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CAGP-CCSMH Speaker & Planning Committee Disclosure Form

  • 25 Oct 2019
  • 26 Oct 2019
  • Banff

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**Speakers please note: Your disclosure slide can be uploaded with your completed COI form. Have your completed slide ready before you begin to fill out this form.

PART 1: all speakers and planning committee members to complete

What to Disclose

It has become increasingly important to Continuing Medical Education/Continuing Professional Development (“CME/CPD”) planners and participants that there is full disclosure and if feasible, resolution of any competing interests with respect to information being presented at a CME/CPD event. Please list any affiliation (financial or otherwise) with a commercial or other interest that may have a direct or indirect connection to the content of a CME/CPD presentation. A potential conflict of interest is a situation where the personal and professional interests of individuals may have actual, potential, or apparent influence. In particular, for the 2 year period prior to a CME activity, we are asking all presenters and course planners to disclose conflicts using the online form by clicking the REGISTER button. A conflict of interest could include, but is not limited to, the following:

  • Any direct financial (or in kind) interests NOT only those relevant to the subject being discussed
  • Ownership interest in a company (i.e. stocks, stock options or other ownership interest, excluding diversified mutual funds)
  • Membership on the company’s advisory board or similar committee(s)
  • Involvement in research sponsored by the company
  • Participation in clinical studies sponsored by the company or using products produced by the company within the last two years
  • Involvement in the design of clinical studies concerning the use of products manufactured by the company
  • Honorarium, consulting fees, salary, royalty, grant-in-aid (“restricted” or “unrestricted”) or other monetary support received from or expected from the company; member of a speaker’s bureau or non-for-profit organization
  • Relationship with one or more other for-profit or not-for-profit organizations that fund this program
  • Investments in a pharmaceutical organization, medical device company, or communications firm, or not-for-profit organization
  • Ownership of a patent for a product referred to in the presentation or marketed by the company
  • Any other financial ties that should be declared

In some cases it can be difficult to determine whether a given relationship or activity may be in “conflict”; in these cases consultation with the CGS CPD committee may be helpful. In general, we recommend that it is prudent to err on the side of disclosing more than less. If there is a potential conflict, the CGS CPD committee should review and help develop mitigation strategies PRIOR to accreditation of the event.

How to Disclose

Each presenter should announce to the audience disclosure of the preceding information, if applicable, prior to any presentation with a slide. Speakers who have no involvement with commercial interests should also inform the audience that they are unable to identify any potential conflict of interest and have nothing to disclose.

PART 2: only speakers need complete

What to Disclose

It is the presenter’s responsibility to ensure that their presentation (including any recommendations made) is balanced, and reflects the current scientific literature. Presentations must give a balanced view of all relevant therapeutic options available and a fair assessment must be presented.

Unapproved use of products or services must be declared at the beginning of the presentation.

In addition, the Royal College and the CFPC require faculty presentations to be consistent in their use generic names during their presentation. When using trade names, it is preferable to use multiple trade names per product (if available) rather than referencing a single trade name.

How to Disclose

Each presenter should announce to the audience disclosure of discussion of off-label use, if applicable, prior to any presentation content with a slide.

False disclosure or failure to disclose conflict of interest as outlined in this document could require the planning committee to replace the presenter/speaker.


Effective June 1, 2012, the CFPC requires all presenters and members of planning committees to complete the Declaration of Conflict of Interest form.

All completed original forms must be retained by the party submitting the program for Mainpro accreditation (referred to herein as the “CPD provider” or “CPD organizer”) for a period of one year following accreditation expiry in the event that the program is audited by the College of Family Physicians of Canada.


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