COURSE DIRECTOR MANUAL
Continuing Education
2013
Sharon K. Whitmer, EdD, MFT
CMDA Accreditation Officer
2
TABLE OF CONTENTS
Christian Medical & Dental Associations Continuing Education Mission Statement
Page
3-4
A) Continuing Education Committee
Policy 1.0 – Continuing Education Committee Members
Page
5
Page
6
Policy 2.1 - Expenditures and Income for an Activity
Page
7
Policy 2.2 - Joint Sponsorship
Page
8-9
Policy 2.3 – Direct Sponsorship
Page
10-11
Policy 2.4 - Social Events
Page
12
Policy 2.5 - Photography at CMDA CE Activities
Page
13
Page
14
Policy 3.1 – Disclosure
Page
15
Policy 3.2 - Identification and Resolution of Conflicts of Interest
Page
16
Policy 3.3 - Methods of Content Validation and Verification
Page
17
Page
18
Page
19-20
Page
21-32
Promotional Content for a CMDA CE Activity
Page
33-34
Disclosure Form
Page
35
CMDA Conflicts of Interest Resolution
Page
36
Commercial Exhibitor Form
Page
37-38
ACCME Standards for Commercial Support
Page
39-41
AGD Standard XII Commercial or Promotional Conflict of Interest
Page
42-43
B) Conference Policies
Policy 2.0 - Application and Approval of AMA PRA Category 1 CreditTM
And AGD PACE Credit
C) Faculty/Speaker/Presenter Policies
Policy 3.0 - Course Director/Planner & Presenter Honorariums/Reimbursements
D) Commercial Support and Booth Space Policies
Policy 4.0 – Commercial Support
Policy 4.1 –Non-commercial and Commercial Exhibitors
E) FORMS
CE Application
3
MISSION
The mission of Christian Medical & Dental Associations (CMDA) Continuing Education (CE)
Department is to: assist physicians, dentists and other health care professionals in the content
translation, diffusion, and application of evidence-based knowledge; support the CMDA institutional
mission of partnering with national and international organizations to provide education to health care
professionals and meet the physical, emotional and spiritual needs of patients by eliminating barriers
and developing and implementing strategies to identify and narrow professional practice gaps by
changing the learners’ knowledge, competence and performance in order to change patient outcomes.
Purpose: CMDA CE has four purposes. First, provide educational resources, networking
opportunities, medical missions, and a voice for Christian health care professionals through
collaboration with the Christian Medical & Dental Associations’ stakeholders. Second, identify
professional practice gaps; and design, deliver, evaluate and document educational activities and
initiatives to change health care professionals’ competence, performance and patient outcomes for the
purpose of improving the health and welfare of patients. Third, provide a forum for the challenges
faced by Christian healthcare professionals concerning bioethics, rights of conscience and other
controversial topics. The Christian Medical & Dental Associations’ stakeholders include its members,
physicians, dentists and other health care professionals practicing in missions regionally, nationally
and internationally. Fourth, build collaborations with national and international organizations
including ministries of health, hospitals, universities and others.
Content Areas: The CMDA CE will develop educational content and strategies to change physician,
dentist and other health care professionals’ knowledge, competence and performance in order to
improve the health and welfare of patients. In addition, CMDA will assist in making practice and
system changes in the health care delivery environment.
Target Audience: CMDA CE will serve two primary audiences, internal and external. The internal
audience includes professional staff, affiliated health care organizations and health care
professionals. For the internal audience, CE will play a critical role within CMDA for education,
providing Category 1 Credits, AGD Credits as well as other credits, and participating in improving the
health and welfare of patients through partnerships with the CE Committee initiatives. The external
audience consists of a broad population of national and international health care providers,
administrators, and others who impact the health of patients beyond the CMDA stakeholders.
Types of Activities:
1.
Educational Activities: The primary strategy for accomplishing the mission
will be the development and implementation of a range of educational
activities. These activities will be developed around specific needs related to
gaps in knowledge, competence and performance. They will be delivered in a
4
variety of formats, including, live events (e.g., lectures, workshops, and
seminars) and enduring materials.
2.
Identification of Barriers to Change: As part of the activity planning, activity
planners will identify barriers to change, recommend and implement into
activities ways to overcome those barriers. The activity evaluation will assess
the level of change resulting from the educational intervention.
3.
Interdisciplinary Team Approach to Education: Improving the health of
patients requires the education and participation by a variety of health care
professionals and others. Educational interventions will include a variety of
professionals and stakeholders in the educational activities in order to promote
change and improvements.
4.
Partnerships and Alliances: CMDA will partner with a variety of
organizations, and other groups whose missions overlap with the
CMDA/CE. Some of these include: quality improvement
organizations/departments, administrators, educational institutions, patient
advocacy groups, relief organizations and others.
5.
Non-educational tools and strategies for change: As an adjunct to educational
programming, CMDA will develop and disseminate non-educational tools and
resources that facilitate changes in competence, performance and changes to
patient care.
6.
Physician competencies and desirable physician attributes: As part of its
planning, the CMDA will incorporate the Maintenance of Certification (MOC)
competencies designed by the American Board of Medical Specialties (ABMS),
the competencies established by the Accreditation Council for Graduate
Medical Education (ACGME), and the desirable physician attributes
established by the Institutes of Medicine (IOM) these include: patient care,
medical knowledge, practice-based learning and improvement, systems based
practice, professionalism, interpersonal skills and
communication, Interdisciplinary Teams, quality Improvement and Utilization
of Informatics.
Expected Results: CMDA will utilize evaluations and outcome surveys that encourage learner selfassessment and self-directed decisions that will encourage changes and make improvements in health
care practices. A follow-up outcomes survey will include an open-ended question on patient outcomes
(no patient identification) and will be used to measure changes in competence, performance and patient
outcomes. Both instruments will provide data on the impact of the educational activities, overall
Program and drive an ongoing quality improvement process within CE. Where possible, assessment of
patient care indicators or other data will be used to provide objective insight into the impact of the
educational activities. CMDA expects results to demonstrate changes in competence, performance and
patient outcomes as a result of its educational interventions and the impact and scope of its overall CE
program.
Approved by Christian Medical & Dental Associations CE Advisory Committee / Board of Trustees –
September 2013
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Policy 1.0
Policy Name: Continuing Education Committee Members
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Sept 2012
Revision Date
Revision Date
Policy (from Board Policy Manual 2.19.6)
The Continuing Education Committee (CE Committee) insures that all of the requirements of the Accreditation
Council for Continuing Medical Education, the Academy of General Dentistry and the CMDA/CE Mission
are achieved. With consideration to recommendations for the Committee, the Chair and Committee Member
appointments will be made by the CMDA President and ratified by the Board of Trustees. The term of
appointment is two years with option of renewal without limit.
Procedure
1) Committee members will complete a disclosure annually. No one will be permitted to serve on the
Committee if they refuse to disclose. A member who has a conflict of interest concerning a CE educational
activity will recues them self from reviewing that activity.
2) If a Committee member elects to discontinue service, another Committee Member will be appointed.
3) If a Committee member does not attend meetings or review applications for one fiscal year, the member will
be released from the committee. This does not apply to members who notify the Department of Continuing
Education of mitigating circumstances in writing and still perform tasks such as reviewing applications and
presentations.
6
Policy 2.0
Policy Name: Application and Approval of AMA PRA Category 1 CreditTM and AGD PACE Credit
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Sept 2012
Revision Date
Revision Date
Policy
Activities must be reviewed and approved by the CMDA CE Committee.
Procedures
The activity director/planning committee will work with the CE Director and the CMDA Accreditation Officer
to complete the following:
1) Disclosures from planners prior to planning an activity.
2) Resolution of Conflicts of Interest prior to planning an activity.
3) Completion of the activity application.
4) Budget for the activity.
5) Once the planning of the activity is completed, the CE Director will submit the application to the CMDA/CE
Committee for review and determination of approval or denial of CMDA sponsorship for the CE activity.
