Gap Analysis Worksheet Template printable pdf download

Gap Analysis Worksheet Template

Gap Analysis Worksheet

This form will be useful in capturing feedback from planners, course directors or from the target

audience associated with a CME intervention in the planning stage. You may enter information by

handwriting or by clicking in the grey data entry boxes below and auto populating the boxes. Link the

responses in this form with other sources of needs; the learning objectives; development of the

educational design and assessment of changes or improvements in physician competency, performance-

in-practice, or patient outcomes as a result of this activity or group of activities.

Probe Question #1—What has changed in the practice of your specialty over the past year, and would

therefore merit educational interventions focused on these issues?

Responses:

Probe Question #2—Have there been areas where quality indicators suggest a focused improvement

is appropriate? If so, please provide specific information on topic and plan to incorporate into the

activity or group of activities.

Responses:

Probe Question #3—Is there breaking research in your specialty that physicians will find interesting

and medically relevant to the quality of care for their patients? What are the educational strategies

that will expedite the translation of the research to practice?

Responses:

Probe Question #4—Are there traditional core performance areas in your specialty that are worth

reinforcing and updating?

Responses:

Probe Question 5—Have there been recent untoward patient incidents concerning safety and efficacy

that would merit an educational intervention or inclusion in a larger activity?

Responses:

Gap Analysis Worksheet Template