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  • Divison of Continuing Education

     

  • Speaker Activity Development and Faculty Form

  • If you have any questions while completing this form, please refer to the Faculty Guidance Packet (click here) or contact Megan Littleton at megan.littleton@st-claire.org or 606-783-7578. Powerpoint presentation slides will need to be presented at least two weeks prior to your presentation date. Slides must include disclosure statement. See examples here. 

  • Presenter Information:

  • If you would like to designate a point of contact, do so here:

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  • Activity Information

  • Overall Activity Learning Objectives*
    (ACCME Criteria 2, 3, 11)

    • Please list at least 3 objectives for your presentation.
    • Objectives should be specific, measurable, and align with Bloom's Taxonomy for action verbs). 
    • For Competency/Knowledge-based activities, please the Bloom's Taxonomy verbs found in the Faculty Guidance packet (click here) on page 2 under the knowledge and comprehension sections of the table. 
    • Note: What is the overall program learning objectives that will address the identified professional practice gap?
  • Overall Activity Learning Objectives*
    (ACCME Criteria 2, 3, 11)

    • Please list at least 3 objectives for your presentation.
    • Objectives should be specific, measurable, and align with Bloom's Taxonomy for action verbs). 
    • For Application/Practice-based activities, please the Bloom's Taxonomy verbs found in the Faculty Guidance packet (click here) on page 3 under the application, analysis, synthesis and evaluation sections of the table.
    • Note: What is the overall program learning objectives that will address the identified professional practice gap?
  • Materials

    Handouts are encouraged for providing participants with further resources for continuing education possibilities beyond the activity time frame. Handouts may be brought by the faculty, sent to the Northeast KY AHEC for distribution, or if no handouts are planned then a content overview of presentation slides will be given to participants.

     

  • Conflict of Interest Resolution

    If speakers are found to have a financial relationship when completing the Speaker Disclosure form, the Northeast Kentucky Area Health Education Center will follow appropriate steps to ensure a conflict of interest does not intrude upon the education content of the continuing education program. The NE KY AHEC, by either the Continuing Education Coordinator or their designee, will complete the following steps:

    1. Identify the conflict of interest as documented in the speaker disclosure form and documents that the conflict has been addressed.
    2. Contact the speaker(s) to discuss the definition of a Conflict of Interest as defined in the policy on the Speaker Disclosure form.
    3. The speaker will be required to submit their presentation slides at least 7 days prior to the activity, so that the committee can look over approve it is free of any commercial bias.
    • In order to meet accreditation requirements regarding potential conflicts, speakers must adhere to the following requirements:
      Any recommendations involving clinical medicine must be based on evidence accepted within the medical profession as appropriate for the care of patients.
    • Research reported or referred to should conform to accepted standards
    • Content should promote improvements in quality of care and not a specific business or ineligible company.
    • A balanced view of therapeutic options should be given, along with generic names to provide impartiality.
    • Educational materials can't contain any advertising, trade names or produced messages.
  • You must complete a Disclosure of Financial Relationships form.
    Click here to fill out the form.

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  • For questions, please contact Megan Littleton at megan.littleton@st-claire.org. 

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