7
Policy 2.1
Policy Name: Expenditures and Income for an Activity
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Sept 2012
Jan 2013
Revision Date
Policy
Expenses and income for all CMDA/CE activities must be submitted to the CE director.
Procedures
1) No expenses for an activity will be paid if the expenses were not approved by the CMDA/CE Committee.
2) If CMDA pays all the expenses for an activity; any remaining proceeds will be transferred to a departmental
account or educational partner. No remaining funds will be paid directly to a course director or planning
committee member(s).
3) Direct and Joint sponsorships that are designated by CMDA to manage the income and expenses will submit
documentation and a financial wrap-up of income and expenses for the activity.
4) CMDA will not sponsor or joint sponsor a CE activity that is commercially supported.
5) CMDA will sponsor CE activities that are supported by commercial exhibitors as long as commercial
exhibitors complete the Commercial Exhibitor Form and follow ACCME Standards for Commercial
Support and the CMDA Guidelines.
8
Policy 2.2
Policy Name: *Joint Sponsorship
CE Committee
Approval Date
May 2010
Revision Date Revision Date Revision Date Revision Date
May 2011
April 2012
Sept 2012
Revision Date
Jan 2013
Policy
The CMDA Department of Continuing Education will enter into joint sponsorships.
Procedures
1) The planner(s) will complete the CMDA disclosure form and any conflicts of interest will be identified by the
CE Director and the CMDA Accreditation Officer and resolved according to the CMDA Procedures for
Resolving Conflicts of Interest.
2) No commercial support will be given to CMDA/CE sponsored or jointly sponsored activity. Therefore,
CMDA will not provide or sign a Letter of Agreement and a commercial interest cannot require (as a
condition of contributing funds or services) that they be allowed to provide advice or services concerning
content, teachers, authors, participants, logistics or any other educational activity matter.
3) Since CMDA does not accept commercial support, exhibit space cannot be offered as part of receiving an
educational grant; however exhibit space may be acquired by commercial entities at some CMDA/CE
activities for a fee through the event manager.
4) The planner(s) will work with the CMDA Accreditation Officer to complete the Application and insure that
the activity has been planned in compliance with the ACCME Criteria, Standards for Commercial Support
and the policies and procedures of the CMDA.
5) Once the planning of the activity is completed, the CE Director will submit the application to the CE
Committee for review and determination of approval or denial of CMDA joint sponsorship for a CE activity.
6) Jointly sponsored CMDA/CE activities will adhere to the following:
A) CMDA must approve all materials prior to printing.
B) Activity evaluation, outcomes survey and welcome letter will be prepared by CMDA.
C) CMDA will provide provisions for attendance reporting.
D) Appropriate wording and usage of the Accreditation, Credit Designation statements, and
Logo use.
E) Delineation of the role of the CMDA staff in planning and executing the activity.
F) Submit documentation and financial wrap-up of income and expenses.
G) Provide sign-in sheets and any other documents deemed necessary by the CMDA.
H) Social events or meals at the activity cannot compete with or take precedence over the
Educational activity.
I) Honorarium and out-of-pocket expenses may be paid directly to the teacher or author,
However documentation of the payment must be provided to the CMDA.
J) No payment or reimbursement of expenses will be made to the learners.
9
K) If a teacher or author is listed on the agenda as facilitating or conducting a presentation, they
May receive honorarium and reimbursement of expenses for that portion of their
Participation. If they choose to be a learner for the reminder of an activity; they cannot
Receive any payment for learner participation.
L) No other payment may be provided to the directors, planners, presenters, joint sponsors,
Learners or any others involved with the CMDA/CE activity.
PLEASE NOTE:
CMDA is not approving jointly sponsored activities that are supported by commercial entities, however
commercial exhibitors are permissible.
*Jointly sponsored CE activity is one that is planned and implemented by CMDA and an organization that is not
accredited by the ACCME nor approved as a PACE provider.
10
Policy 2.3
Policy Name: *Direct Sponsorship
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Sept 2012
Jan 2013
Revision Date
Policy
The CMDA Department of Continuing Education will enter into direct sponsorships.
Procedures
1) The CMDA planner(s) will complete a disclosure form and any conflicts of interest will be identified by the
CE Director and the Accreditation Officer and resolved according to the CMDA Procedures for Resolving
Conflicts of Interest.
2) No commercial support will be given to the activity. Therefore, CMDA will not sign a Letter of Agreement
and a commercial entity has no rights regarding (as a condition of contributing funds or services) advice or
services concerning content, teachers, authors, participants, logistics or any other educational matter.
3) Since CMDA does not accept commercial support, exhibit space cannot be offered as part of receiving an
educational grant; however exhibit space may be acquired by commercial entities at some CMDA/CE
activities for a fee through the event manager.
4) The planner(s) will work with the CMDA Accreditation Officer to complete the Application and insure that
the activity has been planned in compliance with the ACCME Criteria, Standards for Commercial Support
and CMDA policies and procedures.
5) Once the planning of the activity is completed, the CE Director will submit the application to the CMDA/CE
Committee for review and determination of approval or denial of CMDA sponsorship for the CE activity.
6) Direct sponsorships will adhere to the following:
A) No Commercial support for the activity.
B) CMDA/CE must approve all materials prior to printing.
C) Activity evaluation, outcomes survey and welcome letter will be prepared by CMDA.
D) CMDA will provide provisions for attendance reporting.
E) Appropriate wording and usage of the Accreditation, Credit Designation statements, and
Logo use.
F) Delineation of the role of the CMDA staff in planning and executing the activity.
G) Submit documentation and financial wrap-up of income and expenses.
H) Social events or meals at the activity cannot compete with or take precedence over the
Educational activity.
I) Honorarium and out-of-pocket expenses may be paid directly to the teacher or author, however
Documentation of the payment must be provided to the CMDA CE Director.
J) No payment or reimbursement of expenses will be made to the learners.
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K) If a teacher or author is listed on the agenda as facilitating or conducting a presentation, they
May only receive honorarium and reimbursement of expenses for that portion of their
Participation. If they choose to be a learner for the reminder of an activity, they cannot
Receive payment.
L) No other payment may be provided to the directors, planners, presenters, joint sponsors,
Learners or any others involved with the supported activity.
PLEASE NOTE:
CMDA does not approve direct sponsored CE activities that are supported by commercial entities; however
CMDA does sponsor CE activities that are supported by commercial exhibitors.
*A directly sponsored activity is one that is planned and implemented by CMDA, which includes its
Commissions.
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Policy 2.4
Policy Name: Social Events
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
May 2011
April 2012
Revision Date
Revision Date
Revision Date
Policy
The CMDA Department of Continuing Education does not plan or arrange social events.
Procedure
Upon request, Continuing Education staff will provide names and contact information of event planners to
course directors/planning committees.
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Policy 2.5
Policy Name: Photography at CMDA CE Activities
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
May 2011
April 2012
Revision Date
Revision Date
Revision Date
Policy
Photography may be used at a CMDA direct or jointly sponsored CE activity by adhering to the following
procedures:
Procedures
1) Photographs of participants and speakers are allowed at CMDA direct or jointly sponsored CE activities.
2) Photographs of patients serving as demonstrators or speakers; and a speaker’s slides cannot be
Photographed. This includes photos by a camera, cell phone, videos or other electronic photography
Devices.
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Policy 3.0
Policy Name: Course Director/Planner & Presenter Honorariums/Reimbursements
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
May 2011
April 2012
Revision Date
Revision Date
Revision Date
Policy
Honorarium and reimbursement expenses are paid by the CMDA CE Department, a CMDA affiliate or
a joint sponsor designated by the CE Director. If honorarium and/or reimbursement expenses are paid
by an entity other than the CMDA CE Department, documentation of those payments must be
submitted to the CE Department.
Procedures
1) Honorarium and reimbursements of out-of-pocket expenses are paid by CMDA, its educational
partner or joint sponsor directly to course directors, teachers, authors and/or presenters and in
compliance with the ACCME Standards for Commercial Support and the CMDA written
policies and procedures.
