FACULTY DISCLOSURE, GENERAL INFORMATION

It is the policy of the American Society of Neuroimaging to insure balance, independence, objectivity and scientific rigor in all its education programs. In compliance with Accreditation Council for Continuing Medical Education Standards it is required that any faculty (speaker) who makes a presentation at a program designated for AMA Physician's Recognition Award (PRA) Category I credit must disclose to the activity audience any financial interest or other relationships (i.e., grants, research support, consultant, speakers bureau, major stock holder, etc) that faculty member has with the manufacturer(s) of any commercial product(s), (drugs, devices, or services) and with any commercial supporters of the activity, whether or not these will be specifically discussed in the presentation.
 
The American Society of Neuroimaging does not imply that such financial interests or relationships are inherently improper or that such interests or relationships would prevent the faculty (speaker) from making a presentation. If a conflict of interest is determined to exist, it must be resolved prior to the CME activity. If speaker refuses to disclose relevant financial relationships, he/she will be disqualified form participating in the planning and implementation of this CME activity.
 
The speaker will make every effort to insure that data regarding the company's products (or competing products) are objectively selected and presented, with balanced discussion of prevailing information on the product(s) and/or alternative treatments.


In keeping with this policy, faculty are required to sign the following disclosure statement.

TERMS AND CONDITIONS

The faculty member understands and accepts the following rules as required by the American Society of Neuroimaging in conformance with the Essential Areas and policies of the ACCME and the rules of the American Medical Association:
 
A.  Disclosure. Faculty must complete and submit a Disclosure Statement prior to the presentation, and that Disclosure Statement shall be complete and truthful to the best of the presenter’s knowledge. Faculty are required to disclose any financial relationship they may have with the manufacturer of any product or class of products they discussed in an educational activity as well as with the commercial supporter(s) of this activity. As the commercial supporter is usually not known at the time faculty are invited, ASN recommends disclosing all financial relationships with any proprietary entity producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related companies.
 
B. Fair-Balance. Faculty are required to prepare fair-and-balanced presentations which are objective and scientifically rigorous. 
 
C. Use of Generic versus Trade Names. Presenters should use scientific or generic names in referring to products in their lectures. Should it be necessary to use a trade name, then the trade names of all similar products or those within a class should be used.
 
D. Commercial Supporter Influence. ASN defines “commercial supporter” as any commercial entity that supports the CME Activity with money or in-kind donations. Faculty are not permitted to receive any direct remuneration or gifts from the commercial supporter(s) of this CME activity, nor should they be subject to direct input from a commercial supporter regarding the content of their presentation. Inherent in any direct remuneration is the incentive to maintain or increase the value of the relationship. ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity.
 
E. Resolution of Personal Conflicts of Interest. Course Directors will review speaker materials for balance and commercial bias according to the ACCME policy on Content Validation. Directors have the right to request revisions based on this review and to disqualify speakers if deemed to have any commercial bias. Participants will be asked to evaluate presentations for objectivity and to identify any perceived bias. If a speaker’s presentation is perceived to be unbalanced and perceived to have commercial bias the following steps will be taken:
 
1. If perceived by the Moderator during the presentation, he or she will draw attention to the potential that the material is unbalanced.
2. Speaker will be a) required to submit all presentation materials for advance review at any and all subsequent presentations or b) blacklisted and not invited to speak in future.
 
F. Content Validation Statement. It is expected that all presentations will comply with the following content validation statement:
 
1.  All the recommendations involving clinical medicine in a CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.

All scientific research referred to, reported or used in a CME activity in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection and analysis. Presentations must not present activities that promote recommendations, treatment or manners of practicing medicine that are not within the definition of CME, or known to have the risks or dangers that outweigh the benefits, or known to be ineffective in the treatment of patients.

Full Name: *

1. List the names of commercial entities as defined in the above policy that you and/or your spouse/partner have, or have had, a financial relationship with in the past 12 months. Next, describe what you or your spouse received. ASN is not interested in the amount.  Lastly, describe the role you or your spouse had or have with the commercial interest.

Definitions:

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

The ACCME does not consider providers of clinical service directly to patients to be commercial interests.

http://www.accme.org/requirements/accreditation-requirements-cme-providers/policies-and-definitions/definition-commercial-interest

 

What was received: includes salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g. stock, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.

Roles: include employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities (please specify).

DISCLOSURE 1

Name of Commercial Interest:
What was Received?
For what Role?

DISCLOSURE 2

Name of Commercial Interest:
What was Received?
For what Role?

DISCLOSURE 3

Name of Commercial Interest:
What was Received?
For what Role?
Please list any additional disclosures:

Please answer the following questions regarding faculty compliance:

If I am presenting at a live event, I understand that an ASN will monitor will be attending the event to ensure that my presentation is educational, and not promotional, in nature. *

Clear Selection
I understand that ASN may need to review my presentation and/or content prior to the activity, and I will provide educational content and and resources in advance as requested. *

Clear Selection
I have not and will not accept any honoraria, additional payment or reimbursements beyond that which has been agreed upon directly with ASN. *

Clear Selection
Recommendations involving diagnosis and treatment discussed in my presentation are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindication in the care of patient and DOES NOT promote a specific propriety of business or commercial interest. *

Clear Selection
By clicking here you confirm that you have read and agree to the Terms and Conditions on this form and attest that the information you have provided above is correct. *

Clear Selection



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