Opinion 4.1 Graph

& Gap Analysis

Title of Activity:

___________________________________________________________________________________________________

Description of current state: ___________________________________________________________________________________________________

Description of desired/achievable state: ___________________________________________________________________________________________________

Identified Gap(s): __________________________________________________________________________________________________

Gap to be addressed by this activity:

Knowledge (add as many numbers as you need)

1.

2.

3. T

Skills

1.

2.

3.

Practice

1.

2.

Other:

1.

Learning Outcome (s)

Cognitive:

1.

2.

_____________________________________________________________________________________________________________

Affective:

1.

2.

_________________________________________________________________________________________________________________

Psychomotor:

1.

2.

3.

CONTENT

(Topics)

TIME

FRAME (if live)

PRESENTER/ AUTHOR

TEACHING METHODS/LEARNER ENGAGEMENT STRATEGIES

Provide an outline of the content

Approximate time required for content

List the Author

List the learner engagement strategies to be used by Faculty, Presenters, Authors

List the evidence-based references used for developing this educational activity:

Current State

Desired State

Identified Gap

Gap due to knowledge, skills, or practice

Purpose

Outcome Measure

Where the learner is now?

Where the learner should be?

What does the learner not know, not know how to do, or cannot do in practice?

Identify type of gap

How is this education activity going to help close the identified gap?

How will you know/measure whether or not the activity helped to close the identified gap?

&

Gap Analysis

Title of Activity:

___________________________________________________________________________________________________

Description of current state:

_____________________________________________________________________________________________

__

____

Description of desired/achievable state:

__

___________________________________________________________________________

__________

____________

Identified Gap(

s):

__________________________________________________________________________________________________

Gap to be addressed by this activity:

Knowledge

(add as many numbers as you nee

d)

1.

2.

3.

T

Skills

1.

2.

3.

Practice

1.

2.

Other:

1.

& Gap Analysis

Title of Activity:

___________________________________________________________________________________________________

Description of current state:

___________________________________________________________________________________________________

Description of desired/achievable state:

___________________________________________________________________________________________________

Identified Gap(s):

__________________________________________________________________________________________________

Gap to be addressed by this activity:

Knowledge (add as many numbers as you need)

1.

2.

3. T

Skills

1.

2.

3.

Practice

1.

2.

Other:

1.

The Clinical Issue And Research Questions Developed Using PICOT