2) If the honorarium and reimbursements are paid by the educational partner, CMDA must have
documentation of the payment. No other payment will be paid to course directors, planning
members, teachers, authors, presenters, joint sponsors, or any others involved in the (CMDA
does not accept commercial support) educational activity.
3) Honorarium and out-of-pocket expenses are paid for planning, conducting, facilitating and
presenting.
Reimbursement
4) If planners, teachers, authors and presenters participate in the remainder of an educational
activity as a learner, their expenses cannot be reimbursed and honorarium is paid only for their
role as a planner, teacher, author and/or presenter. No honorarium or reimbursement of
expenses is paid to a learner.
5) No direct payment from an ACCME-defined commercial interest is given to the director of an
activity, any planning committee member, teacher, author, joint sponsor or any others involved
in a CMDA CE activity.
15
Policy 3.1
Policy Name: Disclosure
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Jan 2013
Revision Date
Revision Date
Policy
All persons involved in planning, implementing, coordinating, presenting, and/or authoring a CMDA CE
activity must complete a disclosure form.
Procedures
1) Everyone (including immediate family members) who are in a position to control the content of an
Educational activity must disclose all relevant financial relationships with a commercial interest.
2) Should it be determined that a conflict of interest exists as a result of a financial relationship, the
Conflict must be resolved prior to participating as a planner, implementer, coordinator, presenter and/or
Author of a CE activity.
3) Failure to complete a disclosure form disqualifies a person from being a planner, implementer,
Coordinator, presenter and/or author and they may not have any involvement in the content of a CMDA
CE activity.
4) Information regarding individuals who have no relevant financial relationship(s) is reported to the
Learners.
16
Policy 3.2
Policy Name: Identification and Resolution of Conflicts of Interest
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Sept 2012
Jan 2013
Revision Date
Policy
Conflicts of Interest (COI) will be identified by the CE Director and the Accreditation Officer and
resolution of the conflict will occur before anyone is allowed to plan, coordinate, implement, present
and/or author a CE activity.
Procedure
1) If a conflict of interest is identified from the disclosure form by the CE Director and the
Accreditation Officer, the individual must adhere to the CMDA Conflict of Interest Resolution. See
The CMDA Conflict of Interest Resolution in this Manual.
2) Failure to adhere to the CMDA Procedures for Resolving Conflicts of Interest will result in
Exclusion from planning, coordinating, implementing, authoring and NO Category 1 CreditTM or
AGD PACE approval for a presentation.
17
Policy 3.3
Policy Name: Methods of Content Validation and Verification
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Sept 2012
Jan 2013
Revision Date
Policy
The CMDA Continuing Education Department will document content validation and verification.
Procedures
Course directors will read the following statements on the planning application and faculty will read these
statements on the disclosure form and use a check mark to attest to the following:
1) All recommendations involving clinical medicine in a CE activity are based on
Scientific evidence that is accepted within the profession of medicine as adequate justification for their
Indications and contraindication in the care of patients.
2) All scientific research referred to, reported on, or used in this CE activity will support or justify
Patient care recommendations that conform to the generally accepted standards of experimental design,
Data collection and analysis.
3) The content of this activity will be based on evidence that constitutes “best practices.”
The CE Committee members will:
1) Review the educational activity application and validate and verify the content before approving that
CMDA will sponsor or jointly sponsor a CE activity.
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Policy 4.0
Policy Name: Commercial Support
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Jan 2013
Revision Date
Revision Date
Policy
CMDA does not sponsor or joint sponsor CE activities that are commercially supported.
Procedures
1) CMDA will notify the ACCME should it decide to accept commercial support.
2) If CMDA decides to accept commercial support, see the “Forms” section of this
Manual for an example of the CMDA Letter of Agreement.
3) If CMDA decides to accept commercial support, it will adhere to the ACCME Standards for
Commercial Support.
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Policy 4.1
Policy Name: Non-commercial and commercial Exhibitors
CE Committee
Approval Date
May 2010
Revision Date
Revision Date
Revision Date
May 2011
April 2012
Jan 2013
Revision Date
Revision Date
Policy
CMDA will accept both non-commercial and commercial exhibitors for sponsored and joint-sponsored CE
activities.
Definitions
Commercial Support
Commercial Support for a CE activity is financial or in-kind contributions given by a commercial interest,
which is used to pay all or part of the costs of a CE activity.
Commercial Interest
Commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services
consumed by, or used on, patients.
Non-commercial Interest
Non-commercial interest provide clinical services directly to patients, such as hospitals, health systems,
medical group practices, blood banks, and diagnostic laboratories, are an integral component of accredited
CME and CDE because they represent the provision of CE by the profession for the profession. Therefore,
these entities have been deemed NOT to be commercial interests.
Procedures
1) Commercial Exhibitors must complete the exhibit form (see exhibit form in this Manual)
2) Commercial interests are not eligible for ACCME accreditation or AGD PACE Approval.
Commercial interests cannot be accredited or PACE approved providers and cannot be joint sponsors.
3) Arrangements for commercial exhibits or advertisements cannot influence planning or interfere with
the presentation, nor can they be a condition of the provision of commercial support for CME
activities (CMDA does not accept commercial support for CE activities).
4) Product-promotion material or product-specific advertisement of any type is prohibited in or during
CE activities. The coincidence of editorial and advertising material on the same products or subjects
must be avoided. Live (staffed exhibits, presentations) or enduring (printed or electronic
advertisements) promotional activities must be kept separate from CE. There will be no ‘commercial
breaks.’ For live, face-to-face CE, advertisements and promotional materials cannot be displayed or
distributed in the educational space immediately before, during, or after a CE activity. CMDA will not
allow representatives of Commercial Interests to engage in sales or promotional activities while in the
space or place of the CE activity.
5) Print advertisements and promotional materials will not be interleafed within the pages of the CE
content. Advertisements and promotional materials may face the first or last pages of printed CE
content as long as these materials are not related to the CE content they face and are not paid for by
the commercial supporters of the CE activity (CMDA does not accept commercial support for CE
activities).
6) Computer based advertisements and promotional materials will not be visible on the screen at the
same time as the CE content and not interleafed between computer ‘windows’ or screens of the CE
content. Audio and video recording advertisements and promotional materials will not be included
within the CME.
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7) Print or electronic information distributed about the non-CE elements of a CE activity that are not
directly related to the transfer of education to the learner, such as schedules and content descriptions,
may include product-promotion material or product-specific advertisement.
8) CMDA will not use a commercial interest as the agent providing a CE activity to learners, e.g.,
distribution of self-study CE activities or arranging for electronic access to CE activities.
9) CMDA will ensure that their learners can participate in educational activities without seeing, reading
or hearing promotional or marketing information from commercial interests. In addition, CMDA will
ensure that the selling of advertising or exhibit space is a business transaction entirely separate from
the acceptance of commercial support for accredited CME or CDE by refusing to accept commercial
support for CMDA educational activities.
10) CMDA follows the policies of the ACCME and the AGD by insisting on the separation of education
from all promotional activities, materials and messages. CMDA may create a print or text based
document that goes along with an activity and provides information that is supplementary to the
educational content - like reproductions of slides, graphics, thumb drives or other handouts. These
documents, in print or electronic, are an integral part of the education and as such will not have any
advertising, trade name or a product-group message associated with them.
11) If a commercial interest seeks to purchase advertising and promotional opportunities with resources
designated for that purpose and an agreement for advertising and promotion between CMDA and the
commercial interest is established, CMDA will not accept commercial support and no written
agreement for commercial support will be considered. Any event or product that contains advertising
or promotional opportunities will not be part of the educational CE activity and must not be paid for
by commercial support and the advertisement and/or promotional opportunity will be assigned to the
"exhibit hall." Advertising pages or screens or promotional receptions or meals will be clearly
identified as such to the learner by CMDA.
12) Promotional events at CMDA CE activities (e.g., exhibit halls) are kept distinct and separate from CE
activities by not only their location and time in the program schedule, but also in how these events
are clearly described as "Promotional" to CMDA learners.
