Abstract Submission Form

Abstract Deadline: Monday, November 15, 2021, 11:59 PM PT


Download Author Instructions

* - required field

Abstract
* Abstract Category:
Aesthetic
Breast
Craniofacial/Pediatrics
General Reconstruction
Head & Neck
Trunk & Extremity
Research
Community Plastic Surgery
Other
* Abstract Title:
* Author Block:
Individual(s)
Institution(s)
Sample author block:
Individual(s) Ethan Kung1, Allessandro Giardini2, T-Y Hsia2, Alison Marsden1, MOCHA Investigators2
Institution(s) 1UCSD, La Jolla, CA; 2Great Ormond Street Hospital for Children, London, United Kingdom
* Abstract Body
PLASTIC SURGERY RESIDENT COMPETITIONI am a plastic Surgery Resident in a California ACGME Accredited Plastic Surgery Residency Program and I wish this paper to be considered for the Resident Competition. Please note: Limit of one abstract per resident to be submitted for consideration in the Resident Competition.
Upload Charts & Tables:
Tables and charts are each worth 25 words and can be uploaded directly.
500 WORDS TOTAL FOR ALL 4 SECTIONS INCLUDING FIGURES AND TABLES
 
ACCME PRACTICE GAPS REQUIREMENTS:
* What professional practice gap does this abstract address?
(A practice gap is the difference between actual and ideal performance and may include the difference between actual and ideal patient outcomes.)


* How will this abstract influence change in competence, performance or patient outcomes?
500 WORD LIMIT FOR EACH QUESITON
 
Abstract Presenter
* First Name:
  Middle Initial:
* Last Name:
  Suffix:
* Degree:
* Institution:
* Address:
* City:
* State:
* Zip:
* Country:
* Phone:
  Fax:
* Email:
 
CME Activity Conflict of Interest Policy with Disclosure and Acceptance of Responsibility Form
Policy and Definitions

Cine-Med is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Learners participating in all formats of CME activities sponsored, co-sponsored, or jointly provided by the Cine-Med must be provided the opportunity to properly evaluate the objectivity of the information, analysis, and recommendations presented during an activity. It is important that the learners be informed of any aspect of personal or professional circumstance, originating with anyone in a position to control educational content, out of which a perception of a conflict of interest would arise.

An ineligible company is defined by the ACCME as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, with some exceptions, such as, eligible non-profit or government organizations, non-health care related companies, and providers of clinical service directly to patients. Circumstances calling for disclosure include, but are not limited to: receipt of financial support from an ineligible company, as defined above, for research activities or other scientific work reported on during the program, or, a personal financial or proprietary interest in, or consultant relationship to, a company that is a commercial supporter of the activity or whose product or service is discussed as part of the subject matter of the activity. Specifically, any financial relationship in any amount occurring in the last twenty four (24) months (even if the relationship has been divested), including those of a spouse/partner, must be disclosed.

A conflict of interest exists wherein an individual has or uses the opportunity to inject bias based on the held financial interest into the educational content or dissemination of related information. According to the ACCME, financial relationships create actual conflicts of interest in CME when individuals have both a financial relationship with an ineligible company and the opportunity to affect the content of CME about the products or services of that ineligible company, as defined above.

Based on the above, ALL CME-related persons involved with content, including committee members, activity chairs/co-chairs, reviewers, presenters, moderators, authors, editors, staff, and others as applicable, must:

  • Disclose any aspect of his/her personal or professional circumstances which might reasonably be related to the educational activity content or material being presented or disseminated OR indicate that they have nothing to disclose.
  • Confirm that any financial relationship/affiliation disclosed will in no way influence the content of material being presented or disseminated. For persons with oversight responsibility, recusal from the formulation process is required for any CME activity or activity segment which is directly related to the held financial relationship.
  • Confirm that the above submitted disclosure statement must, and will, be stated verbally from the podium prior to presentation and included in print on any audio/visual or handout material. Cine-Med will additionally publish the submitted disclosure information in related activity materials, in print and/or online, as applicable.

Presenters/Authors:

  • Confirm that the presentation/educational materials will contain absolutely NO recommendations or promotion regarding any products or services for which a financial relationship exists. ANY mention of a product or device within the verbal presentation, visuals or handout material MUST be technique/procedure oriented only; must be based on peer reviewed, best available evidence/independent unbiased scientific research, and will relate to content in a way that conforms to the standards of medical care published within generally accepted literature.
  • Confirm that no commercial support or honoraria will be accepted from outside sources for participation in CME activity content formulation, approval, individual presentation, publication, or attendance at a program.
  • Confirm that the guidelines outlined in the disclosure/Acceptance of Responsibility/ Form will be followed, including but not limited to presentation, handout and audio-visual content, verbal and written disclosures, identification and resolution of conflict of interest, and honoraria policies.
  • Acknowledge that if reasonable information is obtained by the accredited provider which results in doubt as to the validity of the confirmations above, that participation in the related activity formulation will be revoked; a replacement may be assigned and/or the material substituted, or other action taken, as appropriate.

Please provide information in table for the last 24 months and use actual corporate names. (Trade names or product group messages will not be published, therefore only component or generic names may be used, IF needed to clarify a financial relationship or affiliation.

NOTE: ACCME does NOT require disclosure of CME speaker/author honoraria if it is from an accredited provider.

