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TPMA Instructor Information Form

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  • TPMA Annual Meeting Instructor Info Form

    Thank you for coming to this page to complete the Instructor Information Forms for your participation in the 2019 Annual Meeting of the Tennessee Podiatric Medical Association.  Start by selecting your name from the drop down menu below and entering your email address so that you can receive a copy of this form.  Clicking "Next" will take you to the second page where you can complete the marked sections and continue through the form by selecting "Next" each time.  After you've reached the end, click "Submit" and your information will be sent to TPMA.  Should you have any questions, please contact Gary Odom by email: gary@tnpma.org.  Thank you! 

     

  • INSTRUCTOR NAME

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  • LECTURE OBJECTIVES

  • Lecture objectives are clearly defined and measurable statements that indicate what a participant is expected to accomplish upon completion of the lecture. A learning objective expresses a specific, short-range outcome and is stated in behavioral or action-oriented terms.

    A lecture objective is NOT what you, as the speaker, hope everyone will learn from your presentation.

    Tips on how to write effective objectives:

    Appropriate Verbs for Learning Objectives:

    • Comprehension: Assess, classify, compare, contrast, demonstrate, describe, differentiate, explain; Application: Apply, calculate, develop, operate, practice, prescribe, select, solve, translate, use, utilize;
    • Analysis: Analyze, appraise, debate, deduce, diagram, distinguish, measure, question,summarize;
    • Evaluation: Critique, determine, estimate, evaluate, judge, rank, recommend, revise, score, test;
    • Those that impart skills: Administer, demonstrate, diagnose, diagram, employ, integrate, measure, operate, palpate, process, project, record;
    • Those that convey attitudes: Acquire, consider, encourage, exemplify, modify, plan, reflect, revise;
    • Those that convey information: Cite, define, identify, list, quote, repeat, state, tabulate, trace, update

    Do not use the following words: Appreciate, know, learn, increase, improve, understand, become, expand, and believe as they are vague and open to many interpretations. Objectives beginning with these words cannot be readily measured.

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  • PROTECTION OF PATIENT CONFIDENTIALITY

  • As the creator of your PowerPoint file(s) to be presented at this conference, it is your responsiblity to ensure that all patient protection standards are in place to maintain confidentiality.  Applicable primarily to the photos/videos used in your PowerPoint, as well as in discussion of cases and patient care, you ensure that you:

    • Obtain prior written informed consent from the patient
    • Utilize aseptic conditions and appropriate equipment and instruments
    • Ensure that instructors provide sufficient clinical supervision
    • Provide continuity of care
    • Provide emergency services 

    The material(s) presented and/or distributed shall be in accordance with the Health Insurance Portability and Accountability Act (HIPAA), as amended.

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  • COMMERCIAL SUPPORT STANDARDS TO ENSURE INDEPENDENCE

  • In compliance with CPME standards, the following policies apply to all speakers and their presentations for Goldfarb Foundation conferences. The policies must be acknowledged by all speakers, regardless of whether funds from an unrestricted educational grant will be used to support your participation in the event.

    1. Educational materials that are part of a continuing education activity, such as slides, abstracts and handouts, cannot contain any advertising, trade name or a product-group message. Specific lecture titles cannot contain a trade name.
    2. The content or format of a continuing education activity or its related materials must promote improvements or quality in healthcare and not a specific proprietary business interest or a commercial interest.
    3. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names from several companies must be used, not just trade names from a single company.
    4. An individual must disclose to attendees 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. This information will be made known during the introduction of each speaker by the moderator and in the meeting program. The disclosure information will be taken from your Instructor Disclosure Form (following page).
    5. For an individual with no relevant financial relationship(s) the attendees must be informed that no relevant financial relationship(s) exist. This information will be made known during the introduction of each speaker by the moderator and in the meeting program.
    6. 'Disclosure' may include the use of a trade name but not a product-group message.

    Some of the above verbiage has been taken from CPME 720 and The ACCME Standards for Commercial SupportSM, Standards to Ensure Independence.

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  • INSTRUCTOR DISCLOSURES

  • Disclosures will be made to meeting participants in the event program and prior to your lecture(s).

  • If applicable, please check which type of disclosure(s) you need to make and then list the relevant names of the companies/organizations.

  • If you selected above that you do have a disclosure and selected the type of diclosure, list the names of the relevant companies below.

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  • ELECTRONIC SIGNATURE

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  • SUBMIT

  • You're almost finished!  Please hit the submit button below to submit this information and you will also receive a copy sent to your email.  Thank you!

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Phone : 717-763-7665
Fax : 717-761-4091
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The William L. Goldfarb Foundation 757 Poplar Church Road
Camp Hill, PA 17011