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For Office Use Only
11/2013
CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS
Planning Document & Application for
CME Category 1 credit™
X
DISCLOSURES OF THE COURSE DIRECTOR, COURSE CONTACT PERSON AND
PLANNING COMMITTEE MUST BE COMPLETED, SIGNED AND E-MAILED TO
Barbara@cmda.org BEFORE BEGINNING THE PLANNING. ANYONE WHO REFUSES TO
COMPLETE A DISCLOSURE FORM CAN NOT PARTICIPATE IN THE PLANNING,
EXECUTION OR PRESENTATION OF A CMDA EDUCATIONAL ACTIVITY.
Christian Medical & Dental Associations (CMDA) retains the right to withhold/adjust credit at
any time, should it determine that the ACCME Criteria, Policies, ACCME Standards for
Commercial Support and/or Christian Medical & Associations policies and procedures are
violated.
Requirements for Certification by Christian Medical & Dental Associations: Please
read and check that you have read them.
___In order to be considered for sponsorship or joint-sponsorship, completion of this
application is required and emailed to Barbara@cmda.org two months prior to your
activity date. REMEMBER: You can NOT promote CME until the application is approved.
Incomplete applications cannot be reviewed or approved by the CMDA Committee, which
has the final decision on all applications for Continuing Medical Education, dental and
other healthcare professional credits.
___The content of your application must meet:
 ACCME Criteria, Policies, and Standards for Commercial Support
 The American Medical Association (AMA) requirements and
 The CMDA policies and procedures (Go to www.cmda.org/CE)
___HIPPA compliance is the responsibility of the course director
___Recommendations involving clinical medicine in a CME activity are based on scientific
evidence that is accepted within the profession of medicine as adequate justification for
their indications and contraindications in the care of patients.
___Recommendations must conform to the generally accepted standards of experimental
design, data collection and analysis
___All scientific research referred to, reported on, or used in this CME activity will support or
justify patient care recommendations that conform to the generally accepted standards of
experimental design, data collection, and analysis.
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___Christian Medical & Dental Associations maintains full oversight and responsibility for the
planning, completion of the application and the educational activity
Screening Criteria: In order to be considered for continuing medical education credit, all of
the criteria listed below must be met. Planner confirms that:
___The content of this activity will be based on evidence that constitutes “best practices”
___Planners have identified a defined professional practice gap(s) that exists between current
and best practices
___This activity will provide educational content aimed at closing the defined professional
practice gap(s) to result in changed patient health by changing participants’ knowledge,
competence, performance and/or practice
List any prerequisite knowledge/skill required for attending this
activity__________________________________________________________________________
COURSE OVERVIEW
1)
School/organization/department making request:
2)
Direct-sponsored (Organization within the CMDA)
Joint-sponsored (Organization outside of CMDA)
3) Title of course:
4) Course date(s):
5) Course location (include street address, city, state):
6)
Please provide a one or two paragraph description of your course. This statement will
be used for promotional materials (brochures, web pages, etc.) a needs assessment, and/or
to obtain additional professional credits. The description should give an overview of the
course and let potential attendees know why this course is an important one for them to
attend:
7) Number of CME Credits Requested (hours):
8)
Indicate all professional credits being sought for this course. (A Dental Application is
required to receive AGD PACE credit):
___ CME
CDE (additional fee & Dental Application must be completed)
AAFP (additional fee)
Nursing (additional fee) In order for CMDA to apply for nurse practitioner credit,
you must submit speaker Bio sketches, speaker & planner disclosures and speaker
abstracts with this application two months prior to your conference
Nurse Practitioner (additional fee) - In order for CMDA to apply for nurse
practitioner credit, you must submit speaker Bio sketches, speaker & planner
disclosures and speaker abstracts with this application two months prior to your
conference
Physician Assistant (additional fee)
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COURSE PLANNERS AND FACULTY
9)
10)
Name of Course Activity Director:
E-mail:
Telephone:
FAX:
Name of Course/Activity Coordinator (contact person):
E-mail:
Telephone:
FAX :
11)
Planning Committee Member – Please list individuals who are planning committee
member(s).
Planning Committee Member
Telephone Number
Barbara Snapp, CE Director
Sharon K. Whitmer, EdD, MFT
Accreditation Officer
CE Committee Members
E-mail Address
barbara@cmda.org
sharon.whitmer@cmda.org
On file
12) Who are the proposed faculty for this activity? MANDATORY: List confirmed and nonconfirmed faculty. You must include their name & credentials, business title, E-mail
address & whether honorarium and travel expenses will be paid to faculty.
Name and credentials
(MD, PHD, etc.)
Business title,
institutional affiliation &
location
example:
Professor of Medicine
University of Education
Mayberry, FL
E-mail address
Will honorarium
and/or travel
expenses be
provided to the
faculty member?
(CMDA must have
documentation of
payment)
24
CONTENT DEVELOPMENT
13) How does this activity support the CMDA CE Mission (see the CMDA Mission in the Course
Director Manual)?
14) This CME activity is planned to meet the needs of what groups of practicing healthcare
professionals (target audience)? List all groups:
15) How does the content of this activity match the learners’ current or potential scope of
professional activities?
16) What are the educational format(s) for this CME activity? (check all that apply)
___Lecture
___Teleconference
___Internet
___Roundtable
___Q & A session
___Self-directed
___Case studies
___Panel discussion
___Skilled demonstration
___Stimulations
___Lab activity
___Audience Response System
17) Please UNDERLINE the activity type for this CME activity?
Live Activity
Enduring Material
Journal-based CME activity
Internet
CD-ROM/DVD
Podcast
Other (explain)_____________________________________________________________________
18) Briefly explain how your format and type of activity are appropriate for the setting,
objectives, and the results of this educational activity.
25
19) What procedures were used to identify the existing professional practice gap(s) between
current and best practices of your target audience? Please check all that apply. If a part
of your process has been identification of gaps by experts and your planning committee,
faculty or planners’ perception of need, or opinion leader interviews, please attach a one
or two paragraph description detailing your discussions and how you intend to address
gaps through the educational activity.
Documentation for each procedure indicated must be attached
___Survey of targeted learners
___Review of peer reviewed literature
___Clinical practice data
___Professional Practice Gap(s) identified by target audience/expert
___National clinical guidelines (NIH, NCI, AHRQ)
___Requirements of state licensing board, specialty societies
___Required by practice administration
___Required by governmental authority/regulation/law
___Research findings/translations of research into practice
___New information (diagnostic techniques, treatment plans)
___Requests from physicians or physicians groups
___*Helps to meet CMDA CE Mission
___Public health data
___Faculty and/or planners’ perception of need (attach a statement)
___Summary of previous outcomes data
___Practice or specialty society clinical guidelines
___Committee findings/audits
___Epidemiological data
___Direct to consumer ads
___Lay press
___Societal trends
___Other (please attach description)
*Please review CMDA Mission (see Course Director Manual)
20) Please provide citations of peer-reviewed articles (scientific/medical journals, etc.) that
were used as one of the determining factors for identifying each of the professional
practice gaps.

21) Identify the professional practice gaps(s), what has caused the gap, the desired results of
the educational intervention and classify the need for this educational intervention in
terms of knowledge, competence or performance (see chart below).
IDENTIFY THE
EDUCATIONAL PRACTICE
GAP(S)
(Current practice)
DESCRIBE WHAT HAS
CAUSED THE
PROFESSIONAL
PRACTICE GAP
Desired results
(best-practice)
What are healthcare
professionals not doing?
Why aren’t they doing it?
What will be the results of
solving this problem?
EXAMPLE
Physicians are not using the
diagnostic criteria to screen
EXAMPLE
Literature indicates that at
least 25% of physicians have
EXAMPLE
Participants will be able to:
-Write the diagnostic criteria
Classify the
educational needs in
terms of knowledge,
competence,
performance and/or
patient outcomes
Changes in
competence and/or
performance are
required.
_X_Knowledge:
_X_Competence
_X_Performance
26
pre-school age children for
Autism.
not been educated on the
diagnostic criteria for autism
screening.




