ࡱ> JLI bjbjAA G7++$n @@@dTD,4c!c!c!04242424242424$69FV4-@c!#!@c!c!c!V4_4###c!v8@04#c!04##1|(2#ҁy!v24404"29O"09$229@2 c!c!#c!c!c!c!c!V4V4#c!c!c!4c!c!c!c!9c!c!c!c!c!c!c!c!c! :  Circle type of activity CME Activity Title: _____________________________________________ Live Meeting Activity Date: ________________________________________________ Regularly Schedule Series Speaker: ____________________________________________________ Enduring Material Conflict of Interest Resolution This form is used when a potential Conflict of Interest (COI) exists. Identification of COI What material has been submitted by the presenter/faculty? (Check all that apply) Financial Disclosure Form C.V. Abstract or Outline Final Presentation Indicators of COI: (Check all that apply) Speaker/Planner indicated relevant financial relationships with commercial interest on Disclosure Form. Brand names used in materials Speakers materials do not provide a balanced discussion of treatment options/products/services Previous Evaluation Data identifies prior biased presentation Other (Explain below in Comments section) Risk Assessment None Identified COI(also complete parts II & III) Comments: ______________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Managing the Conflict What methods have been used to manage or resolve the conflict? (Check all that apply) Peer review of materials Changes to slides/handouts (i.e., remove commercial bias/branding) Documented validation of the recommendations (i.e., limit scope of presentation, narrow or omit specific material) Removal/Replacement of the speaker or faculty exhibiting COI Assign on-site monitor (provide name of monitor & identify any issues in part III) Final Outcome Risk Assessment: %None %Low %High Comments or additional explanation of issues, actions taken, and resolution ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Peer Reviewer/Onsite Monitor Attestation:  CME Documents.COI Review & Resolution Revised February 2016 / Approved for use 2016-17 Page 1 of 2 91Ƭ CME COI REVIEW & RESOLUTION FORM INSTRUCTIONS Clarifications, Suggestions and Answers Q: When do relationships create "conflicts of interest?" (SCS 2.1) A: The ACCME considers financial relationships to create actual conflicts of interest (COI) in CME when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. Q: Is failure to return or provide disclosure information on relevant financial relationships the same as a refusal to disclose? A: Yes. Refusal to disclosure is not limited to the explicit act of saying "no" to a provider's request for such information. Unresponsiveness that precludes the provider from implementing a mechanism to identify and resolve COI is equivalent to a refusal. Speaker materials must be received with enough time to identify and resolve potential conflicts of interest. Q: Can a provider choose to implement a mechanism to resolve conflicts of interest only for relationships they deem to have created "substantial" conflicts of interest? A: No. If there is any relevant financial relationship, there is a conflict of interest. A mechanism to resolve conflicts of interest must be implemented in all such cases. Final Outcome Risk Assessment: After your review, If you find the material to be free of commercial bias, circle no risk If you suggested modification to the presentation and know the speaker understands that he needs to present medical evidence, circle low risk If you find the presentation to be biased towards a company or product and/or you are fearful that the presenter might not made the suggested recommendations and will deliver a presentation to promote a company, then you should mark it high risk If you assign an on-site monitor due to the high risk nature of the presentation then provide the name of the assigned, un-biased on-site monitor. Include any comments indicating your findings and/or concerns. CME Documents.COI Review & Resolution Revised February 2016 / Approved for use 2016 -17 Page 2 of 2     I attest that I have no relevant financial relationships that would bias my review of this material. 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