ON-SITE MONITOR REPORT FOR CONTINUING MEDICAL EDUCATION ACTIVITIES UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE (UMSOM) OFFICE OF FACULTY AFFAIRS AND PROFESSIONAL DEVELOPMENT Please read the accompanying On-Site Monitor Guidelines before completing this questionnaire. Name of Meeting: Date(s):
Time Frame:
Location: Course Length (Days, Half Days): Total Credit Hours: Activity Director (include UMSOM title and any other titles):
Speakers and/or moderators and their institutions:
Commercial Supporters:
Names of representatives present at the meeting:
List the affiliation(s) of the on-site registration staff:
Third Party/Joint Sponsor Meeting Planner:
List names of the Third Party/Joint Sponsor Coordinators present:
ATTACH COPIES OFANY EDUCATIONAL OR PROMOTIONAL LITERATURE THAT WAS DISTRIBUTED AT THE MEETING, INCLUDING SYLLABUS, PENS/PENCILS, NOTE PADS, ETC.
ON-SITE MONITOR REPORT FOR CONTINUING MEDICAL EDUCATION ACTIVITIES
ANNOUNCEMENTS ON EVALUATIONS •
Was there an announcement requesting (and encouraging) registrants to fill out the evaluation form? Yes
No
Comments:
GENERAL COMMENTS ON COURSE CONTENT/FACULTY AND POSSIBLE COMMERCIAL BIAS Yes No
1.
Were possible speaker conflicts of interest disclosed?
2.
How?
3.
Did you or anyone perceive a speaker’s talk/presentation (including print or audio visual material) to be potentially or actually biased? Yes No If yes, please cite speaker’s name and who suggested this possibility (i.e. registrant, peer faculty, coordinators, yourself as Monitor, etc.). This information is needed to allow consideration about the suitability of speakers (or educational material) to be used in future CME events.
COMMENTS ON 1.
Meetings Room(s):
2.
Presence or absence of commercial influence in the room. If present, please describe the nature of the influence. Absence
COMMERCIAL EXHIBITS, BREAKS, MEALS •
As indicated on the Reviewer’s Guidelines, please comment on the meal functions as they comply to the ACCME standards.
ON-SITE MONITOR REPORT FOR CONTINUING MEDICAL EDUCATION ACTIVITIES
REGISTRATION DESK/AREA 1.
Where was the registration desk located?
2.
Was the space educationally autonomous?
3.
Were the meeting implementation duties carried out by the appropriate coordinator personnel? Yes No
4.
Were there any inappropriate commercial associations or activity at the registration desk? Yes No If yes, please describe:
Yes No
AMBIANCE, AMENITIES, AND SOCIAL SERVICES •
Please describe any social events and associated activities. Note On-Site Monitor Guidelines and make comments or criticisms if needed.
OBJECTIVES 1.
In your judgment, were the stated objectives Educational Objectives met? Yes No
2.
Please score on a scale of 1-5 with 5 being the highest score. 5
3.
Additional comments on Objectives:
HOTEL READER BOARD •
How was the meeting reported on the hotel reader board?
PODIUM SIGN 1.
Was there a podium sign?
2.
What did the podium sign say?
Yes No
1
2
3
4
ON-SITE MONITOR REPORT FOR CONTINUING MEDICAL EDUCATION ACTIVITIES
SUMMARY AND OTHER OBSERVATIONS •
Please give your general impressions of the meeting. List any other comments, questions, or criticisms you think should be mentioned. Also give commendations if, and where, deserved. Please give your overall assessment of 1) the excellence of the course, and 2) the total effect (hindrance or help) of the commercial involvement of the course.
DISTRIBUTION OF MATERIALS •
What materials were distributed at the registration desk and/or in the meeting room to participants? Please be specific and identify the materials, including whatever is put inside the program booklet or folder.
POST-CONFERENCE MATERIALS •
Did you, as the On-Site Monitor, collect the evaluations, sign-in sheets, educational materials, etc., and return them directly to UMSOM Office of Faculty Affairs and Professional Development? Yes No If no, how were they handled?
Please accept our thanks for your kind assistance in monitoring this meeting. Some final requests: 1.
Would you be willing to do this type of review again?
2.
Please complete the following information. Reviewer Name: Title: Address: Phone:
3.
Yes No
Fax:
Mail this review along with all necessary attachments to the address listed below so that we can reimburse you for your efforts.
UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE OFFICE OF FACULTY AFFAIRS AND PROFESSIONAL DEVELOPMENT 655 W. BALTIMORE STREET BALTIMORE, MD 21201 TEL: (410) 706-3958 FAX: (410) 706-3103