Residency Essentials Module Reviewer Agreement

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Thank you for agreeing to participate in the review and update of a module for the SIR Residency Course. 

Please complete the form in it's entirety. If you have any questions, please contact Charlotte Rendon at crendon@sirweb.org.  
Module Developer Agreement














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Financial Disclosure

Statement of Purpose
As an educational provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Society of Interventional Radiology must ensure balance, independence, objectivity and scientific rigor in its individually sponsored educational activities. The intent of this disclosure is not to prevent a developer with a financial or other relationship from participating in an educational activity; rather the intent is to provide planners and learners with information on which they can make their own judgments, and to help SIR manage any conflicts of interest that may arise. It remains for the audience to determine whether the participant’s interests or relationships may influence the course with regard to exposition or conclusion.


Financial Disclosure Requirement
The ACCME requires faculty disclosure of all relevant financial relationships with any commercial interest that create a conflict of interest occurring within the 12 months preceding the educational activity. Faculty must also report that no relevant financial relationship(s) exists, if applicable.


Definition of Financial Relationship
Financial relationships are those relationships in which the individual, or the individual’s spouse or partner, benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected.

Contracted research includes research funding where the institution gets the grant and manages the funds and the person is the principal or named investigator on the grant.


Definition of a Commercial Interest
The ACCME defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Exceptions within the context of this definition and limitation include providers of clinical services directly to patients (i.e., hospitals and group medical practices), government organizations, non-health care related companies, health insurance providers and 501c non-profit organizations.


Definition of Conflict of Interest

The ACCME considers financial relationships to create actual conflicts of interest in CME when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. The ACCME considers “content of CME about the products or services of that commercial interest” to include content about specific agents/devices, but not necessarily about the class of agents/devices, and not necessarily content about the whole disease class in which those agents/devises are used.


Resolving Conflicts of Interest
All financial disclosures will be reviewed by SIR to identify conflicts of interest. Anyone who discloses a financial relationship with a commercial interest will be contacted by the society to resolve the conflict.


Availability to Learners
Your disclosure information will be made available to all learners. If there is a change in relevant financial relationships between the time of your disclosure and the educational activity, it is your responsibility to provide this information to SIR.

Disclosure






If you answer "Yes," a box will appear for you to enter financial disclosure details. Please select the appropriate Relationship from the drop down menu and enter the corresponding Company Name in the box. If you have more than one relationship to disclose, please select the "Add another response" link as many times as needed.

Relationship & Company Name