, including not-for-profit organizations. A “sponsor” is an individual, group, corporation or organization who contributes funds, goods or services to support accredited educational activities, learning resources or tools. The provision of an “in-kind” contribution does not allow the names of organization to be tagged to specific components, but should be acknowledged in a general way as a sponsor or collaborator of the entire activity. Sponsorship acknowledgements should be located on a page separate from the educational program (for example, on the back page of the program).
Are there any options where sponsorship funding can be linked to specific educational activities within an approved activity?
Linking a sponsor to a specific educational session within an approved activity is permissible if the educational activity is unaccredited. Unaccredited sessions cannot be advertised in the educational program and must occur at times that do not compete with accredited activities. These types of activities are referred to as “satellite symposia.”
Can an award that is named after an industry sponsor be presented at a President’s Gala?
Yes, this would be ethically permissible as the activity is an award presentation, which is not considered an accredited group learning activity.
If an Internet café is sponsored and the kiosks are located inside the exhibit hall within the sponsor’s booth (an unaccredited venue), is tagging permissible?
Linking a sponsor to a specific educational session within an approved activity is ethically permissible for all non-educational activities and items. It is ethically preferable for the internet café to be located in an exhibit hall (or similar) separate from the space where the educational activities occur.
Are activity organizers permitted to distribute one-page promotional items at the registration booth advertising satellite symposia?
Yes, this is ethically permissible; however, the activity organizer is not required to do so. Satellite symposia are unaccredited group learning activities, which must occur at times that would not conflict with, or compete with, accredited group learning activities. Satellite symposia may not be listed or advertised within conference brochures or schedules (including preliminary and final programs).
If a social activity (such as a lunch) can be tagged, can there be a sponsor’s sign in the room where lunch is being served?
Sponsorship of non-educational events such as lunches within an accredited educational activity is ethically permissible. Therefore, a sign may be placed in the room where lunch is being held indicating the sponsor’s name.
What is co-development?
Co-development is the process by which two or more organizations — at least one of which must be a physician organization — prospectively collaborate to develop and implement an accredited educational activity, learning resource or tool.
How is co-development different from sponsorship?
Sponsorship is the process by which individuals, groups, corporations or organizations provide support (financial or in-kind contributions) to a CPD organizer to support an accredited educational activity, learning resource or tool. Co-development is the process by which two or more organizations — at least one of which must be a physician organization — prospectively collaborate to develop and implement an accredited educational activity, learning resource or tool. Co-development may or may not include the provision of sponsorship. In a co-development relationship, the physician organization must assume control over all aspects of the planning process (needs assessment, learning objectives, content, evaluation, speaker selection) as if they were planning the event independently. If the co-development relationship is with a pharmaceutical/medical device company, there are several additional important restrictions. Members of the pharmaceutical/medical device company cannot participate as members of the planning committee that determines the content, speakers, educational format, etc. Non-physician organizations can contribute their expertise to needs assessment strategies, evaluation strategies and logistical support for the activity.
With the understanding that in a co-development relationship an industry representative cannot sit on the planning committee, can the industry representative recommend a physician to sit on the planning committee?
For CPD activities accredited for Royal College Maintenance of Certification (MOC) Program Section 1 or 3 credits, representatives of a sponsor or any organization hired by a sponsor may attend SPC meetings but are not permitted to participate in decisions related to CPD program elements. For CPD activities accredited for CFPC Mainpro+ credits, representatives of a commercial interest, as defined by the National Standard, or any organization hired by a commercial interest cannot attend SPC meetings. Sponsors who are not commercial interests may attend SPC meetings but are not permitted to participate in decisions related to CPD program elements.
How far along in the program planning process can a co-development relationship begin?
For a physician organization to assume responsibility and control all aspects of the activity, the co-development process must begin early in the planning process. Although it is ethically preferable for the physician organization to identify a need to develop an activity, it is ethically permissible for a non-physician organization to approach a physician organization with needs assessment data. In this circumstance, the physician organization must validate the relevance of the needs assessment data and determine what educational response is appropriate to meet the needs of the defined target audience.