for screening pre-school age
children for Autism,
-Create individualized
treatment plans to manage
pre-school age autistic
patients, and
-Develop procedures to
screen pre-school age
children who present with
autistic behaviors.
Patient outcomes: Using
procedures to screen preschool age children earlier
and the individualized
treatment plan will change
the outcome of the patients.
_X_Patient Outcomes
_ _ Knowledge
Competence
Performance
___Patient Outcomes
_ Knowledge
Competence
Performance
___Patient Outcomes
Knowledge
Competence
Performance
___Patient Outcomes
_ _ Knowledge
Competence
Performance
___Patient Outcomes
(add additional rows to this table as needed)
22) Based on the desired results you described in the gap chart above, list the learning
objectives for this activity. Learning objectives help learners understand the specific
result they can expect to achieve by participating in this educational activity. LIST AT
LEAST ONE OBJECTIVE FOR EACH OUTCOME YOU LISTED ABOVE As a result of
participating in this activity, participants will be able to: (example: Explain the diagnostic
criteria used to screen autism).
1.
2.
3.
(continue numbering if additional objectives are listed)
23) Is this activity designed to change competence, performance and/or patient outcomes?
24) The competencies/physician attributes were founded on the Maintenance of Certification
(MOC) competencies designed by the American Board of Medical Specialties (ABMS) the
competencies established by the Accreditation Council for Graduate Medical Education
(ACGME), and the desirable physician attributes established by the Institutes of Medicine
(IOM). Once you have decided on the competencies/physicians attributes to be used to
develop this activity, (1) place an “X” in the first box of the table for each
competency/physician attribute, (2) write the objective(s) number in the last column of
the table that corresponds to the competency/physician attribute you selected. Example:
Objectives numbers 1, 3, and 6.
27
PLACE AN “X”
COMPETENCIES/PHYSICIANS ATTRIBUTES
Patient Care (provide care that is
compassionate, appropriate and effective
treatment for health problems and to promote
health).
Medical Knowledge (demonstrate knowledge
about established and evolving biomedical,
clinical and cognate sciences and their
application in patient care).
Practice-based Learning and Improvement
(investigate and evaluate patient care
practices, appraise and assimilate scientific
evidence and improve practice of medicine).
Systems-based Practice (demonstrate
awareness of and responsibility for larger
context and systems of healthcare; call on
system resources to provide optimal care, e.g.,
coordinating care across sites or serving as the
primary case manager when care involves
multiple specialties, professions, or sites).
Professionalism (demonstrate a commitment to
carrying out professional responsibilities,
adherence to ethical principles and sensitivity
to diverse patient populations).
Interpersonal and Communication Skills
(demonstrate skills that result in effective
communication and teaming with patients, their
families and professional associates, such as
fostering a therapeutic relationship that is
ethically sound; using effective listening skills
with non-verbal and verbal communications;
working as both a team member and at times as
a leader).
Provide patient-centered care (identify,
respect, and care about patients’ differences,
values, preferences and expressed needs;
relieve pain and suffering; coordinate
continuous care; listen to, clearly inform,
communicate with, and educate patients; share
decision making and management; and
continuously advocate disease prevention,
wellness, and promotion of healthy lifestyles,
including a focus on population health).
Work in Interdisciplinary Teams (cooperate,
collaborate, communicate, and integrate care in
teams to ensure that care is continuous and
reliable).
Employ Evidence-based Practice (integrate
best research with clinical expertise and patient
Content in this activity
that reflects the
competencies you
selected – Cite the
learning objective
number(s) 1, 3, 6, etc.
28
values for optimum care; participant in learning
and research activities to the extent feasible).
Apply Quality Improvement (identify errors and
hazards in care; understand and implement
basic safety design principles; continually
understand and measure quality of care in
terms of structure, process and outcomes in
relation to patient and community needs;
design and test interventions to change
processes and systems of care with the
objective of improving quality).
Utilize Informatics (communicate, manage
knowledge, mitigate error, and support decision
making using information technology).
25) Based on the Gap (educational needs) of your target audience, provide a timed agenda
along with the topics and the faculty names for each topic. Application cannot be
reviewed if this information is missing. (CMDA approves to the quarter hour and only the
time actually spent in the educational session)
EXAMPLE:
TIME
8 - 9 am (1 HR Requested)
9:00 am
9:15 – 10 am (.75 HR
Requested)
10:00 AM
TOPIC TITLE
Overview of Autism
Break
Topic
FACULTY NAME
John Doe, MD, PhD
N/A
Jane Doe, MD
Adjourn
26) Please provide an abstract for each topic. Include the topic title and faculty name with
each abstract. Application cannot be reviewed if this information is missing.
EDUCATIONAL EVALUATION, BARRIERS, NON-EDUCATIONAL STRATEGIES







27) CMDA will develop an online evaluation to evaluate and analyze changes in your learners’
professional practice gaps (i.e., changes in knowledge, competence, performance and
practice changes). Three to four months after the completion of the activity, CMDA will
send a follow-up outcomes survey to measure changes to professional practice as well as
competence, performance and/or patient outcomes from this activity. The outcomes
survey is sent to all participants who submitted the initial evaluation.
28) Please identify factors outside your control that have an impact on patient outcomes
(examples: insurance, patient not following recommended dosage, patient’s support
system, etc.).
29) Identify anticipated barriers that the participant’s may have in trying to implement
changes in their practice (examples: formulary restrictions, insufficient time for
implementation of new skills or behaviors, lack of insurance reimbursement, lack of
organizational support, lack of resources, policy issues within the organization,
29
unwillingness to make changes). Recommend educational strategies that you will
discuss during this activity to remove, overcome, or address these barriers.
ANTICIPATED BARRIER(S) TO PARTICIPANT
CHANGES IN PRACTICE
PLANS TO ADDRESS OR OVERCOME THE
BARRIER(S)
30) Planners of this activity are encouraged to employ non-educational strategies for
participants (examples: handouts, CD’s, videos, websites, etc.) to reinforce the intended
results of this activity. Please list any non-educational strategies that you will use and the
purpose of the strategy.
Non-educational Strategy
CMDA will E-mail a follow-up outcomes survey
to participants of this activity.
Purpose of the Strategy
The outcomes survey will remind participants
of the changes they will implement as well as
focus on changes in professional practice.
COURSE LOGISTICS
CMDA neither sponsors nor joint-sponsors activities that are supported by a commercial
interest, however CMDA does accept commercial exhibitors.
The ACCME definition for a commercial interest: “A commercial interest is any entity
producing, marketing, re-selling, or distributing health care goods or services consumed by,
or used on, patients.”
31) Will this activity have Commercial exhibits?
Yes
No
See definition of commercial interest above. Review the ACCME Standards for
Commercial SupportSM) in the Course Director’s Manual. If Yes, please provide list of
participating commercial exhibitors and COMPLETE THE EXHIBIT FORM.
The ACCME requires that a list of all exhibitors be distributed to your participants before
the educational activity is presented. For that reason, CMDA will provide a Welcome
Letter, which will include this information for your participants.
NAME OF EXPECTED/INVITED COMMERCIAL EXHIBIT ORGANIZATION(S)
and contact e-mail address:
NAME OF ORGANIZATION
E-MAIL ADDRESS
Add additional rows to this table as needed
30
The ACCME definition of non-commercial exhibitor: Providers of clinical services directly to
patients, such as hospitals, health systems, medical group practices, blood banks, and
diagnostic laboratories, are an integral component of accredited CME and CDE because they
represent the provision of CME by the profession for the profession. Therefore, these entities
have been deemed NOT to be commercial interests.
32) Will this activity have non-commercial exhibits?
Yes
No
See definition of non-commercial interest above. Review the ACCME Standards for
Commercial SupportSM) in the Course Director’s Manual. If Yes, please provide list of
participating non-commercial exhibitors. NON-COMMERCIAL EXHIBITORS DO NOT
NEED TO COMPLETE THE EXHIBIT FORM.
The ACCME requires that a list of all exhibitors be distributed to your participants before
the educational activity is presented. For that reason, CMDA will provide a Welcome
Letter, which will include this information for your participants.
