Training Mitigation of Financial Relationships Form

(Verbatim per the ACCME) ... determine whether each person’s financial relationships with ineligible companies are relevant to the content of the education you are planning. Financial relationships are relevant if the following three conditions are met:

A financial relationship, in any amount, exists between the person in control of content and an ineligible company.
- It is relevant whether the person is speaking directly about the ineligible company’s products/services or not.
The content of the education is related to the products of an ineligible company with whom the person has a financial relationship.
- For example, a person is presenting on an oncology topic, and they have a relationship with a company that makes oncology medications. The ACCME determined that is sufficient to establish that the relationship is relevant.
The financial relationship existed during the past 24 months.

Determine which mechanism appropriately mitigates the specific financial conflict of interest and indicate how the mitigation was conducted.  If a financial conflict of interest cannot be mitigated, the person with the conflict cannot control content of the accredited continuing education or credit may not be awarded for the content presented by said individual.

Choose a mitigation strategy for each person who has a relevant financial relationship and implement that strategy before the person assumes their role.

1 Start 2 Complete

Name of individual with reported financial relationship *

Title of accredited continuing education activity *

Date of accredited continuing education activity *

Month

Day

Year

For this activity, does the individual serve as a planner, scientific committee member, course director, moderator, session chairperson, editor, or abstract rater? (Yes/No)

Yes

No

The following mechanisms were used to mitigate the financial relationship:

The relationship with the ineligible entity ended, thus mitigating the conflict of interest.

A peer review of the planning process was conducted by someone with no financial relationships.

The individual recused themselves from controlling aspects of planning and content with which there is a financial relationship.

Other...

The following mechanisms were used to mitigate the financial relationship: Other...

The control over planning was changed by:

Upon peer review of planning process, no further actions required

Another individual was selected to plan content where a conflict was present

For this activity, does the individual serve as a speaker, author, content creator, or poster presenter? (Yes/No)

Yes

No

The following mechanisms were used to mitigate the financial relationship:

Best available evidence is documented to support recommendations.

The relationship with the ineligible entity ended, thus mitigating the conflict of interest.

A peer review of the content was conducted by a person with no financial relationships.

Limit his/her content to data and information while other faculty members addressed the implications and make recommendations.

The content assigned was changed so the content no longer relates to the financial relationship disclosed.

The control over planning was changed by:

Upon peer review of content, no further actions required

Another individual was selected to provide the content

Focus of content was altered to resolve the financial conflict of interest

Limited the person's content to reporting scientific discovery with no practice recommendations

Rationale *

The ACCME asks that you please provide your rationale for your decision. Per the ACCME, please provide the rationale for your decision.

Signature *

I attest that I have conducted the resolution of financial conflict of interest process to ensure fair and balanced content in accredited continuing education. e-signature below.

Date *

Month

Day

Year

Leave this field blank