LAFP Logo74th Annual Assembly & Exhibition
July 22 - 25, 2021  |  The Roosevelt Hotel – New Orleans, LA

Faculty CME Proposal Application

Please review all information before submitting your proposal.  This information will be used in our records for communication and reimbursement purposes.  If you have any questions, please contact the LAFP at 225.923.3313 for more information.
FACULTY CONTACT INFORMATION:
NOTEThe Academy is required by the Federal Government to issue Form #1099-MISC to each speaker that receives money from the Academy.  This is related to honoraria only.  Please make sure you have given us your Social Security Number.  No additional amounts connected with the preparation of manuscripts or illustrative materials, including duplications, slides, etc., used in the speaker’s presentation will be paid.
PRESENTATION INFORMATION:















Description/Problem
 
Direct Bearing on Patient Care
 
Area of Patient Care
 






Learning Objectives:

Describe the behavior in measurable terms that you, a faculty member, would expect to observe of the learner upon engaging with this session. This is not a list of how you plan to teach (i.e. “explain”, “describe”, “discuss”), but rather what you expect learners to be able to do when they return to practice. (e.g. Screen for eye conditions commonly associated with type 2 diabetes.)  See Guidelines for Writing Learning Objectives.

Recommended Practice Changes
Succinctly describe up to three recommended practice changes that you will challenge learners to implement as you summarize the key takeaways in the final slide of your presentation.
ACGME Core Competency
According to the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education, the core competencies are knowledge, abilities, or the expertise that contribute to a physician’s overall ability to function at the highest level possible in order to meet the needs of his patients and the expectations of the medical profession.






Osteopathic Medicine Relevance
As appropriate, the AAFP is interested in incorporating osteopathic medicine principles into education developed for both MDs and DOs. These principles emphasize the interrelated unity of all systems in the body, each working with the other to heal in times of illness.


Presentation Format Description: (Please check one)
The baseline expectation is that you are able to effectively develop and deliver a didactic lecture. *Note: if you are submitting for a Clinical Procedural Workshop (CPW), the baseline expectation is that you teach a hands-on workshop. In addition to interactive lecture submission, the following educational formats are commonly used during LAFP CME meetings. You may select one or more of these additional formats. If your proposal is accepted, you will be notified as to acceptance of additional format proposal(s).


Honorarium/Expenses
Please indicate the following:
 
File Upload
Please upload the following files below:
Recording Acknowledgement
By singing this Faculty Agreement, I am consenting to this Affidavit and Audio/Videotaping Release.   I affirm this proposal conforms to all of the LAFP’s submission instructions outlined.  I understand that a presentation is a requirement of all LAFP Assembly CME programs. I agree to provide this presentation at least six weeks before the meeting. I understand that my failure to provide the presentation by the deadline could result in the cancellation of my presentation and could adversely affect the acceptance of future proposals.  NOTE: Some programs are not audio/videotaped.
Content Permission
In connection with my presentation at the LAFP CME Activity, I will prepare certain materials for distribution to program attendees. I give LAFP and its designee’s permission to use these materials as follows: Inclusion in compilations offered on electronic media, such as Online CME, CD-ROM or DVD. Inclusion as a part of LAFP program materials made available through the Internet and other online networks. Inclusion in reprints, anthologies and other LAFP publications.
Authors
My submission of this Faculty Agreement does not transfer my ownership rights in any materials and does not prohibit me from using my materials in any way I desire. This permission shall not expire and will not be affected even if I sell my copyright material.
 
I confirm that I am the sole author of the materials to be provided (except as noted below) and that LAFP’s use of these materials as described above will not infringe on the copyright of any other person or entity.
 
I further understand all speakers in this program must sign disclosure declarations and abide by the non-promotional guidelines set forth by the LAFP and the ACCME.
Certification of Completion of COI
 


Additional Teaching Opportunities
 



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