Thank you for coming to this page to complete the Instructor Information Form for the Foundation's 19th Annual Montana Meeting. This form consists of nine sections:
1. Instructor Information- Select your name, enter your email, and list your lecture topics if TBA appears for you on the lecture schedule
2. AV Needs- Let us know what materials/devices you'll use or need for your presentation
3. Lecture Objectives- List 3 descriptions of the intended outcome from someone having participated in your lecture
4. Protection of Patient Confidentiality- Review and select the check box
5. Commercial Support Standards to Ensure Independence- Review and select the check box
6. Instructor Disclosures- List any relevant financial disclosures which will be made in the meeting program and prior to your presentation
7. Copyright Agreement
8. Agreement to the Review of PowerPoint files
9 Electronic Signature
After you have completed each sections, those areas marked in red being required, click submit and the details will be sent to Lara at the Foundation. You will also receive a copy by email.
The selections made below for audiovisual apply to all lectures you will present at the meeting.
The Foundation’s PC is equipped with the 2016 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.
If you are presenting journal articles, those specific articles are being supplied to you by Dr. Hart. After reviewing the articles, please create your lecture objectives from the content of the article(s).
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:
Those with a second lecture are: Altmanshofer and Ritter
At the conclusion of this lecture, the attendee shall be able to:
Dr. Hart has a fourth lecture.
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.
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.
- 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.
- 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.
- 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.
- 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 Faculty Disclosure Form (following page).
- 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.
- '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.
If applicable, please check which type of disclosure(s) you need to make and then list the relevant names of the companies/organizations.
If your web browser auto-fills your name into the sections below, please remove it.
I acknowledge to the Goldfarb Foundation that the presentation(s) noted above, to be presented by me at the Goldfarb Foundation's Montana Meeting, are free from copyright infringements.
I acknowledge that I have:
- Not infringed on any copyrighted material
- Received permission to use any and all copyrighted material from the owner of the work
- Utilized my own copyrighted work.
I acknowledge that copyright materials within a presentation may include, but are not limited, to:
- Written works
- Drawings/cartoons/photographs
- Music
- Video/Film/TV
- Spoken word.
As noted above in the Commercial Supports Standard, I recognize that my presentation cannot be biased or cannot contain any advertising, trade name or a product-group message, and that specific lecture titles cannot contain a trade name. As such, I acknowledge that my PowerPoint file(s) will be reviewed by the Montana Meeting chairman prior to the start of the meeting. Should it be requested, I agree to make any necessary changes to the file(s) to be in complete compliance with the Goldfarb Foundation's requirements and CPME Standards 720 and 730.