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Physician organization
Select the option that applies to your organizationWe are a physician organization that is co-developing this educational event with a non-physician organization. We (the physician organization) have been prospectively involved in planning this event and accept accountability for its entire program
Administrative intake information
What type of activity are you seeking accreditation for?Section 3: Self-assessment Program
Date of application04/03/2025
Event location (insert city and province)Montreal, QC
Activity start date06/06/2025
Activity end date07/06/2025
Title of learning activity (as it will appear on the certificate of attendance)CADDRA Intensive 2025
Website Link to Registration (or insert ‘not applicable’)https://www.caddra.ca/caddra-intensive-2025/
Delivery method of group learning activityBoth in-person and virtual
How many times will this activity be held in a year?1
Has this activity been previously accredited?No
Has this activity been submitted to another CPD Accreditor? i.e., RCPSC, CFPC, CNA, CCCEPNo
Has this activity been rejected by another CPD Accreditor?No
Do you want this event posted on the Royal College (RCPSC) website?Yes
Anticipated number of participants:300
Physician organization information
Physician organization requesting accreditation
Name of physician organization (as specified by the tool tip) Website address (or insert 'not applicable')
CADDRA - Canadian ADHD Resource Alliance caddra.ca
Chair of the Scientific Planning Committee
First name Last name Address Email Phone number
Martin Gignac Institut Philippe-Pinel / martin.gignac.med@ssss.gouv.qc.ca martin.gignac.med@s (514) 648-8461
Contact information for main point-of-contact for participants
First name Last name Address Email Phone number
Stacey Espinet 366 Adelaide St E, Suite 221Toronto, ON M5A 3X9, stacey.espinet@caddra.ca 416 306-8584
Organizations co-developing the activity. Do not include sponsors as co-developers.
Name Is the co-developing organization a physician organization? (Yes/ No) Email Phone number Website address
NA
The physician organization agrees to maintain attendance records for 5 years. Do you comply?Yes
Was the content developed by the Scientific Planning Committee?Yes
Intended Primary Target Audience and Learning Objectives
Who is the intended primary target audience of the activity?
  • Addiction Medicine
Which assessment strategies were used to identify the PERCEIVED learning needs of the target audience? Indicate all that apply
  • Consultation with Scientific Planning Committee Members
  • Surveys
  • Direct request from target audience.
Attach minutes or list of topics of consultation with Scientific Planning Committee membersTest-file.docx?rlkey=2vbnzejdl5kd2sips1rxw5luy&dl=0
Which assessment strategies were used to identify the UNPERCEIVED learning needs of the target audience? Indicate all that apply
  • Published literature (RCT, cohort studies)
  • Others
List others
  • CADDRA's Canadian ADHD Practice Guidelines
Which learning needs or gap(s) in knowledge, attitudes, skills, or performance of the intended target audience did the scientific planning committee identify for this activity?

A need for advanced-level training on ADHD in adults, covering ADHD and substance use, misuse and diversion; ADHD, sex and hormones, ADHD and complexities in pharmacological treatment. There was also a need identified to review the nuances of assessing and managing complex cases using interactive, interdisciplinary case discussion.

Did the Scientific Planning Committee use the needs of the target audience to develop the activity overall learning objectives?Yes
Did the scientific planning committee share the needs assessment results with the speaker who is responsible for developing the overall learning objectives.Yes
What other methods were used to develop overall learning objectives?

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Does your program have sessions or modules?No
Do the overall Learning Objectives clearly describe the intent of the educational activity, and are written from the perspective of the learner, and express the expected outcomes determined by the SPC and faculty?Yes
Are the overall Learning objectives available to participants prior to registration?Yes
Indicate where Learning Objectives are listedWebsite
Attach a pdf for each place where Learning Objectives are listedTest-file1.docx?rlkey=4zcdko39v6lz476i4ohsjeh9v&dl=0
Are the learning objectives incorporated into the evaluation to participants?No
CanMEDS Role(s) relevant to this activity? Select all that apply
  • Medical Expert 
  • Leader
  • Professional 
  • Health Advocate 
  • Collaborator 
Which learning formats/methods are used to support the following: the perceived and/or unperceived educational needs, meet the stated learning objectives, and address CanMEDS roles

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Which learning methods were selected to incorporate a minimum of 25% interactivity?

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Does the program and/or brochure identify the opportunity for interactive learning?Yes
Those developing or delivering the educational content were informed of the following
  • The identified needs of the target audience
  • The intended overall learning objectives for the activity
  • Ensuring that the description of therapeutic options utilize generic names (or both generic and trade names) and not reflect exclusivity and branding
Evaluation
How will the overall activity and individual sessions or modules be evaluated by participants?Evaluation survey
Does the assessment strategy intend to use post-course reinforcement activities and to reinforce changes in knowledge, skills or attitudes of learners, and support development of a learning plan?Yes
Does the assessment strategy intend to use post-course quality improvement activities to measure improved health care outcomes, or improved patient performance?Yes
Self- Assessment Program
Does this course have online modulesNo
Describe the key knowledge areas or themes assessed by the self-assessment program

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State the sources of information selected by the planning committee to develop the content of this activity

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Which learning methods were selected to help the CPD activity meet the stated learning objectives? Describe the rationale for the selected format to enable participants to review their current knowledge or skills in relation to current scientific evidence.

