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Welcome to the ADMSEP 2009 Presentation Application


Dear Colleagues:

ADMSEP was founded over thirty years ago to provide support for psychiatric faculty responsible for medical student education. Our members, including psychiatric educators from any year of medical student training, keep in touch throughout the year via our active listserv discussions and meet annually to exchange ideas in a supportive, collegial atmosphere. The Annual Meeting presentations take the form of plenary presentations, workshops, and posters.  This year’s meeting will be June 18-20, 2009 at the Sheraton Harborside (http://www.sheratonportsmouth.com/) in Portsmouth, NH.

You are invited to submit proposal abstracts on any topics relevant to medical student education in psychiatry. Based on current members’ interests, we would welcome proposals on leadership challenges in psychiatric education, technological tools to enhance teaching, guidance for new directors, dealing with difficult student situations, innovative teaching methodology, or overcoming learning barriers.  Proposals on other topics are also certainly encouraged--be creative.  Please note that, due to its popularity this year, we plan on having the ADMSEP poster competition again in 2009!

For the sake of clarity, a "plenary" is a group of three to four presentations that are in some way related.  If you choose to submit a plenary presentation, you will be giving a 12-15 minute formal presentation to the entire ADMSEP membership, on an area that will be of interest to the majority of the attendees.  "Workshops" are semi-structured learning sessions designed to facilitate interaction and collective learning. Unlike the lecture format, the interaction and discussion with the participants is expected to be lively. They are given to smaller audiences, 75 minutes in duration, with at least 30 minutes of prepared formal material. 

This year we have moved the application process online; you will find it and the directions below.  Please note that in we must have all relevant application components from all persons in your presentation by the deadline (October 3, 2008) in order to review the respective application in the October '08 Council meeting.  On receipt of your submission, you will see a confirmation page.   Please do not hesitate to call or email  if you have any questions. 

We are looking forward to your submissions.  On behalf of the Council and Membership, thank you, and hope to see you in Portsmouth in 2009!


Sincerely,

Greg Briscoe, MD
Program Chair
Dept of Psychiatry and Behavioral Sciences
Eastern Virginia Medical School
825 Fairfax Avenue
Norfolk, VA  23507
briscogw@evms.edu
757-880-7497

Directions:   This application page has 4 components:  Contact information, Abstract, Biosketch and Disclosure Statement; all are important for various reasons, including CME accreditation status.  All persons involved in a presentation must complete the contact information and disclosure.  However, where you lie in the authorship order determines what other components you must complete.  Thus, based on the table below, please complete those that apply to you:

What application components must I complete?
Plenary Workshop Poster
1st Author a, b, c, d a, b, c, d a, b, c, d
2nd, 3rd, 4th, etc. Authors b, c, d c, d c, d
Key:  a= abstract, b= biosketch, c=contact info, d= disclosure

All applications must be submitted electronically (mailed and faxed versions will be returned).  You may wish to anticipate allowing sufficient time to complete all parts of the application below, as one cannot save a draft for later revision.  You may take as long as you like (this form should not "time out"), however you cannot do part of the form, navigate away from this web site or log off your pc, and return later to complete the form.  Doing so will result in a blank form on return, and loss of information entered.  Unless otherwise noted, all fields below are required.  More specific details are discussed below.

If you have more than one presentation, please submit each separately (however, we only need one biosketch and disclosure on file per person, so you do not have to reenter this information more than once).   Questions?  

Contact information

Last Name Institution Name:  
First Name Title (MD, PhD, Ed.D. etc)  
Street Address Cell Phone or Pager (e.g.. 223-446-5000)
Address (cont.) Work Phone (e.g.. 223-446-5000)
City E-mail
State/Province    
Zip Code    

In this presentation, in the authorship order, I am ___ author


If you are not the first author, who is ? [last name]:


Title of presentation I am involved in on this application

Abstract

This is for first authors only (if this is not you, skip to next section).  Please note that submissions containing actual data, even if preliminary or anticipated, are preferred. 

What kind of presentation are you submitting?

Plenary Workshop Poster

This is the:   first time I have submitted this abstract    a revision

If you are first author, please list the other persons involved in this project:, in descending author order:
Last Name First Name Degree Institution Email Phone

Title:


Please provide your abstract body and educational objectives in the box below. 
-Be sure to view and use one of the required abstract format choices when composing your submission. 
-Word count ≤ 350 (includes Title, Authors, Body, Objectives). 
-You may wish to consider composing your abstract in a word processing program first, e.g. Microsoft Word, save it on your local pc (as a safeguard), copy it and paste it in the box below.  Additionally, MS Word provides spell check, grammar check, and word count, unlike direct entry below.  
-If you have additional submission materials that are not text based, e.g. a picture (.jpg), embedded graph ,or you have some critical formatting requirements, they will not be retained in the text-only box below.  If this is the case, please email these items separately (as attachments to the email).
-Note that the objectives should describe the abilities or attitudes (learning outcomes) that complete the sentence, “At the conclusion of this presentation, the participant should be able to (e.g., demonstrate, recognize, diagnose, treat, etc.).” Be as specific as possible. Don’t say what you are going to teach, say what you want participants to learn.


