LAMED Policy on Faculty Disclosure
 
Preamble:
 
The criteria of the Accreditation Council for Continuing Medical Education and the Ohio State Medical Association are used for faculty disclosure.
 
It is LAMED policy to insure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty participating in any LAMED sponsored activities are expected to disclose to the audience any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of the continuing medical education activity. This pertains to relations with pharmaceutical companies, biomedical device manufactures, or other corporations whose products or services are related to the subject matter of the presentation topic. This disclosure shall be required whether or not educational grants have been received from commercial supporters.
 
The faculty names, company, and nature of the relationship must be disclosed to the participants prior to the activity. This may be verbally or in writing.
 
If the faculty member does not return their signed disclosure form, this fact will be announced to the participants and the faculty will be asked to make their disclosure verbally to the participants prior to the beginning of the educational activity.
 
Steps in Progress
 
1.                    Obtain signed disclosure declaration from all faculty participating.
2.                   Disclose any relationship to the participants. If the faculty discloses no actual or potential conflict of interest, this must also be made known to participants. The disclosure will be made to participants using one of the following methods:
®     Written announcement on the CME Monthly Calendar
®     Written announcement on posted/mailed flyers or brochures
®     Written announcement by slide or overhead prior to the activity
®     Verbal announcement by physician/staff member who is introducing faculty
®     Verbal announcement by faculty prior to the activity
3.                   Document in the activity file how the disclosure was made, by whom, and when.
 
Attachment:  Faculty Disclosure Statement
 
 
Adapted by CME Committee: 4.18.2000
Reviewed by LAMED Board of Trustees: 5.20.2003
Reviewed & approved by Board of Trustees (email): 6.25.09
Approved by Board of Trustees (email): 9.11.09
 
 
 
 
 
 
 
 
 
 
 
 
Lima Area Medical Education Development, Inc.
Faculty Disclosure Declaration
 
As a provider accredited by the Ohio State Medical Association (OSMA), it is the policy of LAMED to insure balance, independence, objectivity, and scientific rigor in all its individually sponsored or jointly sponsored education activities. We are required to identify and resolve all potential conflicts of interest with any individual in a position to influence and/or control the content of CME activities. A potential conflict of interest is considered to exist if the individual and/or their spouse or partner has received financial benefit in any amount from a commercial interest involved in the activity within the past 12 months. A commercial interest is defined as any proprietary entity producing healthcare goods or services consumed by, or used on patients, with the exemption of non-profit, government organizations and non-health care related companies. All disclosure information will be reviewed to determine if a potential conflict of interest exists. Additional information may be requested to make this determination. In the event of any changes in the disclosure information should be given to LAMED immediately. 
 
All faculty participating in any LAMED sponsored activities are expected to disclose to the audience any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of the continuing medical education activity. This pertains to relationships with pharmaceutical companies, biomedical device manufactures, or other corporations whose products or services are related to the subject matter of the presentation topic. The intent of this policy is not to prevent a speaker with a potential conflict of interest from making a presentation. It is merely intended that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias in either the exposition or the conclusions presented. Failure to comply could result in disqualification from this CME activity.
Please complete blanks below and sign part A or complete and sign part B.
 
Date:                                                            
Title of Presentation:                                                                                                                                             
Presenter’s Name:                                                        Presenter’s Phone:                                                  
Presenter’s E-mail:                                                                                                                                                     
CME Activity Role:   Presenter  Planning Committee Member  Board Member   Other:                             
 
Neither I nor my spouse/domestic partner have at present and/or have had with in the last 12 months a relevant financial relationship with a commercial interest. There is not an actual or potential conflict of interest in relation to this activity/presentation. I will disclose off-label uses of any products mentioned.
 
 

                                                Signature                                                                       Date
 
I have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this activity/presentation. 
(Please complete backside of page for Resolution)
 
(check all that apply) 
Relevant Financial Relationship (check all that apply)
Commercial Interest/Company
(list name of company)
Relate to You as faculty
Relate to Spouse
Partner
Grant
Research
Support
Consultant
Stocks
Bonds (excluding mutual funds)
Speakers Bureau
Other (please list)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Please note you are responsible for communicating to LAMED any changes/additions in relevant financial status prior to the CME activity. Your cooperation in complying with this standard is appreciated. 
 
                                                                                                                               
                    Signature                                                                       Date
 
Please provide your Social Security Number or Tax I.D. for the 1099 Form                                                   

FULL DISCLOSURE STATEMENT FORM
RESOLUTION
 
To be completed only if a relevant financial relationship exists. Must complete if Part B was completed and signed.
 
LAMED has implemented a process where everyone who is in a position to control the content of an education activity has disclosed to us all financial relationships with any commercial interest. In addition, should it be determined that a conflict of interest exists as a result of a financial relationship you may have, this will need to be resolved prior to the activity. This information is necessary in order for us to be able to move to the next steps in planning this CME activity. If you refuse to disclose relevant financial relationships, you will be disqualified from being a part of the planning and implementation of this CME activity.  
 
If you have disclosed a relevant financial relationship pertaining to your involvement in this CME activity and believe that this relationship will not constitute a conflict of interest, please check one of the following reasons. If none of these reasons are applicable, this does not mean that you will be unable to participate in the CME activity. The CME office will contact you to further discuss your participation.
 
Commercial interestis defined as any proprietary entity producing health care goods or services consumed by, or used on patients, with the exemption of non-profit, government organizations and non-health care related companies.
 
Financial relationshipsare those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. Relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.
 
Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.
 
  The financial relationship does not relate my educational assignment/presentation.
 
  I will be using best available published evidence to support my presentation. Please list evidence/studies cited:
                                                                                                                                                                                   
 
     
  I am changing my relationship with the commercial interest.
 
Nature of change:                                                                                                                                  
 
  All scientific data referenced or used as justification of patient care recommendations confirms to the generally
      accepted standards of experimental design, data collection, and analysis. Please list data referenced:
 
                                                                                                                                                                                                                                                                                                                                                                       
 
  Other:                                                                                                                                                                   
 
  I am unsure how to resolve my potential conflict of interest. Please have someone from the CME office contact me.
 
We will contact you if further information is required.
Your cooperation in complying with this standard is appreciated.