Conflict of Interest Resolution Agreement

Continuing Medical Education

Conflict of Interest Resolution

A “conflict of interest” is designated to occur when an individual, who has a financial relationship with a commercial entity, has the opportunity to affect CME content that concerns the products or services of the commercial entity. CME providers must ensure that conflicts of interest are disclosed and resolved prior to offering a Category 1 activity.

 

‘ Conflict of Interest is not applicable: the content of my presentation is not related to products or services provided by commercial entities with which I have a significant financial relationship.

 

~~ OR ~~

 

‘ Conflict of Interest is applicable: I will place on the first page of any presentation materials (e.g.: slides, handouts, etc.) all significant financial relationships I have with commercial entities and ensure verbal disclosure of said relationships.

 

To resolve this conflict, I agree to: (select one or more of the following):

___  Cite the best available evidence and identify the level of evidence I reference as well as any conclusions such evidence supports in my presentation.

 

___  Provide a detailed outline of the content of my presentation for peer review. I agree to make changes if requested by the reviewers.

 

___ Other methods to resolve conflict (explain or attach supporting document).

 

 

 

___________________________                              ______________________________

Signature                                                                     Date

 

 

___________________________

Print/Type Name

 

To download a PDF version of this to print and sign go here:

EMSA Conflict of Resolution Agreement

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