SAMPLE SELF-STUDY REPORT

attached example of the AST Summary Report of Program Participant Evaluations. IMPORTANT NOTE: The Provider should keep all CE documents on file that pertain to a 3-year approval cycle with the exception that the Self-Study Report should be permanently maintained by the State Assembly. PROVIDER SELF-STUDY REPORT FOR AST APPROVAL PERSONNEL INFORMATION (Form A-2) List below the personnel that are involved in the continuing education activities of the Provider and identify their responsibilities by the code provided and the percentage of time devoted to each activity.<br><br> Code: (A) administrative; (B) CE development and planning; (C) coordination of instructors; (D) instructor; (E) review of participant evaluations; (F) marketing; (G) administrative assistant; (H) secretarial and clerical; (I) development of learning objectives; (J) review of CE offerings to determine relevancy to practice; (K) other (specify) Name & Title Responsibility(ies) % of Time (First Example) President, State Assembly A 25% B 25% E 25% F 25% Vice-President, State Assembly B 25% C 25% E 25% F 25% Secretary B 25% G 37% H 37% (Second Example: If State Assembly has an Education Committee) Chairperson A 50% C 25% E 25% Committee Member A B 75% F 10% H 15% Committee Member B C 50% E 25% F 25% Committee Member C F 100% Criterion 1: Provider must demonstrate the establishment of a mission statement of which the contents include the purpose of the provider and target audience. Standard 1A: Provider demonstrates compliance by submitting a mission statement that states the aim of the organization and target audience of its continuing education offerings. 1.<br><br> Copy of mission statement provided in Self-Study Report. __ X _ Yes ____ No Explanation for mission statement not included in Self-Study Report __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Criterion 2: Provider has an established review process for the continuous improvement of its continuing education program, activities, or course. Standard 2A: Provider demonstrates compliance by submitting a process for continuous quality improvement of its continuing education offerings.<br><br> 1. Explanation of process submitted with Self-Study Report. CQI includes how evaluation tools, such as participant evaluations are used for improvement of CE offerings.<br><br> Include internal methods of Provider to improve CE offerings such as annual review of all offerings. __ X __ Yes ____ No Explanation for process not included with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 3: Provider can demonstrate the types of activities provided and the content areas of its continuing education programs, activities, or courses.<br><br> Standard 3A: Provider demonstrates compliance by submitting information pertaining to the various types of continuing education offerings including written offerings that are hard copy, CD-ROM, or on-line, and live events or recorded live events that are presented on-line or on CD-ROM. 1. Brief description of the various types of continuing education offerings is provided in the Self-Study Report.<br><br> __ X __ Yes ____ No Explanation for descriptions not included with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 4: Provider has an appointed individual or individuals that are responsible for the organization and planning of continuing education programs, activities, or courses. Standard 4A: Provider demonstrates compliance by submitting evidence that identifies the individual or individuals that are responsible for overseeing, managing, and organizing the policies and procedures of its continuing education offerings including the development of such activities.<br><br> 1. Forms A-1 and A-2 are completed and included with Self-Study Report. __ X __ Yes ____ No Explanation for completed forms not included with Self-Study Report.<br><br> _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 5: Provider has the necessary resources to support the CE activities that it offers. Standard 5A: Provider demonstrates compliance by submitting evidence that if funds are needed to sponsor continuing education activities sufficient financial resources for the development and offering of continuing education is available. 1.<br><br> Financial resources are necessary for the development and offering of continuing education activities. ____ Yes __ X __ Explanation for no required financial resources. The State Assembly meetings and/or continuing education events are held at local hospitals who allow us to use meeting room(s) at no cost including AV equipment.<br><br> In addition the hospitals allow us to use their photocopy machines at no cost to print the program brochures. The State Assembly also regularly receives donations from med/surg companies to offset expenses. Criterion 6: Provider has qualified personnel that are involved in the instruction of each program, activity, or course.<br><br> Standard 6A: Provider demonstrates compliance by submitting evidence of personnel with proper qualifications that instruct or oversee each continuing education program, activity, or course. (Keep on file copies of AST Speaker & Educational Program Content Information forms for each speaker for each event) 1. Evidence submitted with the Self-Study Report.