NAME OF EXPECTED/INVITED NON-COMMERCIAL EXHIBIT
ORGANIZATION(S) and contact e-mail address:
NAME OF ORGANIZATION
E-MAIL ADDRESS
Add additional rows to this table as needed
*NOTE: A final list of confirmed exhibitors MUST be submitted 30 days prior to the conference so that required
follow-up can be done by the CE Department.
33) If this activity will have commercial and/or non-commercial exhibitors, where will they be
located with respect to the CE educational activity?
_________________________________________________________________________________
34) Is there a registration fee for participants?
If yes, how much?
Physicians $
Physicians Assistant
Residents, $
Nurses $
Students, $
Others (please specify): $
Yes
No
X Signature Activity Director (electronic signature or typed name is acceptable if sending
electronically)
Signature
31
Date:
IF THIS ACTIVITY IS CANCELED WITHIN 30 DAYS OF THE START DATE, THERE WILL BE A
$500 ADDITIONAL CANCELLATION FEE PLUS COLLECTION OF ANY EXPENSES INCURRED
BY CMDA.
Christian Medical & Dental Associations does not share in profit or loss for this symposium.
Christian Medical & Dental Associations educational activities are reviewed by the CMDA
committee for scientific content, relevance to healthcare professionals, congruence with the
CMDA mission, and credentials of speakers. All symposiums must be approved by the CMDA
committee. By serving in this role, the Committee is serving as part of the planning process
for all activities sponsored by the CMDA.
CMDA FEE FOR SPONSOR/JOINT-SPONSORSHIP
ACTIVITY FEE(s)
*CME Application Fee for direct sponsored activity - $500.00
*CME Application Fee for jointly sponsored activity - $850.00
Total Activity Fee due UPON SUBMISSION OF APPLICATION
$
$
$
*IF during the review process the application is denied by the review committee
OR if the activity is cancelled at any time after submission, there will be a $200
non-refundable application review fee.
DUE AFTER COMPLETION OF THE ACTIVITY
Transcript Fee - $10 per credit hour approved/Per person
(Example: 4 hours approved for the activity = $40 post activity fee x 22 participants
claiming CE = $880.00 Post Activity Fee Due)
A Financial wrap-up report along with Transcript Fee for this course is required within 30
days following activity completion.
__________________________
NOTE: The CMDA CE Department desires to keep its fees reasonable in comparison to the national
average. For large organizations or large events, the CMDA CE Department is willing to base its fees
on the number in attendance and/or whether it is a sponsored or joint-sponsored CE activity. Please
contact Barbara Snapp (1-888-230-2637 or barbara@cmda.org) to discuss additional options if needed
before submitting this application.
FEE FOR ADDITIONAL SERVICES (non-negotiable)
$300 AAFP Credits
$300 Dental (Academy of General Dentistry - IF submitted separately from the medical
application)
$300 Nursing (in order for CMDA to apply for nursing credit, you must submit speaker Bio
sketches, speaker & planner disclosures and overview of each speaker presentation
with this application)
32
$300 Nurse Practitioner (in order for CMDA to apply for nurse practitioner credit, you must
submit speaker Bio sketches, speaker & planner disclosures and overview of each
speaker presentation with this application)
$300 Physician Assistant
Course/Activity logistics that must be provided to the CMDA/CE office:








Application for Credits (must be approved by the CMDA Committee).
Draft brochure for review and approval.
5 original brochures.
Sign-in sheets/attendance verification document (typed and electronic).
Copies of faculty/course director reimbursement checks for travel and lodging
etc.
Copies of faculty/course director honoraria checks
List of exhibitors (If applicable)
Budget reconciliation - accounting of income and expenses.
BEFORE YOU SUBMIT THIS APPLICATION MAKE SURE:
APPLICATION IS SIBMITTED ELECTRONICALLY IN A WORD DOCUMENT
ALL QUESTIONS ON THE APPLICATION ARE ANSWERED
PROPOSED BUDGET
33
PROMOTIONAL CONTENTS FOR A CMDA CE ACTIVITY
(For planning purposes)
Following is a list of what is needed on the brochure/flyer:
A COPY OF THE PROMOTIONAL PIECE IS REQUIRED TO BE APPROVED BY THE
ACCREDITATION OFFICER OR CE DIRECTOR PRIOR TO PRINTING:
Brochure Content
-Course title
-Agenda (course content)
-Teaching method to be used
-Target audience
-Educational objectives
-Special needs statement (see below)
-NO COMMERCIAL SUPPORT FOR THIS ACTIVITY at the bottom of the brochure/flyer.
-Faculty names and credentials
-Costs and Refund policy (if applicable)
-Course location, date, time etc.
-Contact information (for registration and follow-up questions)
-CMDA logo must be used (Program provider)
-Accreditation with ACCME logo and designation statements (see below)
PLEASE NOTE: Each of the statements below must be worded exactly as they appear. If you need
clarification, call the CE Department.
Special Needs
If you need special accommodations due to a disability or for an alternative form of course materials, please
contact us at YOUR ORGANIZATION’S TELEPHONE NUMBER at least 14 days prior to the program.
CMDA’s Department of Continuing Education fully complies with the legal requirements of the ADA and the
rules and regulations thereof.
CONTINUING MEDICAL EDUCATION Sponsorship Statement
Accreditation Statement (sponsorship)
The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing
Medical Education to provide continuing medical education for physicians.
CONTINUING MEDICAL EDUCATION Joint Sponsorship Statement
Accreditation Statement (joint sponsorship)
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the
Accreditation Council for Continuing Medical Education through the joint sponsorship of the Christian Medical
& Dental Associations (CMDA) and the <Name of non-accredited provider>. Christian Medical & Dental
Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing
medical education for physicians.
The AMA Designation Statement (direct sponsorship)
The Christian Medical & Dental Associations designates this educational activity for a maximum of <credits
approved> AMA PRA Category 1 Credits(s) ™. Physicians should only claim credit commensurate with the
extent of their participation in the activity.
NOTE: Please be sure to italicize AMA PRA Category 1 Credit(s) TM and use the superscript TM CAPITALIZED.
34
DENTAL CONTINUING EDUCATION
(If applicable to your event. A separate application and additional processes are also required.)
(IF Joint Sponsored) This activity has been planned and implemented in accordance with the standards of
the Academy of General Dentistry (AGD) Program Approval for Continuing Education (PACE) through the
joint program provider approval of Christian Medical & Dental Association and <Name of non-approved
program provider>.
AND. . . .
The Christian Medical & Dental Associations is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of
this program provider are accepted by AGD for Fellowship/Mastership and
membership maintenance credit. Approval does not imply acceptance by a state or
provincial board of dentistry or AGD endorsement. The current term of approval
extends from 1/1/2011 to 12/31/2014. Provider ID# 218742
Also, the Academy of General Dentistry PACE logo must appear somewhere in the
brochure preferably near the AGD statement (no more than 2 inches in height).
The AGD requires a Course Completion Code on the attendance verification form
for dental credit.
THE FOLLOWING STATEMENTS ARE APPLICABLE
ONLY IF YOU ARE REQUESTING THESE CONTINUING EDUCATION
CREDITS FOR YOUR ACTIVITY
(See application to request credit and for fees associated with this service)
AAFP Credit
Application for AAFP credit has been filed with the American Academy of Family Physicians. Determination
of credit is pending. (be sure to highlight the last sentence)
Physician Assistant
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1
CreditTM by an organization accredited by the ACCME or a recognized state medical society. Physician
assistants may receive ___ hours of Category 1 credit for completing this program.
Nurse Practitioner
Verbiage will be provided upon approval.
Nursing
Verbiage will be provided upon approval.
ALL PROMOTIONAL MATERIALS MUST BE APPROVED
BY THE CMDA/CE DEPT PRIOR TO BEING RELEASED.
