The following information will guide you through the submission form step by step. You may print this information to use as you craft your submission.
Faculty Contact Information
Enter your personal contact information in the application form.
Co-Faculty
The form will allow you to indicate whether you are teaching independently, or if you are proposing to teach with co-faculty.
Live Meeting Activity
The proposal form allows you to indicate your availability with preferred date and time for your presentation. Submission on multiple topics is encouraged. Please refer to the 2021 draft agenda for the CME lecture days and times that are available.
Title
Provide a title for your proposal no more than 80 characters including spaces.
Description/Problem
Provide an overall description of the problem you are addressing.
Direct Bearing on Patient Care
Provide a description regarding how this education has a direct bearing on patient care, or how it supports the physician’s role in patient care, or how it has a direct bearing on a physician’s ability to deliver patient care.
Area of Patient Care
Identify one or more areas of focus (e.g. screening, treatment, etc.)
Practice Gaps and Learning Objectives
The proposal form will guide you through the process of identifying practice gaps that the learning objectives are intended to address. View Guidelines for Learning Objectives (2 page PDF).
Recommended Practice Changes
All LAFP faculty are expected to challenge learners to implement three recommended practice changes. Key takeaways for the session should be summarized on the Practice Recommendations slide of the PowerPoint 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. Select one or more appropriate core competencies:
- Interpersonal and communication skills
- Medical knowledge
- Patient Care
- Practice-based learning and improvement
- Professionalism
- Systems-based practice
Osteopathic Medicine Relevance
As appropriate, the LAFP 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 Formats
For most topics, the baseline expectation is that you can proficiently develop and teach a 45-minute didactic lecture with 15-minutes of Q&A. The proposal form will allow you to submit optional formats for consideration. Note: if you are proposing a Clinical Procedural Workshop (CPW), as indicated in the topic listing, the baseline expectation is that you can proficiently teach a hands-on workshop. Additionally, the LAFP is moving toward a flipped-classroom model for CPWs; please include your prior experience with teaching a flipped-classroom format in your description. Be prepared to briefly describe your plan to teach a hands-on procedural workshop and provide a list of needed equipment and/or materials.
Teaching Expertise
Describe your prior teaching experience related to the topic of this proposal, including dates, type of audience, size, and evaluation scores.
Honorarium and Expenses
Please indicate is you will require an honorarium and expenses for your presentation.
File Upload
You will be prompted to upload relevant files (i.e. bio, CV, professional photo).
Recording Acknowledgement
Acknowledgment that your presentation may be recorded.
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.
Please list, by corresponding number, any of the above uses for which you are NOT granting permission.
Authors
List authors of materials that may be provided during the presentation.
Certification of Completion of COI
The applicant must read the CME Policy and Procedures for Full Disclosure and Identification and Resolution of Conflicts of Interest and submit the CME Conflict of Interest Disclosure form. The applicant must completely and accurately disclose all financial relationships he/she has had in the 12 months prior to the form completion date and will have 12 months into the foreseeable future with a commercial interest. Should the status change during the course of the application process or the activity, the conflict of interest (COI) disclosure form should be updated as appropriate. COI forms must be completed or updated in order for submissions to be reviewed.
Having a financial relationship does not preclude an individual from presenting. If any financial relationship is determined to be a potential conflict of interest as it relates to the topic(s) submitted for the CME activity, the applicant will be notified, and a resolution will be discussed. For individuals with a conflict of interest, a resolution strategy must be in place prior to confirmation of the individual’s participation and all conflicts must be appropriately resolved prior to the activity being delivered to learners.
All conflicts of interest (as determined by the LAFP) or lack therefore, must be disclosed to learners, and LAFP staff will include that information in the PowerPoint presentation to be verbally noted by the presenter at the beginning of the session. Any individual who refuses to disclose a conflict of interest will be disqualified from presenting.
The LAFP complies with the Accreditation Council for Continuing Medical Education’s (ACCME’s) Standards for Commercial Support, the American Medical Association’s (AMA’s) Council on Ethical and Judicial Affairs (CEJA) ethics policies, and other laws, regulations, and codes that pertain to conflicts of interest. All faculty are required to read and comply with the LAFP’s CME COI policy. Noncompliance will result in honorarium penalties and one-year probation from a faculty appointment.
The LAFP Annual Assembly and Exhibition are CME activities with AAFP credit. All sessions must comply with AAFP and ACCME rules and; therefore, must be educational in nature. If you have a financial interest, such as a book or a mobile app, it is permissible to mention only if it is educational in nature and done so in a fair and balanced manner. Promotional messages of any kind are prohibited in CME.Additional Teaching Opportunities
Indicate your interest in being contacted by the LAFP regarding teaching opportunities that may arise outside of the context of this proposal.
All sections of the application must be completed prior to submission.