When activities are co-developed with a non-physician organization, any speaker expenses (such as honoraria, travel expenses and accommodation expenses) must be paid by the physician organization. Can other expenses related to the activity (such as food, AV, room rental) be billed to and paid by the non-physician organization?
The CPD provider organization or SPC can assume or delegate to a third party the payment of travel, lodging, legitimate out of pocket expenses and any honoraria offered to members of the SPC, speakers, moderators, facilitators and/or authors. The CPD provider organization or the SPC must approve what payments are delegated and retain overall accountability for these payments.
How can industry’s participation in a co-developed event be acknowledged?
All accredited co-developed programs should be acknowledged as such in program brochures or materials. It is ethically permissible to include an acknowledgement of the co-developed activity in the outline of the program. All co-developed relationships should be acknowledged using the following statement: “This [program/workshop/seminar] was co-developed with [name of the organization] and was planned to achieve scientific integrity, objectivity and balance.” It is ethically permissible to include the non-physician organization’s logo in the co-development statement that is published in the meeting materials.
On web-based activities
Can online group learning activities developed by a Royal College-accredited CPD provider be designated for AMA PRA Category1 Credits™?
All web-based group learning activities approved for MOC Section 1 credits by either an accredited national specialty society, or simulation program are eligible for conversion to AMA PRA Category 1 Credits™.
Are there additional criteria for web-based group learning activities to be approved for Section 1 MOC credits?
In addition to the organizational, educational and ethical standards established for accredited group learning activities, there are four requirements applicable to all asynchronous web-based group learning activities.
1) Asynchronous group learning activities delivered via the web must provide an opportunity for interaction between participants and faculty/facilitators and enable participants to observe the interaction of other participants with the course faculty/facilitator.
2) Acceptable options to incorporate interactivity for accredited group learning activities delivered in an electronic format include, but are not limited to:
- discussion forums/chat groups
3) Participants must log on to the interactive component. Fellows can only claim the time spent reviewing posted materials under MOC Section 2 (scanning).
4) Certificates of participation should only be given to participants after they have logged on to the interactive component.
Can sponsorship recognition on a website include hyperlinks to the main pages of the sponsors’ websites?
This is ethically permissible only on pages that do not contain e-CPD material, per the CMA Guidelines for Physicians in Interactions with Industry (2007), which state: “There should be no direct links to an industry or product website on any web page which contains e-CPD material” (guideline 37). All e-CPD activities approved for MOC Program credits must be free of any promotional displays, infomercials or any form of industry advertisements, including corporate logos.
On self-assessment programs
I am reviewing a self-assessment program (SAP) that has a minimum passing grade which must be met in order for participants to receive credit and a certificate of participation. Does this make this program ineligible for MOC Section 3 credits?
Not necessarily. In order for a SAP to be approved for MOC Section 3 credits, all accreditation standards must be met, including the standard that states: “Self-assessment programs must provide detailed feedback to participants on their performance to enable the identification of any area(s) requiring improvement through the development of a future learning plan.” Providing specific feedback on which answers were correct and which were incorrect, with references, enables learners to determine if there are significant gaps in their knowledge, skills, clinical judgment or attitudes that need to be addressed through further learning activities. The Royal College standards for self-assessment programs do not require a minimum passing grade to obtain credit. Therefore, if all learners receive the level of feedback that meets the standard outlined above, regardless of the grade achieved, the passing grade would not be considered a barrier to accreditation. If learners only receive feedback on their performance once a passing grade is achieved, the program would not meet the standard. Upon completion of an accredited learning activity, all participants must receive a certificate of participation.
Can a learning activity with a pre- and post-activity test be accredited as a self-assessment program?
It could be. If the pre/post test is designed to provide learners with an opportunity to assess their knowledge and use the data and feedback to identify gaps and develop an appropriate educational response, then it is possible that the program would meet the accreditation standards. Self-assessment programs use a gap analysis strategy that must.
- be based on an identified learning need,
- enable a learner to demonstrate their knowledge, competence or performance,
- provide the participant with their performance in relation to the current evidence, and
- meet all the ethical standards established by the Royal College.
