• Gaps / Practice gap: The difference between a current state and desired state. Gaps are typically expressed in terms of normative data.
• Gap analysis (GA): The methods used to collect a Gap and an interpretation of the information.
• Needs: 1) contributing factors to the formation of a Gap. 2) The knowledge or skills that must be remedied to help close a practice gap.
• Target Audience: The intended recipients of an educational activity.
• Wants: Possible solutions proposed to close a gap by targeting a need.

The following tools are designed to help your organization uncover or document the practice gaps of your target audience.

• Assessment of Gaps Worksheet - blank
• Assessment of Gaps Worksheet - with sample

Articles on Gap Analysis

• CME Highlights, Volume 1, Issue 1, Fall 2009

Videos on Practice gaps

• Examples of Professional Practice Gaps, by ACCME CEO Dr. Murray Kopelow

• Link the subject to the environment where a learner will encounter the gap
• Avoid generalities
• Quantify the information being presented
• Provide backup for claims and statements

The following information is garnered from internal research by the American Academy of Ophthalmology.

• Diagnose This Review: Summer, 2011. Gaps uncovered via online diagnosis simulation, reviewed for validity and contributing needs.
  • Evidence in:
    • Contact lens fitting and management of related complications.
    • Diagnostic evaluation of white retinal lesions.
    • Management of orbital lymphangioma.
    • Differentiation of abnormal and normal gonioscopic findings.
    • Differentiation of microbiologic studies.

• AAO Gaps in care, by Practice Emphasis Area (PEA)

The below information assisted in planning an accredited activity. Each file represents a method of gap analysis. If you chose to use any of the material below to aid in the planning of your activity, remember to demonstrate the validity of the information to your target audience.

• 2011 America Glaucoma Society (AGS) Annual Meeting - Abstracts
• 2010 American Association of Pediatric Ophthalmology and Strabismus (AAPOS) - Paper Abstracts
• 2010 America Glaucoma Society (AGS) Surgery Day Open Angle Glaucoma - Gap worksheet 
• 2010 America Glaucoma Society (AGS) Geonomics workshop - Gap worksheet

• Compliance with screening for diabetic retinopathy was 42.8% for type 1 and 24% for type II diabetic patients (sample size encompassing both group, n=100) [Performance gap]
• 36 patients were enrolled in this study. Average age was 12.08 years (range 7months-75 years). Mean time between consent and surgery was 38 days (range 6-96 days). 34 patients (94%) felt they had adequate understanding of the surgery. However; of the 504 answers in the 14 questions presented, 322 (64%) were either incorrect or not sure. [Performance gap]
• [For an activity in March, 2011] In findings from April 30, 2010: Mechanical modeling suggests that greater inferior than superior Lateral Rectus (LR) zone contraction in orbit tilt up contributes to ocular extorsion, while greater inferior zone relaxation contributes to intorsion in orbit tilt down. This differential zonal LR behavior is absent in Superior Oblique (SO) palsy, compounding the deficiency in Ocular Counter-rolling (OCR) due to SO weakness. [Knowledge gap]
• In a study, concluded in 2009 at St. Jude Children's Research Hospital, 46.5% of the 101 children who both underwent bone marrow transplantation (BMT) and met inclusion criteria, 46.5% developed ophthalmic complications. Complications included cataracts in 42 (41.6%), dry eye disease in fourteen (13.9%), and infectious retinitis in 2 (2%). [Knowledge gap]

Each of the following websites can be used as sources for statistical information.

• Centers for Medicare and Medicaid Services (CMS)
• the CDC's NCHS Health Interview Survey
• the CDC's NCHS National Health and Nutrition Examination Survey
• Community Health Status, Inc. - DHHS
• the Bureau of Labor Statistics
• the Bureau of the Census
• The Cochrane Collaboration
• Hospital Compare - DHHS
• State Health Facts.org - The Kaiser Family Foundation
• the U.S. Food and Drug Administration
• Institute for Healthcare Improvement
• Healthy People.gov
• Child Stats.gov
• Fedstats.gov
• Agency for Healthcare Research and Quality (AHRQ)
• The AHRQ National Guidline Clearinghouse
• U.S. National Library of Medicine, National Institutes of Health
• The CDC National Center for Health Statistics – one of four general-purpose statistical agencies of the federal government charged with collecting, compiling, analyzing and publishing data for general use

While the following focus on the larger task of Needs Assessment, each resource provides valuable information on the sub-process of Gap Analysis.

 Witkin, Belle Ruth., and James W. Altschuld. Planning and Conducting Needs Assessments: a Practical Guide. Thousand Oaks, Calif. u.a.: Sage Publ., 2006. Print.

Altschuld, James W., and Belle Ruth Witkin. From Needs Assessment to Action: Transforming Needs into Solution Strategies. Thousand Oaks, CA: Sage Publications, 2000. Print.

Gupta, Kavita, Darlene F. Russ-Eft, and Catherine Sleezer. A Practical Guide to Needs Assessment. San Francisco, CA: Pfeiffer/Wiley, 2007. Print.

World Health Organization (WHO) Needs Assessment: Evaluation of Psychoactive Substance Use Disorder Treatment