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Annapolis Instructor Information Form

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  • Annapolis Instructor Info Form

    Thank you for coming here to complete the online Instructor Information Form for the 2022 Annapolis Meeting.  This page contains 10 sections:

    1. Instructor Information (select your name)
    2. Submission of PowerPoint
    3. AV Needs
    4. Lecture Objectives
    5. Protection of Patient Confidentiality
    6. Agreement for Commercial Support Standards to Ensure Independence
    7. Instructor Disclosures
    8. Hotel Accommodations
    9. Instructor Expense Information

    You will be prompted to complete each section; those highlighted in red are required.  After completing the form, click the "SUBMIT" button and you will be taken to a page confirming that your information has been received.  You will receive a copy of the form by email as well.  If you have any questions regarding this form or lecturing at the Clinical Conference, contact Lara Beer-Caulfield.

     

  • 1) INSTRUCTOR INFORMATION

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  • 2) SUBMISSION OF POWERPOINT

  • PowerPoint Files for Review

    As a speaker at the Annapolis Meeting, we require you to provide to us a copy of your PowerPoint for the event by November 4.  You can submit the files as PDF (preferred) or PowerPoint, but no Key files can be accepted.  The files will be reviewed by the Foundation's Compliance Coordinator to ensure there is no bias or commercial interests represented in the lecture content.  

    Additionally, PDFs will be made available for meeting attendees to download.  The Foundation has received negative feedback in the past about handouts when speakers do not provide their handouts.

    Files should be uploaded to Dropbox by November 4.

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  • 3) AUDIOVISUAL NEEDS

  • The selections made below for audiovisual apply to all lectures you will present at the meeting.
    The Foundation’s PC will be equipped with the 2007 version of PowerPoint. Note if you are bringing your own laptop and it is a Mac, you must bring the appropriate converter to connect the computer to the projector.

  • An LCD projector, LCD Panel/Screen, wireless microphone, and laser pointer will be provided for every lecture. Additionally, WIFI will be available on-site at the event and during the lectures. If you require additional audiovisual needs, please list them here: 

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  • 4) LECTURE OBJECTIVES

  • Each speaker at the Annapolis Meeting is covering a specific podiatric topic with similar sub-topics.  We have received permission from CPME to have 3 lecture objectives cover all of your lectures, instead of you creating 3 objectives for every single lecture.  When creating the objectives, take into consideration the material you'll be presenting in all of your lectures.

    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.

  • At the conclusion of this lecture, the attendee shall be able to:

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  • 5) 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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  • 6) COMMERICAL SUPPORT STANDARDS TO ENSURE INDEPENDENCE

  • In compliance with CPME standards, the following policies apply to all instructors and their presentations for Goldfarb Foundation conferences.  The policies must be acknowledged by all instructors, 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. The Foundation will make this information 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.
    5. For an individual with no relevant financial relationship(s) the attendees must be informed that no relevant financial relationship(s) exist.  The Foundation will make this information 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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  • 7) INSTRUCTOR DISCLOSURES

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

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    If your web browser auto-fills your name into the sections below, please remove it.

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  • 8) HOTEL ACCOMMODATIONS

  • HOTEL INFORMATION:  The William L. Goldfarb Foundation will make reservations for you at the Historic Inns if we receive your paperwork by the deadline.  If your travel expenses are covered by an unrestricted educational grant, the Foundation will make your hotel reservations but you will be required to pay for the room yourself as reimbursement is provided with your honorarium check.  If a grant is not covering your travel expenses, your room, tax, and parking will be billed to the Foundation’s master account but you will be required to present a credit card at check-in for incidentals.

    Arrival and departure dates are based upon the days that you will be lecturing.  If you see an N/A listed for the arrival or departure date, it means that we expect you will not need a room.  Please make any necessary changes to the dates listed, and indicate the type of room you would like.  If you will not need a room, you can indicate such below.

    PLEASE NOTE: If you require a reservation for days outside of what the Foundation deems to be a reasonable amount of time related to your speaking engagement, please note those details below.  The Foundation will make one reservation for all of your needs and instruct the hotel to charge the appropriate night(s) to the master account and the additional nights to your personal credit card which you’ll provide at check-in.  Example: Bob Smith, DPM is speaking on Friday morning at the conference but wants to stay through Sunday at the hotel.  The Foundation will pay for his room on Thursday night but he’ll be responsible to pay for Friday and Saturday nights.  The Foundation will make his reservation for arrival on Thursday, departure on Sunday.  Dr. Smith will present his credit card upon arrival at the hotel and when he checks out on Sunday, will have paid for any Thursday incidentals, plus room, tax, and incidentals for Friday and Saturday nights.