35
CMDA - DISCLOSURE - CONFLICT OF INTEREST RESOLUTION - CONTENT VALIDATION
(CMDA) - RESOLUTION PERSONAL CONFLICTS OF INTEREST
Christian Medical & Dental Associations has implemented a process where everyone (including immediate family members) who is in a position to
control the content of an educational activity has disclosed to us all relevant financial relationships with any commercial interest. In addition, should it be
determined that a conflict of interest exists as a result of a financial relationship that you may have, it will need to be resolved before we can move to the
next step in planning this CE activity. An individual who refuses to disclose relevant financial relationships will be disqualified from being a planner,
teacher, or an author of CE and cannot have control or responsibility for the development, management, presentation or evaluation of a CMDA CE
activity. If you have a conflict of interest and it is not resolved, your presentation cannot be awarded CE credit.
Glossary of Terms
Commercial Interest
A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients.
(The only exception is those received from non-profit or government organizations)
Financial Relationships
Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting
fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial
benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted
research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from
which remuneration is received, or expected. ACCME and AGD consider relationships of the person involved in the CE activity to include financial
relationships of a spouse or partner.
Relevant financial relationships
CMDA focuses on financial relationships with commercial interests in the 12-month period proceeding the time that the individual is being asked to
assume a role controlling content of the CE activity. The ACCME or AGD has not set a minimal dollar amount for relationships to be significant.
Inherent in any amount is the incentive to maintain or increase the value of the relationship. To aid in this review, the ACCME defines “’relevant’
financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.
Conflict of Interest
Circumstances create a conflict of interest when an individual has an opportunity to affect CE content about products or services of a commercial
interest with which he/she has a financial relationship.
First, list the names of proprietary entities producing health care goods or services, with the exemption of non-profit or government organizations
and non-health related companies with which you or your spouse/partner have, or have had, a relevant financial relationship within the past 12
months. For this purpose, we consider the relevant financial relationships of your spouse or partner that you are aware to be yours.
Second, describe what you or your spouse/partner received (ex: salary, honorarium etc.). Christian Medical & Dental Associations does NOT want
to know how much you received.
Third, describe your role.
Commercial Interest (company)
What I Received (salary, honorarium,
My Role (speaker, employment, contract)
stocks)
___Neither I nor an immediate family member has a personal financial relationship(s) relevant to the content of this CE activity.
___The relationships identified above are not associated with the content of my presentation and will not be discussed or presented on any material.
Are your recommendations involving clinical medicine/oral healthcare based on evidence that is accepted within the profession of medicine/dentistry as
adequate justification for their indications and contraindications in the care of patients?
___YES ___NO ___N/A
In your presentation, does all scientific research, reported or used in support or justification of a patient care recommendation conform to the generally
accepted standards of experimental design, data collection, and analysis? ___YES ___NO ___N/A
I will use only generic names when discussing therapeutic options. ___YES ___NO ___N/A If no, you must refer to trade names of several companies.
I intend to discuss unlabeled/investigational use(s) of a drug(s) or device(s) in my presentation. ___YES ___NO ___N/A
The materials used in my presentation(s) have not been falsified and will not misrepresent the outcome of treatment. __I agree__ N/A (AGD Requirement)
Print Your Name
Signature
Date_______________
36
CMDA Conflict of Interest Resolution
Disclosure
Provided?
NO: Person cannot participate in coordinating, planning, authoring, speaking, moderating; and
cannot have control of or responsibility for the development, management, presentation or
evaluation of the CME activity.
The disclosure form is evaluated by CE Director & Accreditation Officer. If no disclosures are
Listed, evaluation ends. However, if there are disclosures listed, evaluation continues.
Yes
If financial relationships are disclosed by coordinators, planners, authors, speakers, moderators or immediate family members and the
individual has indicated on the disclosure form that the relationships are not associated with the content of their presentation, the
Accreditation Officer will review the disclosures and determine whether the evaluation ends. However, the evaluation will continue...
If coordinators, planners, authors/speakers, moderators or members of their immediate families have relevant financial relationships that
create a conflict of interest. The following steps will apply:
Coordinators, CE Director, Accreditation Officer recues themselves from planning an activity.
Course directors & planning committee members recues themselves from planning an activity.
CE committee members recues themselves from reviewing an activity application and speaker presentations.
Course directors, planning committee members or CE committee members will review speaker presentations and may require changes. If
the speaker does not comply with edits by reviewers, s/he will be disqualified from presenting.
Moderators & panel members will be replaced with someone who does not have a COI.
37
COMMERCIAL EXHIBITOR FORM
ONLY COMMERCIAL EXHBITORS NEED TO COMPLETE THIS FORM
IF YOU ARE A COMMERCIAL INTEREST (*see definition below), please read and complete this
document, which reflects agreement and adherence to the ACCME Standards for Commercial Support,
CMDA policies, and AGD. Return to the coordinator of this CE activity.
Commercial Exhibitors
ACCME states: Commercial exhibits and advertisements are promotional activities and not continuing medical education.
Therefore, monies paid by commercial interests for these promotional activities are not considered to be commercial
support. CMDA fulfills the requirements of the ACCME Standards for Commercial Support (SCS 4) and AGD Standard
XII in using sound fiscal and business practices with respect to promotional activities.
Definition of Commercial Support
Commercial Support for a CE activity is financial or in-kind contributions given by a commercial interest, which is used to
pay all or part of the costs of a CE activity.
Definition of Commercial Interest
Commercial interest (supporter) is any entity producing, marketing, re-selling, or distributing health care goods or
services consumed by, or used on, patients.
Non-commercial Interest
Providers of clinical services directly to patients, such as hospitals, health systems, medical group practices, blood banks,
and diagnostic laboratories, are an integral component of accredited CME and CDE because they represent the provision of
CE by the profession for the profession. Therefore, these entities have been deemed NOT to be commercial interests.
Commercial Interest Limitations
-Commercial interests are not eligible for ACCME accreditation or AGD PACE Approval. Commercial interests cannot be
accredited or PACE approved providers and cannot be joint sponsors.
-Arrangements for commercial exhibits or advertisements cannot influence planning or interfere with the presentation, nor
can they be a condition of the provision of commercial support for CE activities (CMDA does not accept commercial
support for CE activities).
-Product-promotion material or product-specific advertisement of any type is prohibited in or during CE activities. The
coincidence of editorial and advertising material on the same products or subjects must be avoided. Live (staffed exhibits,
presentations) or enduring (printed or electronic advertisements) promotional activities must be kept separate from CME.
There will be no ‘commercial breaks.’ For live, face-to-face CE, advertisements and promotional materials cannot be
displayed or distributed in the educational space immediately before, during, or after a CE activity. CMDA will not allow
representatives of Commercial Interests to engage in sales or promotional activities while in the space or place of the CE
activity.
-Print advertisements and promotional materials will not be interleafed within the pages of the CE content. Advertisements
and promotional materials may face the first or last pages of printed CE content as long as these materials are not related to
38
the CE content they face and are not paid for by the commercial supporters of the CE activity (CMDA does not accept
commercial support for CE activities).
-Computer based advertisements and promotional materials will not be visible on the screen at the same time as the CE
content and not interleafed between computer ‘windows’ or screens of the CE content. Audio and video recording
advertisements and promotional materials will not be included within the CE.
-Print or electronic information distributed about the non-CE elements of a CE activity that are not directly related to the
transfer of education to the learner, such as schedules and content descriptions, may include product-promotion material or
product-specific advertisement.
-CMDA will not use a commercial interest as the agent providing a CE activity to learners, e.g., distribution of self-study
CE activities or arranging for electronic access to CE activities.
-CMDA will ensure that their learners can participate in educational activities without seeing, reading or hearing
promotional or marketing information from commercial interests. In addition, CMDA will ensure that the selling of
advertising or exhibit space is a business transaction entirely separate from the acceptance of commercial support for
accredited CME or CDE by refusing to accept commercial support for CMDA educational activities.
-CMDA follows the policies of the ACCME and the AGD by insisting on the separation of education from all promotional
activities, materials and messages. CMDA may create a print or text based document that goes along with an activity and
provides information that is supplementary to the educational content - like reproductions of slides, graphics, thumb drives
or other handouts. These documents, in print or electronic, are an integral part of the education and as such will not have
any advertising, trade name or a product-group message associated with them.
