Managing a Speaker's Relevant Financial Relationships

Conflict of Interest resolution

Disclosure of a relevant financial relationship requires that the conflict of interest be resolved prior to the start of the CME activitiy. The conflict must be managed by the Department Chair, CME Activity director or Faculty Designee in collaboration with the UUCME office. This form is to be used to document that evaluatation and resolution of conflicts of interest.

The reviewer must not have a conflict of interest. See the UUCME website for defintions of conflict of interest and relevant financial relationships, as needed. Contact UUCME with any questions (CME.Office@hsc.utah.edu or (801) 581-6886).

To complete this form, you must reference the Speaker's disclosed relevant financial relationships which should have been provided to you along with the link to this survey. You must also have communicated with the Speaker about the plan to manage their conflicts.

Question Title

* 1. About the activity

Name of Activity

Date

Question Title

* 2. Speaker's Name

Question Title

* 3. About you (the reviewer)

Name of reviewer

Title of reviewer

Date of review

Question Title

* 4. Did you review the Speaker's relevant financial relationships?

Yes (please continue)

No (please request the form, if needed, & review the conflicts before proceeding)

Question Title

* 5. Have you communicated and come to an agreement with the Speaker about the conflict(s) will be managed?

Yes, we have come to an agreement for how the Speaker will manage their conflicts of interest. (please continue)

No (please do this before completing this form)

Question Title

* 6. After discussion, the Speaker agrees to manage the resolution of their conflict of interest in the following ways:
Note: these may match the choices the Speaker may have suggested on their disclosure form.

Refrain from making recommendations regarding products or services, e.g., limit presentation to pathophysiology, diagnosis, and/or research findings.

Support presentation and clinical recommendations by referencing the "best available evidence" in the medical literature and by identifying the conclusions that the evidence supports.

Refrain from making any clinical care recommendations.

Use generic names to the extent possible. If she/he needs to use trade names, she/he will use trade names from several companies when available and not just trade names from any single company.

Promote quality or improvements in healthcare and will not promote a specific proprietary business interest of a
commercial interest. Present well-balanced, evidence-based, and unbiased content, including any therapeutic options.

Regulate what is said (Cannot say nor do this....).

Presentation will be peer reviewed using UUCME's Content Review Form to ensure no bias and that the content is valid. (Note: this option requires some additional steps/review. You will need to request content and complete your review of the content before continuing this surve.)

Other (please specify)

Question Title

* 1. About the activity

Question Title

* 2. Speaker's Name

Question Title

* 3. About you (the reviewer)

Question Title

* 4. Did you review the Speaker's relevant financial relationships?

Question Title

* 5. Have you communicated and come to an agreement with the Speaker about the conflict(s) will be managed?

Question Title

* 6. After discussion, the Speaker agrees to manage the resolution of their conflict of interest in the following ways:Note: these may match the choices the Speaker may have suggested on their disclosure form.

Question Title

* 7. I have given the following specific instructions to the Speaker:

* 6. After discussion, the Speaker agrees to manage the resolution of their conflict of interest in the following ways:
Note: these may match the choices the Speaker may have suggested on their disclosure form.