<br><br> Examples of submitting evidence could be a list of all CE offerings with name(s) of personnel and credentials who planned and conducted each CE offering, or use of the AST Speaker & Educational Program Content Information form. _ X _ Yes ___ No Explanation for evidence not included with Self-Study Report. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Standard 6B: Provider demonstrates compliance by submitting evidence that a CST or CFA has been primarily involved in the entire planning process of each continuing education program, activity, or course, including the development of a minimum of five (5) learning objectives.<br><br> This standard is all inclusive, i.e. written continuing education articles that are hard copy, on CD-ROM, or on-line offerings, live events or recorded live events presented on CD-ROM or on-line, or any other CE activity. (Place credentials after names on Form A-2) 1.<br><br> Evidence is submitted with the Self-Study Report. This can be included in the above named list, or list the credentials, e.g. CST, CFA, etc., after the names of the individuals on Form A-2.<br><br> _ X _ Yes ___ No Explanation for evidence not included with Self-Study Report. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Standard 6C: Provider demonstrates compliance by submitting evidence that a CST, CFA, and/or surgeon is principally involved in authoring and/or reviewing all continuing education articles, whether hard copy, on CD-ROM, or on-line. The CST or CFA is directly responsible for authoring the learning objectives.<br><br> When serving in the capacity of reviewer the CST or CFA is responsible for evaluating the article applying the learning objectives in assessing the articles relevance to the practice of surgical technology. The CST or CFA author(s) and/or reviewer(s) name(s) must be indicated on the published article. Standard 6D: Provider demonstrates compliance by submitting evidence that all continuing education articles, whether hard copy, on CD-ROM, or on-line, have undergone a peer review process.<br><br> 1. Evidence submitted with Self-Study Report. This can be included in the list mentioned in Standard 6C, #1.<br><br> ____ Yes __ X __ Explanation for evidence not included with Self-Study Report. State Assembly does not offer continuing education articles in the form of hard copy, CD-ROM, or on-line to the State Assembly members as a method to earn CE credits. Criterion 7: Provider communicates the purpose and/or learning objectives of each program, activity, or course in clear and concise statements to the participant is informed prior to the CE activity.<br><br> Standard 7A: Provider demonstrates compliance by submitting evidence that the purpose and/or learning objectives for each program, activity, or course are published prior to the date(s) of the offering(s). Standard 7B: Provider demonstrates compliance by submitting evidence that learning objectives are developed for each continuing education offering. Standard 7C: Provider demonstrates compliance by submitting evidence that the learning objectives for each CE offering are at a level above entry-level practice and enhance the knowledge of the surgical technology practitioner.<br><br> 1. Evidence provided in Self-Study Report. __ X __ Yes ____ No Explanation for evidence not included with Self-Study Report.<br><br> _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Standard 7D: Provider demonstrates compliance by submitting evidence of method used to determine that each continuing education offering is relevant to the practice of surgical technology. Note: AST recognizes that all CE activities are valuable offerings by the Provider, but that not all offerings meet AST criteria. 1.<br><br> Evidence is given in Self-Study Report. An example of evidence can include course descriptions that show relevancy to practice. __ X __ Yes ____ No Explanation for evidence not included with Self-Study Report.<br><br> _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 8: Provider will have processes or procedures established for each program, activity, or course to assess the achievement of the learning objectives. Standard 8A: Provider demonstrates compliance by submitting evidence of the processes or procedures that are used to determine if learning outcomes were achieved for each continuing education offering. One method used to determine if learning outcomes were achieved is a post-test that may include multiple choice and/or essay questions.<br><br> For home study courses, completion of only an evaluation form is not acceptable. 1. Evidence submitted with the Self-Study Report.<br><br> __ X __ Yes ____ No Explanation for evidence not included with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 9: Provider plans each program, activity, or course according to the identified needs of the target audience. Standard 9A: Provider demonstrates compliance by submitting evidence of how it collects information in relation to on-going continuing education needs of the surgical technologist, how the information is documented, how the information is used to plan programs, activities, and courses, and a system in place for establishing the content areas of the various continuing education offerings.