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Which learning methods will be used by participants to demonstrate or apply knowledge, skills, clinical judgement, or attitudes and record their answers?
  • Role-play case scenarios
  • Web-based assessment tool or link
If other learning method used, please describe

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Attach supporting documents of selected learning methodsTest-file2.docx?rlkey=8lh39f07lojnmqn33n428roaf&dl=0
Feedback and reflection
Which tools will be used to provide feedback to participants on their performance to enable the identification of any areas requiring improvement through the development of a future learning plan?
  • Pre-test
  • Feedback criteria tool
  • Scoring tool
If other feedback tool used, please describe

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Attach supporting documents of selected feedback toolsTest-file3.docx?rlkey=tho5sl7hjedudo8cv7cejn2r7&dl=0
Feedback must include if the answers are correct or incorrect with rational, and references to each question. Please describe how this will be done

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A sample must be provided of the selected feedback tool. Select which will be provided
  • Sample document of answer with reference(s)
  • Sample document of face-to-face instructor-individual participant debrief with references
Describe the process used for administering a reflective tool

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Simulation- based Activity
Sponsorship
Has the CPD activity been sponsored by one or more sponsors?Yes
Please explain if you don’t have agreements, or which agreements you will be submitting after this application

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If sponsorship has been received, are all details included in the CME budget form?Yes
If sponsorship has been received, has the SPC received advice from a sponsor as a condition of receiving financial and in-kind support?No
How is sponsorship being disclosed to the participants?Other
Are there any sponsors or any organizations hired by a sponsor on the SPC?No
Does the SPC ensure that their interactions with sponsors meet professional and legal standards including the protection of privacy, confidentiality, copyright and contractual law regulations?No
Exhibitors and advertisements
Are there any commercial exhibitors or advertisements?No
Does the SPC meet the requirement that product-specific advertising, promotional materials logos, or branding strategies cannot be included on, appear within, or be adjacent to:
  • Activity agendas, programs or calendars of events (preliminary and final)
Does the SPC meet the requirement that product-specific advertising, promotional materials or branding strategies cannot be included on/appear within locations where accredited CPD sessions are occurring (e.g. lecture halls, small group discussion rooms) immediately before, during or immediately after an accredited CPD activityNo
Does the SPC meet the requirement that commercial exhibits or advertisements must be arranged in a location that is clearly and completely separated from the accredited CPD activityNo
Integrity
The SPC may consider data or advice from all sources but must ensure that decision- making related to the following CPD program elements is under its exclusive control. The following CPD elements are under exclusive control of the SPC. Select all that apply
  • Development of learning objectives; providing information to speaker who will develop the learning objectives
  • Selection of speakers, moderators, facilitators, and authors
  • Evaluation of outcomes
If any areas were not under exclusive control of the SPC, please explain

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 If any areas of review were not covered by the SPC, please explain

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In terms of Content Development, the SPC must have a process in place to deal with instances where CPD activities are not in compliance with the National Standard, Element 2. Please describe this process

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In terms of Conflict of Interest, a process must be in place for gathering, managing, and disclosing Conflicts of Interest (COIs). Please describe this process

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Describe how speakers, author’s, moderators, and facilitator’s COIs being collected and disclosed to both physician organization and learners attending the CPD activity

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The Declaration of Conflict of Interest (COI) document provided to SPC and Speakers must ask to disclose the following below. Select all that are included in the COI
  • Membership on advisory boards or speakers’ bureaus
  • Patents on a drug, product or device
What are the Scientific Planning Committee’s methods to manage potential or real conflicts of interest? This is when a conflict of interest occurs during the live activity. Please describe the plan

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Web-based CPD Activities
Is this a Is this a web-based / online delivery method?No
CPD Accreditation Agreements
If you have arranged for this CPD activity to be eligible for credit within any of these systems, please check all that apply
  • Qatar Council for Healthcare Practitioners (QCHP)
Declaration
By clicking “I agree” you are agreeing to the declaration stated belowI agree
Name of Chaircheck
Signature of Chair
Date of signature07/27/2025
Needs Assessment
Program and Learning Objectives
Evaluation
FileTest-file4.docx?rlkey=3he45leuxp7jrwba9ymgxisvb&dl=0
Budget
Sponsor Letter and Written Agreement
Conflict of Interest Disclosure Forms
Brochure/ Promotional Materials
FileTest-file5.docx?rlkey=yloh27tiwb8zrheiwn784bmmk&dl=0
Certificate of Attendance
Fee Payment Form
FileTest-file6.docx?rlkey=kv1q37e10k6bepfe9y42rr4oo&dl=0