The gap analysis strategy must be designed to ensure that the key knowledge areas for a specific topic or condition are assessed in both a comprehensive (breadth) and complete (depth) manner. If the pre/post test strategy is designed to evaluate the effectiveness of the learning activity in enhancing knowledge or skills and not to support a gap analysis strategy, it would likely not meet the accreditation standards. Therefore, it must be determined whether the program is designed to enable learners to assess the extent or depth of their knowledge or if it an assessment strategy is being incorporated into a learning activity evaluation process.
How can an audience response system be integrated into a group learning activity so that participants can receive MOC Section 3 credits?
An audience response system (ARS) can be a useful learning tool. Not only can an ARS be used to enhance the interactivity opportunities in a group learning setting, it can also be used to assess learners’ gaps in knowledge. If designed in such a way that it meets the standards, a group learning activity that integrates an ARS into the learning environment can be accredited as a self-assessment program. To determine whether the accreditation standards will be met, consider the following:
- How will learners record their answers? The standard: Accredited self-assessment programs must provide learners with a process to record their answers.
- How will participants receive feedback on their knowledge? The standard: Accredited self-assessment programs must provide learners with feedback on the answers they provided (which questions were answered correctly/incorrectly).
- Has appropriate depth and breadth of the specific topic been assessed? The standard: Accredited self-assessment programs must be developed to provide a thorough review of all key knowledge areas.
- How will the references for the correct answers be provided to learners? The standard: Accredited self-assessment programs must provide references to facilitate a review of the evidence for incorrectly answered questions.
Integrating accredited self-assessment strategies into group learning is possible, but program developers must ensure that the standards outlined above as well as the other educational and ethical standards are met.
I have just reviewed and approved a self-assessment program for MOC Section 3 credits. Do I have to submit any paperwork to the Royal College?
Yes. In order for MOC Program participants to record SAP activities in MAINPORT ePortfolio, they must select approved programs from a drop-down menu. Our office populates this drop-down menu after receiving the notification of review forms submitted by accredited CPD providers. Please visit our website to access the up-to-date notification forms and submit notification forms as soon as the program is approved to ensure it is added to MAINPORT ePortfolio before the program start date. If you have approved an SAP for MOC credit, please visit our website to check that we have received and processed your notification of review.
What is the maximum accreditation period for self-assessment programs?
Three years, assuming the content has not changed. If the content changes significantly, it must be re-submitted for a partial review at the time that changes are made.
On simulation-based learning activities
Now that simulation programs may apply to become Royal College-accredited CPD providers, can other accredited CPD providers still review simulation activities for MOC Section 3 credits?
All accredited CPD providers may continue to accept and review accreditation applications for simulation-based learning activities. The accredited simulation programs may only assign MOC Section 3 credits for activities they develop or co-develop and are not permitted to review applications from outside organizations.
How can observers of a simulation activity record MOC credits?
Observers of a simulation-based activity do not receive feedback on their own performance and are therefore not able to record MOC Section 3 credits. Observers may record their participation under Section 1 accredited group learning, or they may use the knowledge gained as a stimulus to create a personal learning project under Section 2 of the MOC Program.
What are the feedback requirements of a simulation activity?
Organizers of simulation-based learning activities must include a strategy for instructors to provide performance feedback to participants. Feedback will enable the learner to develop a learning plan that will address areas that require improvement. Feedback can be provided immediately or after the activity is over, either verbally and/or in writing, and must be based on an assessment of performance measured against the learning objectives, competencies and practice standards as supported by published evidence.
When reviewing a simulation activity that includes a group learning component, how do I count the number of hours eligible for MOC credit?
Quite often, simulation-based activities include group learning component(s) and a facilitator will spend some time briefing learners about what they are about to experience, what is expected of them, what the simulator can and cannot do, etc. When estimating the total credit time for MOC credits, all time spent providing instructions and/or a short lecture on the simulation topic, providing the rationale and instructions for the activity, the simulation scenario itself, and debrief time is eligible for MOC Section 3 credits. When a learning component is essential to the simulation activity, it should be considered part of the accredited Section 3 activity.
CPD Accreditation Coordinator
The Royal College of Physicians and Surgeons of Canada
774 Echo Drive
Ottawa ON K1S 5N8
Telephone: 613-730-2587; toll-free 1-800-668-3740, ext. 587