-If a commercial interest seeks to purchase advertising and promotional opportunities with resources designated for that
purpose and an agreement for advertising and promotion between CMDA and the commercial interest is established,
CMDA will not accept commercial support and no written agreement for commercial support will be considered. Any
event or product that contains advertising or promotional opportunities will not be part of the educational CE activity and
must not be paid for by commercial support and the advertisement and/or promotional opportunity will be assigned to the
"exhibit hall." Advertising pages or screens or promotional receptions or meals will be clearly identified as such to the
learner by CMDA.
-Promotional events at CMDA CE activities (e.g., exhibit halls) are kept distinct and separate from CE activities by not
only their location and time in the program schedule, but also in how these events are clearly described as "Promotional" to
CMDA learners.
I attest that I have read this document and agree to abide by its policies and guidelines.
Name of the commercial exhibit organization:
*Name of the Representative(s) from the commercial exhibitor organization:
Email address of the Representative of the commercial exhibitor organization
Title of this CE activity
Date of this activity
Amount of Money Paid to Exhibit at this CE activity $
*Typed name will serve as the signature
I understand that if I reserve exhibit space and do not show to claim such space, the exhibit fee is not waived and is
due and payable to the host organization named above.
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ACCME STANDARDS FOR COMMERCIAL SUPPORT
Standards to Ensure the Independence of CME Activities
Definition:
The Provider is the institution providing the CME credit.
The Educational Partner is the joint sponsor (not the commercial supporter).
The ACCME Standards for Commercial SupportSM
Standards to Ensure Independence in CME Activities
STANDARD 1: Independence
1.1 A CME provider must ensure that the following decisions were made free of the control of a
commercial interest. (See www.accme.org for a definition of a ‘commercial interest’ and some
exemptions.)
(a) Identification of CME needs;
(b) Determination of educational objectives;
(c) Selection and presentation of content;
(d) Selection of all persons and organizations that will be in a position to control the
content of the CME;
(e) Selection of educational methods;
(f) Evaluation of the activity.
1.2 A commercial interest cannot take the role of non-accredited partner in a joint sponsorship
relationship.
STANDARD 2: Resolution of Personal Conflicts of Interest
2.1 The provider must be able to show that everyone who is in a position to control the content of
an education activity has disclosed all relevant financial relationships with any commercial interest
to the provider. The ACCME defines “’relevant’ financial relationships” as financial relationships in
any amount occurring within the past 12 months that create a conflict of interest.
2.2 An individual who refuses to disclose relevant financial relationships will be disqualified from
being a planning committee member, a teacher, or an author of CME, and cannot have control of,
or responsibility for, the development, management, presentation or evaluation of the CME
activity.
2.3 The provider must have implemented a mechanism to identify and resolve all conflicts of
interest prior to the education activity being delivered to learners.
STANDARD 3: Appropriate Use of Commercial Support
3.1 The provider must make all decisions regarding the disposition and disbursement of
commercial support.
3.2 A provider cannot be required by a commercial interest to accept advice or services concerning
teachers, authors, or participants or other education matters, including content, from a
commercial interest as conditions of contributing funds or services.
3.3 All commercial support associated with a CME activity must be given with the full knowledge
and approval of the provider.
Written agreement documenting terms of support.
3.4 The terms, conditions, and purposes of the commercial support must be documented in a
written agreement between the commercial supporter that includes the provider and its
educational partner(s). The agreement must include the provider, even if the support is given
directly to the provider’s educational partner or a joint sponsor.
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3.5 The written agreement must specify the commercial interest that is the source of commercial
support.
3.6 Both the commercial supporter and the provider must sign the written agreement between the
commercial supporter and the provider.
Expenditures for an individual providing CME
3.7 The provider must have written policies and procedures governing honoraria and
reimbursement of out-of-pocket expenses for planners, teachers and authors.
3.8 The provider, the joint sponsor, or designated educational partner must pay directly any
teacher or author honoraria or reimbursement of out-of–pocket expenses in compliance with the
provider’s written policies and procedures.
3.9 No other payment shall be given to the director of the activity, planning committee members,
teachers or authors, joint sponsor, or any others involved with the supported activity.
3.10 If teachers or authors are listed on the agenda as facilitating or conducting a
presentation or session, but participate in the remainder of an educational event as a learner,
Their expenses can be reimbursed and honoraria can be paid for their teacher or author role only.
Expenditures for learners
3.11 Social events or meals at CME activities cannot compete with or take precedence over the
educational events.
3.12 The provider may not use commercial support to pay for travel, lodging, honoraria, or
personal expenses for non-teacher or non-author participants of a CME activity. The provider may
use commercial support to pay for travel, lodging, honoraria, or personal expenses for bona fide
employees and volunteers of the provider, joint sponsor or educational partner.
Accountability
3.13 The provider must be able to produce accurate documentation detailing the receipt and
expenditure of the commercial support.
STANDARD 4. Appropriate Management of Associated Commercial Promotion
4.1 Arrangements for commercial exhibits or advertisements cannot influence planning or interfere
with the presentation, nor can they be a condition of the provision of commercial support for CME
activities.
4.2 Product-promotion material or product-specific advertisement of any type is prohibited in or
during CME activities. The juxtaposition of editorial and advertising material on the same products
or subjects must be avoided. Live (staffed exhibits, presentations) or enduring (printed or
electronic advertisements) promotional activities must be kept separate from CME.
• For print, advertisements and promotional materials will not be interleafed within the pages of the
CME content. Advertisements and promotional materials may face the first or last pages of printed
CME content as long as these materials are not related to the CME content they face and are not
paid for by the commercial supporters of the CME activity.
• For computer based, advertisements and promotional materials will not be visible on the screen
at the same time as the CME content and not interleafed between computer ‘windows’ or screens of
the CME content.
• For audio and video recording, advertisements and promotional materials will not be included
within the CME. There will be no ‘commercial breaks.’
• For live, face-to-face CME, advertisements and promotional materials cannot be displayed or
distributed in the educational space immediately before, during, or after a CME activity. Provider
cannot allow representatives of Commercial Interests to engage in sales or promotional activities
while in the space or place of the CME activity.
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4.3 Educational materials that are part of a CME activity, such as slides, abstracts and handouts,
cannot contain any advertising, trade name or a product-group message.
4.4 Print or electronic information distributed about the non-CME elements of a CME activity that
are not directly related to the transfer of education to the learner, such as schedules and content
descriptions, may include product promotion material or product-specific advertisement.
4.5 A provider cannot use a commercial interest as the agent providing a CME activity to learners,
e.g., distribution of self-study CME activities or arranging for electronic access to CME activities.
STANDARD 5. Content and Format without Commercial Bias
5.1 The content or format of a CME activity or its related materials must promote improvements
or quality in healthcare and not a specific proprietary business interest of a commercial interest.
5.2 Presentations must give a balanced view of therapeutic options. Use of generic names will
contribute to this impartiality. If the CME educational material or content includes trade names,
where available trade names from several companies should be used, not just trade names from
a single company.
STANDARD 6.Disclosures Relevant to Potential Commercial Bias
Relevant financial relationships of those with control over CME content
6.1 An individual must disclose to learners any relevant financial relationship(s), to include the
following information:
• The name of the individual;
• The name of the commercial interest(s);
• The nature of the relationship the person has with each commercial interest.
6.2 For an individual with no relevant financial relationship(s) the learners must be informed that
no relevant financial relationship(s) exist.
Commercial support for the CME activity.
6.3 The source of all support from commercial interests must be disclosed to learners. When
commercial support is ‘in-kind’ the nature of the support must be disclosed to learners.
6.4 ‘Disclosure’ must never include the use of a trade name or a product-group message.
Timing of disclosure
6.5 A provider must disclose the above information to learners prior to the beginning of the
educational activity.
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AGD PACE Standard XII Commercial or Promotional Conflict of Interest
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(Continued: AGD PACE Standard XII Commercial or Promotional Conflict of Interest)