CAEP Declaration of Conflict of Interest Form

Instructions and Guidelines

A conflict of interest is a set of conditions in which judgement or decisions concerning a primary interest (e.g., a patient’s welfare, the validity of research, and/or quality of medical education) is unduly influenced by a secondary interest (personal or organizational benefit including financial gain, academic or career advancement, or other benefits to family, friends, or colleagues).

• All financial or in-kind relationships with for- and not-for-profit organizations (not only those relevant to the subject being discussed) encompassing the two (2) years up to and including the current presentation, must be declared and disclosed. This applies to all scientific planning committee members, presenters, moderators, facilitators, and authors.
• Presenters, moderators, facilitators, and authors are responsible for ensuring that their presentations, or education materials—and any recommendations—are balanced and reflect the current scientific literature. The only caveat to this guideline is where there is only one treatment or management strategy. Unapproved use of products or services must be declared within the presentation.
• Disclosure must be made verbally and also displayed in writing at the beginning of a presentation or included in the written conference materials.
• The conflict of interest declaration forms must be completed and submitted to CAEP prior to the start date of the event or program.
• The scientific planning committee is responsible for reviewing all disclosed financial relationships of speakers, moderators, facilitators and authors in advance of the CPD activity to determine whether action is required to manage potential or real conflicts of interest. The scientific planning committee must also have procedures in place to be followed if a conflict of interest comes to its attention prior to or during the CPD activity.
• Any individual who fails to disclose their relationship(s) as described cannot participate as a member of the scientific planning committee, presenter, moderator, facilitator, or author of a certified/accredited activity.
• False disclosure of or a failure to disclose a conflict of interest as outlined in this document could require the scientific planning committee to replace the speakers, moderators, facilitators, and authors.

Complete this section if you HAVE/HAD an affiliation (financial or otherwise) with a for-profit or not-for-profit organization.