AmericanCollege of Emergency Physicians

Resolving Conflicts of Interest in CME Activities

(Note: to be completed by an Education Committee Member or Staff)

This form is for use by members of the Education Committee or Staff to ensure compliance with ACEP’s policy, “Resolving Conflicts of Interest in CME Activities”, adopted by the Board of Directors in June, 2006. This form must be completed for each faculty member or author/editor participating in a CME activity for which AMA PRA Category 1 CreditTM is awarded, if the faculty or author indicates he or she has disclosed a financial relationship that may be or could be perceived as a conflict of interest.

Name of CME Activity:______

Date of CME Activity: _______

Name of Individual Reporting a Financial Relationship: ______

Assigned Course/Lecture Title(s):

______

Assigned Committee Member or Staff:______

Please speak with the faculty/author that indicated a conflict of interest, explain the ACCME Standards for Commercial Support as they relate to disclosure and resolving conflicts of interest, and emphasize the guidelines listed below. Please acknowledge agreement by the discloser to follow each of the following guidelines, then sign and date below affirming when the conversation took place. Note that each faculty/author has received a copy of the ACCME Standards for Commercial Support.

EVIDENCE-BASED CME CONTENT - All clinical recommendations in the context of your presentation(s) must be evidence-based and not anecdotal. Generic names must be used and there should be a comparison of comparable drugs with the pros and cons in the comparison.

Agreed _____ Disagreed ______

EDUCATIONAL MATERIALS -Product promotion of any type is prohibited in or during CME activities. Educational materials that are part of the CME activity (courses/lectures), such as slides, abstracts and handouts, cannot contain any advertising, trade name or product group message. ACEP reserves the right to review your slides and/or handouts prior to the presentation. (Assigned committee member or staff must note here if they require a review of the slides/handouts prior to the presentation when changes can still occur.)

Agreed _____ Disagreed ______Additional Slide/Handout Review Required: Yes _____ No _____

COMMERCIAL BIAS - The content and related materials of your courses/lectures must promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial entity. Presentationsmust give a balanced view of therapeutic options. The audience judges if commercial bias is present through the evaluationprocess. The assigned Onsite Representative will also monitor each presentation for compliance with these guidelines.

Agreed _____ Disagreed ______

I have discussed these guidelines with this presenter and verified that he/she has received and agreed to abide by ACEP policy and ACCME Standards for Commercial Support.

Yes _____ No ______

______

Education Committee Member Signature Date