Additional information you think is relevant (optional):

If applicable, please list any anticipated AV needs below.  Please note that a laptop and LCD projector will be present for all plenary sessions.  However, due to cost prohibitions, ADMSEP cannot provide laptops for non-plenary presentations.

Need help?

Biosketch

See directions as to whether this applies to you or not.  Please provide a brief biosketch (abbreviated CV) below.  If you wish, you may write it in another program, e.g. MS Word, save it on your local pc (as a safeguard), copy and paste it below.  If your biosketch has non-text based material, e.g. embedded table, or you have some critical formatting requirements, they will not be retained in the text only box below.  If this is the case, please email these items separately (as attachments to the email).

Disclosure Statement
(all persons must complete)

DISCLOSURE AND CONFLICT-OF-INTEREST REVIEW

FOR SPEAKERS AND AUTHORS

The current regulations of the Accreditation Council for Continuing Medical Education (ACCME) require that, in addition to the usual disclosures, an assessment (and if necessary, resolution) of the potential for a conflict-of-interest is made in advance of a CME activity certified for Category 1 credit. If a conflict-of-interest is identified, resolution of the conflict-of- interest must also be made in advance of announcements and advertising for the CME activity. To fulfill these requirements, the CME-sponsoring institution requests that you complete and submit the following questionnaire as soon as possible to the Office of Clinical Affairs, Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064. The presentations of speakers and authors who decline to submit the requested information are not eligible for certification for Category 1 CME credit.               

USE OF GENERIC NAMES:   To avoid commercial bias, or any appearance of commercial bias, speakers and authors should use generic names for medications and other commercial products. When it is important to use a proprietary (trade) name, concurrent mention of the proprietary names of several equivalent products may help avoid the appearance of bias.

INVESTIGATIONAL PRODUCTS AND “OFF-LABEL” USES OF PRODUCTS:  If the speaker or author mentions the use of medications, devices or other products for purposes for which they have not been approved (“off-label”), or products approved only for investigational use, the speaker must clearly indicate that these uses of the product are not approved or are investigational.                                                                                                 

PLEASE ANSWER THE QUESTIONS BELOW

Note that reasonable honoraria, support for travel, lodging or meals, and positive responses to one or more of the other questions do not necessarily indicate a conflict-of-interest.

1.     I (will)   (will not)    be receiving an honorarium for this CME activity.
2.     I (will)   (will not)    be receiving support for travel and/or lodging and/or meals for this CME activity.
3.

No, I have not had within the past 12 months a financial or other significant relationship with a commercial organization that markets a product to which I will refer as speaker or author.  If you select this, then skip to question 4.

Yes, I* have had within the past 12 months a financial or other significant relationship with a commercial organization that markets a product to which I will refer as speaker or author. [Answer below and insert name of the manufacturer(s) of the product(s) to which you will refer]:
   
  (I am) (have been)  a recipient of monetary or other significant research support from:
(I am) (have been)  a paid consultant for:
(I am) (have been)  a
 (full) (part time)  employee of:
  (I am) (have been)  listed on a speakers’ list for:
  (I am) (have been) 
 (paid) (unpaid) a member of an advisory or similar board for:
  (I am) (have been a member of the Board of Trustees of:
  Other type of relationship [please describe and note if current or within the past 12 months]:

  The product to which I will refer will be identified:
 Only by its generic name
 By its proprietary (trade) name but with the concurrent mention of the proprietary names of similar products of other manufacturers
 By its proprietary (trade) name, without concurrent mention of similar competitor products
By its proprietary (trade) name [there are no similar competitor products]

  4.    

(I will) (will not)  be recommending over similar competitor products the use of a product of a manufacturer with which I have a significant financial or other relationship Iif answering in the affirmative, please check the appropriate boxes below]
  The recommendation will be based exclusively on the peer-reviewed results (which I (will present) (will not present) of an unbiased selection of studies not sponsored by the manufacturer of the product.
  true false:  The recommendation will be based on data and/or clinical experience not sponsored by the manufacturer of the product.
  true false:  The recommendation will be based on data and/or clinical experience, some of which was derived from manufacturer-sponsored studies.
  true false:  The recommendation will be based exclusively on data and/or clinical experience that were derived from manufacturer-sponsored studies.

  By checking this box I affirm that I have read the above information, understand it and have accurately responded as submitted. 

Title(s) of  my presentation(s):

 


Contact info

Same as above (if true, you may skip all questions below)  

 

Last Name   Middle Initial   
First Name  Email 
Date of the Activity Phone    

*Includes financial or other significant relationships of the speaker’s/author’s spouse.

CME or disclosure specific questions can be directed to Ms Elsa Kurien, Director for CME & GME Office of Clinical Affairs, Chicago Medical School at Rosalind Franklin University of Medicine and Science, www.rosalindfranklin.edu)

Optional:  Special note I wish to make at this time:

Important:  Please do not click "submit" until you have completed the application in full (see directions above for further information) and reviewed.  After clicking submit, you should see a web page entitled "Form Confirmation" which notes your responses.  Please note that all relevant components must completed by all persons in the presentation by the deadline (October 3, 2008).


11/06/08