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  • 9) INSTRUCTOR EXPENSE INFORMATION

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    This information was previously provided in your Instructor Invitation and is being provided as a reminder to the expense policies for this event.

    HONORARIUMS:  The William L. Goldfarb Foundation pays its instructors for the Annapolis Meeting a flat rate of $1,000.00, unless funding through an unrestricted educational grant is arranged.  Honorariums will be distributed at the conclusion of each speaking engagement.  Any honorariums that are not distributed prior to departure will be mailed immediately following the end of the conference.  All honorariums must be approved by the William L. Goldfarb Foundation.  For more details about unrestricted educational grants, see the documents included with your hard copy invitation.  Regarding unrestricted educational grants, the commercial source will provide a check to the Foundation and the Foundation will then issue the instructor a check for their honorarium and travel expenses as outlined within this policy. If a grant is applied for and not approved, the Foundation will pay for your travel expenses and honorarium as outlined on this page.

    OVERNIGHT ACCOMMODATIONS:  The Foundation will make overnight hotel reservations for each instructor.  The number of nights covered depends upon the day that the instructor has been invited to lecture and the time of the lecture, as well as the instructor's distance from the meeting location.  Each instructor will be required to present a credit card to the hotel for incidentals upon check-in.  The Foundation will not be financially responsible for any incidentals, unless prior permission has been granted.  If you choose to extend your hotel stay beyond what the Foundation will pay for, you will be required to pay for those accommodations separately.

    REIMBURSABLE EXPENSES:

    AIRFARE:  The Foundation will pay for air travel utilizing coach only from the airport closest to the instructor's home and office and the Baltimore-Washington International Airport (BWI) OR Reagan International Airport.  Cost to upgrade to a higher class must be paid by the instructor.  The cost to upgrade to a higher class must be paid by the instructor.  The instructor is responsible for making their flight arrangements at least 6 weeks before the start date of the meeting.  Reservations made less than four weeks in advance of the conference and/or more than $450.00 (roundtrip) must be approved by the Foundation.  Airline reservations made exceeding $450.00 without prior approval from the Foundation will only be reimbursed up to $450.00.  A baggage fee of up to $25 each way is allowed per instructor.  The Foundation will not pay for supplementary fees including “premium” seats with more legroom, early boarding opportunities, reserved seating (such as on Southwest), and other add-ons that the airlines have created since this policy was written.

    PERSONAL AUTO:  Mileage will be reimbursed at a rate of 58.5 cents per mile and tolls will be reimbursed at the fare noted on your receipt (EZ Pass is the preferred payment method for tolls).

    OTHER TRANSPORTATION:  Appropriate parking and shuttle expenses will be reimbursed with receipts.  It is expected that instructors flying to the meeting will use SuperShuttle (www.supershuttle.com) for transport between BWI Airport/Reagan Int’l and the Historic Inns of Annapolis, Governor Calvert House.  Rates are $72 round-trip from BWI for an ExecuCar Sedan Meet and Greet.  If you opt to use a taxi or rent a car instead of using SuperShuttle, you will be reimbursed for the transportation charge, up to the amount listed above for SuperShuttle. 

    MEALS:  You will be able to claim on your expense report a per diem for meals (breakfast, lunch, and dinner) that are NOT provided.  The per diem amount will fall within IRS guidelines for the meeting location and is currently $100/day.

    OTHER DETAILS: 

    •     The Foundation will provide complimentary registration for each instructor during the Conference.  This registration will cover the general lectures Friday-Sunday.

    •     The Foundation will not reimburse expenses of family members or guests accompanying the instructor.

    •     Original receipts and documentation must be submitted on a Foundation Expense Form within 30 days of Conference to receive reimbursement. 

    •     The Goldfarb Foundation agrees to reimburse instructors according to the above policies.  Checks will be issued within 30 days of receipt of the Expense Form.  The instructor will be notified if circumstances prevent the Foundation from meeting this deadline.

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  • UNRESTRICTED EDUCATIONAL GRANTS

  • If you did not previously complete and return these forms to the Foundation with your invitation to lecture at the meeting and you are aware of an unrestricted educational grant that may be available to the Foundation in support of our meeting, download the Unrestricted Educational Grant Application.  The forms must be submitted to the Foundation no later than September 1, 2022 in order for the grant application process to occur.

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  • SUBMIT

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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