ASGE Initial Educational Topic Proposal

*NOTE Proposals are reviewed by ASGE Education Curriculum & Competencies Council quarterly (e.g. April, July, October, December)

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* 1. Your Name and Contact Information:

First Name:

Last Name:

Email address:

Phone number:

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* 2. Please indicate if you are submitting as an individual ASGE member or on the behalf of an ASGE committee or SIG (select one category only).

As an individual ASGE member

On the behalf of an ASGE committee

On the behalf of an ASGE SIG

If on behalf of an ASGE Committee or SIG, please provide name of your Committee or SIG

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* 3. Provide Your Proposed Education Topic Title:

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* 4. What Calendar Year Are You Proposing This Session/Program Be Provided:

2021 (based upon current program availability and off-budget cycle approval)

2022

2023

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* 5. Proposed Type of Educational Activity (choose only one option):

ASGE DDW 60-minute session

ASGE DDW 90-minute session

ASGE Webinar 60-minute session

ASGE Webinar 90-minute session

ASGE 1-day Live Program @ IT&T

ASGE 1.5-day Live Program @ IT&T

ASGE STAR or “STAR-LIKE” Program

ASGE GI Leap (eLearning only) Program

ASGE Journal-Based Program

Other (please specify)

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* 6. Proposed Course Director(s) Name(s):

Last Name:

First Name:

Last Name:

First Name:

Last Name:

First Name:

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* 7. Proposed Activity Description (Required)
Please write a brief, 250 word maximum descriptive that provides some detail to your proposed idea. Please include the type of learner(s) who would best benefit from this proposed educational activity (e.g. GI First Year Fellow or Fourth Year Advanced GI Fellow or All GI Endoscopists or Early Career GI Endoscopists, etc…).

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* 8. Please List Any Potential Pharmaceutical, Medical Device or Other Company Who Might Be Interested in Supporting This Program (Optional):

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* 9. Please indicate if any in-kind device equipment needs are required for your program proposal?

Yes, In-Kind device equipment is anticipated (please describe or list your initial anticipated needs)

No, Not Applicable

If yes, Please describe or list your initial anticipated device needs:

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* 10. Which primary ASGE Domain would your proposed topic/session/program best align with (select only one):

Procedural skills: Proposal highlights how to maintain endoscopy skills and/or incorporates new procedural technologies.

Leadership & Diversity: Proposal demonstrates effective leadership and communication skills.

Quality: Proposal demonstrates effective leadership and communication skills.

Informatics: Proposal utilizes informatics that promote a safe and effective endoscopic unit operation.

Population Health: Proposal addresses and manages critical GI population health issues aligned with diagnostic & therapeutic endoscopy (e.g. Colon, Liver, Pancreatic cancers)

Standards of Care: Proposal employs evidence-based practice and current guideline recommendations.

Practice Management: Proposal promotes cost-efficient care yet optimizes patient safety in practice.

Patient Centered Care: Proposal promotes shared decision making through enhanced healthcare consumer communication that builds stronger value-based care choices and outcomes.

Education & Training: Proposal integrates best practices in quality of teaching and training that includes learner engagement, learner centeredness, adaptability and self-reflection.

Research: Proposal highlights endoscopy research or how to conduct research that advances the field.

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* 11. Date of Topic/Session Proposal Submission:

Please enter date:

Date