<br><br> 1. Evidence is provided in Self-Study Report. An example of collecting information includes surveys of participants, analyzing and documenting survey results which are then used to develop CE offerings to meet the needs of the participants.<br><br> __ X __ Yes ____ No Explanation for evidence not included with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 2. Evidence is provided of a system used for planning the content areas of the various continuing education offerings.<br><br> For example, an orthopedic workshop may be planned, but how does the Provider determine the content to be covered and the content is related to the learning objectives. __ X __ Yes ____ No Explanation for evidence not included with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 10: Provider has a system in place to identify learners who have participated in the provider 9s CE programs, activities, or courses.<br><br> Standard 10A: Provider demonstrates compliance by submitting evidence of how it identifies learners as to the number of CST 9s and CFA 9s, non-credentialed surgical technologists, or surgical technologists with alternative credentials attend programs, activities, or complete courses. 1. Evidence is submitted with the Self-Study Report.<br><br> Evidence can include sign-in sheets for live events, pre-registration list of participants for live events, documentation of who completes home-study courses, etc. __ X __ ____ No Explanation for evidence not included with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 11: Provider will have a procedure for the evaluation of each program, activity, or course by participants.<br><br> Standard 11A: Provider demonstrates compliance by submitting evidence of the procedure that is used by participants to evaluate each continuing education offering. 1. Evidence submitted with Self-Study Report.<br><br> Examples include surveys or evaluation completed by the participant. __ X __ Yes ____ No Explanation for evidence not submitted with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 12: Provider has a certificate of attendance/completion that is given to participants upon successful completion of a program, activity, or course.<br><br> Standard 12A: Provider demonstrates compliance by submitting evidence of a certificate of attendance/completion that is provided to participants upon completion of a continuing education offering. Standard 12B: Provider demonstrates compliance by submitting evidence of placing the following statement on the certificate of attendance/completion. cThis continuing education activity is approved by the Association of Surgical Technologists, Inc.<br><br> for _____ CE Credits for continuing education in surgical technology. d 1. Example of certificate of attendance/completion with AST statement on the certificate submitted with Self-Study Report. __ X __ Yes ____ No Explanation for example not included with Self-Study Report.<br><br> _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Criterion 13: Provider is responsible for following the AST assigned value of the CE credit when calculating the number of CE credits to be awarded for an activity. Fractional presentations are not awarded CE credit(s). Standard 13A: The provider demonstrates compliance by submitting evidence that the following criteria for determining the number of CE credits for any given activity is applied: Live or recorded live event 1 CE credit equals 50-60 minutes of activity Article: printed, on-line, CD-ROM 1 CE credit equals 2,000 words 1.<br><br> Evidence submitted with Self-Study Report. __ X __ Yes ____ No Explanation for evidence not included with Self-Study Report. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ MISSION STATEMENT OF (NAME OF STATE ASSEMBLY) TO DEMONSTRATE COMPLIANCE WITH CRITERION 1 The mission of the (name of state assembly) is to promote the profession of surgical technology through continuing education, legislative, and marketing efforts that ultimately contribute to quality care of the surgical patient.<br><br> PROCESSES OF CONTINUOUS QUALITY IMPROVEMENT TO MEET REQUIREMENTS OF CRITERION 2 The AST Educational Program Evaluation Form and AST Summary Report have been adopted for use by the (name of state assembly). The State Assembly (board of directors and/or education committee) review the forms to target methods of improving the continuing education activities, in particular focusing on the relevant comments of the participants. The (board of directors and/or education committee) also conducts an internal post- program review in order to discuss the positive aspects of an event and ways in which the overall planning and actual day of the event, such as registration, could be improved.<br><br> The internal reviews are conducted during face-to-face meetings, E-mail exchange, and/or conference calls and the results of the meeting are recorded for future reference when planning another CE activity. DESCRIPTION OF CONTINUING EDUCATION OFFERINGS OF (NAME OF STATE ASSEMBLY) TO MEET REQUIREMENTS OF CRITERION 3 The (name of State Assembly) focuses on providing live events to the members of the State Assembly. The events are either scheduled for one or two days and involve business meetings and continuing education lectures.