Learning from Teaching CME Credit Claim Form

Learning Activity Information

Learning Associated With Teaching Medical Students and Residents
Instructions:
Complete this online form to submit to the University of Nevada, Reno School of Medicine Office of Continuing Medical Education in order to claim credit for the time spent learning new clinical information or ways to improve your teaching, in preparation for teaching medical students or residents/fellows in an ACGME‐accredited program.

You may receive two AMA PRA Category 1 Credit(s)™ for each hour that you spend teaching what you have learned. However, if you give the same talk to both residents and students you may only claim the activity once; after all, you only did the learning one time. Time is measured in quarter‐hour increments.

Once reviewed by the CME program your participation in this teaching activity will be confirmed by either Undergraduate Medical Education or the Graduate Medical Education office. At the completion of that step you will receive your credit certificate.

Accreditation:
The University of Nevada, Reno School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Nevada, Reno School of Medicine designates this live activity for a maximum of 2.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

1. Presenter Information

First Name

Last Name

Degree

Specialty

Email Address

Date of Teaching

Course Title or Teaching Activity

Location

2. Who were your learners?

Medical Students
Residents

3. What was the personal skill or knowledge gap that you identified?

4. Describe the learning activity you chose to participate in to address the identified skill or knowledge gap.

5. Describe what you learned and how this learning activity informed or improved your professional practice of teaching. Describe this in terms of new knowledge sought or gained, or a new strategy or practice developed for you.

6. Which competency domain did this gap address? (check all that apply)

Medical knowledge
Clinical Practice/ Patient Care and Procedural Skills
Professionalism
Systems-Based Practice
Communication Skills
Practice Learning and Improvement
Other - Please Describe Please enter an 'other' value for this selection.