SPEAKER FORM - Objectives / Presentation Requirements
Speaker Name *
Email Address *
Required entries with every submission*
In accordance with ACCME Planning Policies, please identify the following in relation to your presentation topic(s):
Best Practice - A best practice may be from a national guideline or consensus statement from a credible organization, from peer-reviewed medical literature where more than one source agree on the practice, or from the considered opinion of the expert-planner in the case when no published guideline exists. This becomes the end-goal for your presentation(s).
Current Practice - You can determine this based on interviews (formal or informal) with members of the target audience, a questionnaire, or a published article that reports on findings from learners. THE KEY IS TO GO BEYOND EXPERT PERCEPTION OF THE GAP AND TO INCLUDE THE PERCEPTION OF THE LEARNER.
Gap - This resulting gap is based on the difference between best practice and current practice. Indicate the type of gap (please check all that apply):
Learners lacked knowledge (K)
Learners lacked competence (C)
Learners couldn't implement in practice or performance (P)
Objectives - The GCEP Education Committee has provided you with basic objectives for the topic(s) that you will be presenting. As an expert in the field however, please expand upon the provided objectives by completing this form. Objectives should include a verb that is chosen to describe something a physician will do in practice (and not what the teacher will teach). For example, do not use verbs such as “discuss” or “describe, learn or understand.” Use words such as “apply, develop a strategy to…, etc.” Ensure that the objective clearly states a standard against which one can judge the success in achieving the objective. You must provide objectives for each talk.
Title of Presentation 1:
Upon completion of this lecture/workshop/panel, the participant should be able to:
Example: administer ABC procedure so that patients see a decrease in ABC symptom
1)
2)
3)
Question - Please submit a multiple-choice question to test attendees' knowledge or competency of each topic pre- and post- presentation(s). Your question should be straightforward; no trick questions please!
Question 1:
Answers - Please enter 1 answer per line
A:
B:
C:
D:
E:
Correct answer:
In an effort to focus our funding efforts, please assist us by listing companies that might find your topic(s) of interest and might want to support the meeting financially:
If you have more than 1 topic, please continue with objectives and questions for presentations 2 and 3.
Title of Presentation 2:
Question 2 :
Title of Presentation 3:
Question 3 :
AUDIO VISUAL REQUIREMENTS - I will need the following equipment for my presentation(s):
LCD Projector/Wireless Remote/Laser Pointer
One 35mm slide projector
Two 35mm slide projectors
Video Player - 1/2" tape
Video Player - 3/4" tape
Overhead Projector
Whiteboard and markers, colors:
Flip chart and markers, colors:
Other AV needed:
I require only voice amplification OR my presentation(s) will include sound beyond my oration.
I will be presenting via Microsoft Power Point and have NO integrated video in my presentation(s) (a laptop will be provided)
I will be presenting via Apple Keynote or other software (speaker must provide laptop to run onsite)
I have integrated video into my presentation file (speaker must provide laptop to run onsite)
FINAL PRESENTATION
IMPORTANT: As you are preparing your final presentation(s), in accordance with accreditation requirements, be sure to include a slide stating your financial disclosures, placed just after the title slide.
If you are using Microsoft Power Point and your presentation has NO integrated video, please mail us a copy of your final presentation(s) on CD ahead of the meeting. Allowing the AV technician to have the presentations pre-loaded on our laptop ensures fewer delays and the meeting running on time.
I will mail a CD of my final presentation(s) by MAY 20 to GCEP - 6134 Poplar Bluff Circle, Suite 101, Norcross, GA 30092
I will email my presentation(s) by MAY 20 to amber@theassociationcompany.com
HANDOUTS
It is highly encouraged that you supplement your presentation slides with supporting documents, articles, research results, etc. In lieu of passing out printed handouts during the meeting, we will be mailing CDs with PDFs of the presentations and any additionally provided handouts to all interested attendees after the meeting.
YES, I will provide handouts and understand that they will be given to attendees via CD. Please read the following disclaimer and "sign" your name to agree with the statements.
The undersigned Faculty (the “Undersigned”) agrees to:
1. Grant to GCEP a nonexclusive, irrevocable worldwide license to reproduce, make derivative works, publish, distribute, and/or sell the recording, transcript, and/or related materials of my presentation. This license does not prohibit the Undersigned from using this presentation in the future for his/her own professional or personal work.
2. Warrant and represent that, to the best of Undersigned’s knowledge, nothing in the presentation violates the personal rights of others (including, without limitation, any copyright or privacy rights), is factual and contains nothing libelous or otherwise unlawful.
3. Warrant and represent that the presentation is the Undersigned’s own original work, that Undersigned has the authority to enter into this agreement, and the Undersigned is the sole copyright holder or that has attained all necessary licenses from any persons or organizations whose material is included or used in the presentation.
4. Indemnify and hold harmless GCEP from any claims for damages, costs or expenses arising from claims of copyright infringement resulting from the publication, sale, dissemination or distribution of any materials submitted and/or presented by the undersigned, either orally or in writing. The undersigned further agrees to indemnify GCEP against any liability from any statements, oral or written, made by the Undersigned during or after this presentation.
Entering your name in the following space acts as my signature and agreement to the above statement:
Select one option below:
I will mail a CD of my handouts to GCEP - 6134 Poplar Bluff Circle, Suite 101, Norcross, GA 30092.
I will email my handouts to amber@theassociationcompany.com
Please acquire a copy of my final presentation from me at the meeting to use as my handout.
NO, I will not be providing handouts for the CD.