<br><br> The events are held once-a-year at a central location within the state. (For those state assemblies that schedule a CE activity/meeting in more than one location on or about the same dates the following statement is suggested: The events are held once-a-year at multiple locations, however the primary business meeting is held once-a-year at a central location within the state.) DEMONSTRATION OF COMPLIANCE WITH CRITERION 5, STANDARD 5A The (name of state assembly) relies on the following methods in which to have sufficient financial resources for the funding of continuing education activities: registration fee for workshops/forums and sale of State Assembly products. DEMONSTRATION OF COMPLIANCE WITH CRITERION 6 Standard 6A: (Name of State Assembly) has adopted the use of the AST Speaker & Educational Program Content Information form that is completed by each speaker for each event scheduled by the State Assembly.<br><br> These are reviewed to ensure the speakers have the proper qualifications to instruct and/or speak at a CE event. Standard 6B: Please refer to Form A-2; the credentials are listed after each name. Standard 6C & 6D: The State Assembly does not publish CE articles.<br><br> DEMONSTRATION OF COMPLIANCE WITH CRITERION 7 The (name of State Assembly) has adopted for use the AST Speaker & Educational Program Content Information form and AST Educational Program Agenda form. These two forms are used to develop the learning objectives for a continuing education offering. The learning objectives are published in the brochure or other literature that is mailed to State Assembly members advertising the continuing education activity and the brochure also has the registration form.<br><br> The (board of directors and/or education committee) review the learning objectives to ensure they are at the appropriate level of knowledge and at a level above entry-level practice. The board of directors defines entry-level knowledge as that which is learned while completing a surgical technology program and does not need to be presented in lectures at a continuing education activity. In addition the review of the objectives is completed to make sure they are relevant to the practice of surgical technology and surgery itself.<br><br> DEMONSTRATION OF COMPLIANCE WITH CRITERION 8 The (name of State Assembly) has adopted for use the AST Educational Program Evaluation Form. The evaluation form includes two criteria that are used to determine if the learning objectives for the continuing education event were achieved. The results of the survey that includes the two criteria are reviewed and analyzed by the (board of directors and/or education committee).<br><br> Methods of improving the continuing education events are determined based upon the survey. DEMONSTRATION OF COMPLIANCE WITH CRITERION 9 The (name of State Assembly) has adopted for use the AST Educational Program Evaluation Form and AST Summary Report of Program Participant Evaluations Form to document and analyze survey results. The (board of directors and/or education committee) review the forms as an aid in planning future workshops and targeting areas of content and subjects requested by the participants.<br><br> The subject areas determined to best further the knowledge of participants and aid them in the performance of their job are targeted for offering at a workshop. Once the content is determined, the learning objectives are developed to match content with learning objectives. The internal reviews of the forms, survey results, and matching content to learning objectives is conducted during face-to-face meetings, E-mail exchange, and/or conference calls and the results of the meeting are recorded for future reference when planning another CE activity.<br><br> DEMONSTRATION OF COMPLIANCE WITH CRITERION 10 The (name of State Assembly) has adopted for use the AST Educational Program Attendance Record and AST Post-program Report. The attendance record is used to record on the post-program report the number of CST 9s, CFA 9s, etc. that attended a CE event.<br><br> These forms will be kept on file in order to report the numbers when the State Assembly submits the Annual Report and is audited. DEMONSTRATION OF COMPLIANCE WITH CRITERION 11 The (name of State Assembly) has adopted the use of the AST Educational Program Evaluation Form that is given to each participant at the end of the continuing education event to complete and return. DEMONSTRATION OF COMPLIANCE WITH CRITERION 12 The (name of State Assembly) has adopted the use of the AST Certificate of Attendance that contains the required statement.<br><br> DEMONSTRATION OF COMPLIANCE WITH CRITERION 13 The (name of State Assembly) recognizes and enforces the AST policy as related to the assigned value of a CE credit being 1 CE credit equals 50 3 60 minutes of activity. This is reflected in the brochures and other literature advertising continuing education events that is mailed to State Assembly members. In addition, proof of following the policy is presented in the completed AST Educational Program Agenda.<br><br> SELF-STUDY SUBMITTED BY: ____________________________________ ________________ Signature, State Assembly President Date ____________________________________ ________________ Signature, State Assembly Vice-President Date ____________________________________ ________________ Signature, AST Director of CE Dept. Date

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