CORNELL
University
Joan and Sanford I. Weill Office of Continuing Medical Education Telephone: 212 746-2631
Medical College 1300 York Avenue, Box 16 Fax: 212 746 -8180 New York, NY 10021
GUIDELINES FOR PRINTED MATERIALS:
JOINT CME INFORMATION PAGE
FORM #CMEG-5A
All attendees at Weill Cornell-approved CME activities must be provided, in writing, required CME information. When applying for credit approval for your activity, you must include a copy of this CME Information Page along with your application. This page must include:
1. Activity title, date and location
2. Name of the Course Director and Co-Course Director, if applicable
3. Identified Practice Gaps/Educational Needs
4. Targeted Audience
5. Course Objectives/Desired Outcomes
6. Disclosure of Commercial Support
7. Disclosure of Relationships/Content Validity Statement
8. Full Disclosure Information for all Course Directors, Co-Course Directors, Independent Clinical Reviewers and Planning Committee Members, if applicable
Note: Any speakers who refuse to complete a faculty disclosure form prior to the activity
must be disqualified from participating as a speaker.
9. Accreditation Statement
10. Credit Designation Statement
11. Course Evaluation Information
12. Statement offering to accommodate those with special needs
The attached sample document is a template CME Information Page that should be used for every approved CME activity. This CME Information Page must be included in the handout materials at your activity. Enduring Materials require additional information on the CME Information Page; please refer to the Enduring Materials section of the CME website for instructions: http://www.med.cornell.edu/education/programs/edr_mat.html
Of particular importance is the section on “Full Disclosure.” Please note that disclosure MUST be made to your audience using this format regardless of whether or not a speaker has any relationships to disclose. In addition, you must note if there will be discussions of off-label or investigational uses of products or devices. This data must be consistent with the Full Disclosure Forms signed by your faculty members and planners.
The Office of CME is available to assist you with the creation of this document.
* EXAMPLE * EXAMPLE * EXAMPLE * EXAMPLE*
CONTINUING MEDICAL EDUCATION
GENERAL INFORMATION
16th ANNUAL FAMILY PRACTICE SYMPOSIUM
Saturday, October 14, 2010
Weill Cornell Medical College
Uris Auditorium
John Smith, M.D., Course Director
IDENTIFIED PRACTICE GAPS/EDUCATIONAL NEEDS
PLEASE NOTE: This statement of need should include an epidemiological statement (on the current state of knowledge, skills, competence, practice, or patient outcomes) and what would be expected (the desired/ideal state of knowledge, skills, competence, performance, patient outcomes).
TARGETED AUDIENCE
This course is designed for family practitioners and primary care physicians as well as nurses and other allied health professionals who specialize in the treatment and diagnosis of common medical illnesses in the adult and pediatric community.
OBJECTIVES/DESIRED OUTCOMES
It is intended that this Weill Cornell CME activity will lead to improved patient care, including improvements in knowledge, competence, or performance. At the conclusion of this activity, participants should be able to:
1. Better identify symptoms of the common cold
2. Provide better treatment to children and adults who present with strep throat
3. Incorporate new research findings and develop new strategies for treating Lyme disease
4. Promote discussions on the importance of vitamin supplements in daily life and how this will lead to greater patient well being
Weill Cornell Medical College gratefully acknowledges funding in part provided by unrestricted educational grants from:
ACME PHARMACEUTICALS, INC., XYZ DEVICE MFG., VITAMINS-R-US, INC.
DISCLOSURE OF RELATIONSHIPS/CONTENT VALIDITY
It is the policy of Weill Cornell Medical College to adhere to ACCME Criteria, Policies, and Standards for Commercial Support and content validation in order to ensure fair balance, independence, objectivity, and scientific rigor in all its sponsored activities. All speakers, Course Directors, Co-Course Directors, planners, reviewers, and staff members participating in sponsored activities are expected to disclose relevant financial relationships pertaining to their contribution to the activity. Relationship information is analyzed to determine whether conflicts of interest exist. All conflicts of interest are resolved prior to participation in the planning or implementation of this activity. Presenters and authors are also expected to disclose any discussion of (1) off-label or investigational uses of FDA approved commercial products or devices or (2) products or devices not yet approved in the United States.
WCMC CME activities are intended to be evidence-based and free of commercial bias. If you have any concerns, please call the Office of Continuing Medical Education at 212-746-2631 to anonymously express them.
Course Director
John Smith, M.D.
· Speaker’s Bureau: Pfizer
· Will not be discussing the off-label or investigational use of products
Course Co-Director (if applicable)
Jennifer Smith, M.D.
· Has no relevant financial relationship to disclose.
· Will not be discussing the off-label or investigational use of products
Independent Clinical Reviewer (if applicable)
Sarah Jones, M.D.
· Has no relevant financial relationship to disclose.
· Will not be discussing the off-label or investigational use of products
Course Faculty
Peter McDonald, M.D.
· Has no relevant financial relationship to disclose.
· Will not be discussing the off-label or investigational use of products
Marilyn Johnson, M.D.
· Speaker’s Bureau: Astra Zeneca
· Research Support: Lilly Oncology and Amgen
· Consultant: Bristol Myers Squibb
· Will be discussing the off-label or investigational use of products
Planning Committee
Joseph Brown, M.D.
· Has no relevant financial relationship to disclose.
· Will not be discussing the off-label or investigational use of products
Lisa Jones, M.D.
· Speaker’s Bureau: Astra Zeneca
· Research Support: Merck
· Consultant: Bristol Myers Squibb
· Will be discussing the off-label or investigational use of products
Course Coordinator
David Smith, M.P.H.
· Has no relevant financial relationship to disclose.
· Will not be discussing the off-label or investigational use of products
CME Staff
· Has no relevant financial relationship to disclose.
· Will not be discussing the off-label or investigational use of products
ACCREDITATION AND CREDIT DESIGNATION STATEMENTS
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Weill Cornell Medical College and ______. Weill Cornell Medical College is accredited by the ACCME to provide continuing medical education for physicians.
Weill Cornell Medical College designates this live activity for a maximum of ____AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
EVALUATION
The CME Evaluation Form is included in your syllabus. Completed forms will be collected at the door at the end of this activity. We encourage you to complete the Evaluation Form as this will allow us to assess the degree to which the activity met its objectives. It will also guide the planning of future activities and inform decisions about improving the educational program.
WCMC is accessible for individuals with disabilities or special needs. Participants with special needs are requested to contact the Office of CME at 212-746-2631.