* Royalty recipient, grant recipient, employee, intellectual property rights holder, independent contractor, board member, review panel member, patent holder, expert witness, speakers’ bureau member, etc. are examples of other terminology used to describe the nature of a financial relationship with an ineligible company.

 
Please complete a disclosure below for each of the authors listed
Author 1:
* Full Name
This author does not have any relevant financial relationships with an ineligible company that pertain to the content of his/her presentation
 
This author does have relevant financial relationships with an ineligible company s that pertain to the content of his/her presentation
Ineligible Company Nature of Relevant Financial Relationship
(Include all those that apply)
What I or spouse/partner received My role
Example: Company ‘X’ Honorarium Speaker
Please email California Plastic Surgeons Administration with your full disclosure statement if you have more than 10 disclosures to report.

What was received: 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. My Role(s): Employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities.
 
Author 2:
* Full Name
This author does not have any relevant financial relationships with an ineligible company that pertain to the content of his/her presentation
 
This author does have relevant financial relationships with an ineligible company s that pertain to the content of his/her presentation
Ineligible Company Nature of Relevant Financial Relationship
(Include all those that apply)
What I or spouse/partner received My role
Example: Company ‘X’ Honorarium Speaker
Please email California Plastic Surgeons Administration with your full disclosure statement if you have more than 10 disclosures to report.

What was received: 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. My Role(s): Employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities.
 
 

If you have disclosed a financial interest please review the following, which lists the mechanisms have been identified for resolving conflict of interest. If a real or apparent conflict of interest is disclosed above, please check all that apply:

* Have you disclosed a financial interest?
Yes    No

Actions to be taken for final resolution of conflict of interest (COI) will be approved or directed by the CME Planning Committee/Program Chairs, etc. responsible for oversight of the CME activity. Alternate suggestions for resolving specific conflicts of interest may be discussed with the appropriate persons responsible for planning the activity.

1 I will support my presentation, materials, and clinical recommendations with the "best available evidence" from medical/scientific literature.
Yes | No
2 I will submit my presentation and related materials in advance to allow for adequate committee/peer review and revise as necessary.
Yes | No
3 I will refrain from making recommendations regarding products or services, e.g., limit presentation to pathophysiology, diagnosis, and/or research findings.
Yes | No
4 I will recommend an alternative presenter for this topic for the planning committee's consideration.
Yes | No
5 I will recommend a change of focus of the activity, presentation, or materials.
Yes | No
6 I will or have divested myself of this financial relationship in:
(Info must still be disclosed for last 12 months)

Yes | No
7 Do you have any off-label/unapproved uses are included in my presentation(s)/material(s)?
Yes | No
If yes, please list the drug/device and its purpose:

Acceptance of Responsibility

  • I confirm that I have disclosed all circumstances relevant to the educational activity content or material being presented/disseminated OR indicated that I have nothing to disclose.

  • I confirm that any financial relationship/affiliation disclosed will in no way influence the content of material being presented or disseminated, and if my role is one of oversight responsibility, I will recuse myself from participation in content development for any CME activity or activity segment which is directly related to the held financial relationship.

  • I acknowledge that the above submitted disclosure information must, and will, be stated verbally from the podium prior to the activity/presentation and additionally published in related activity materials, in print and/or online, as required.

  • I confirm that the activity content over which I have responsibility to formulate, approve, plan, develop, present, or manage will contain ABSOLUTELY NO recommendations or promotion regarding any products or services for which a personal financial relationship exists. ANY mention of a product or device within the verbal presentation, visuals, handout, or published materials MUST be technique/procedure oriented only; must be based on peer reviewed, best available evidence/independent unbiased scientific research, and will relate to content in a way that conforms to the standards of medical care published within generally accepted literature. Content validation is a necessary process in CME.

  • I confirm that all educational materials submitted (slides, handouts, articles, etc.) will contain, and will be reviewed for, the proper disclosure statement(s) and references to the best available evidence.

  • I confirm that I will accept no commercial support in any form, or honorarium, from outside sources for participation in CME activity content formulation, approval, individual presentation, publication, or attendance at a program.

  • I confirm that I will work, as appropriate to my role of responsibility in this activity, to ensure that this activity is in compliance with all CME policies, standards and guidelines as outlined above, including but not limited to presentation, handout and audio-visual content, published materials, verbal and written disclosures, identification and resolution of conflict of interest, and honoraria policies; appropriate consequences of non-compliance may include, but are not limited to, participant censure and/or removal from the current and/or future CME activities.

  • I acknowledge that if reasonable information is obtained by the accredited provider which results in doubt as to the validity of the confirmations above, that participation in the related activity formulation will be revoked; a replacement may be assigned and/or the material substituted, or other action taken, as appropriate.

  • I agree to comply with the requirements to protect health information under the Health Insurance Portability & Accountability Act of 1996. (HIPAA)

  • Presenters/Authors: I represent that my presentation/material will contain no sexually suggestive content nor content which contains inappropriate references to race, color, religion, sex, or national origin, and I accept full responsibility for the presentation of appropriate and ethical material. I acknowledge that the organization coordinating this educational activity is not responsible for the content of my presentation/material and that it may curtail or terminate my presentation/material in the event it contains content which is determined to be in violation of the foregoing representation.

  • Presenters/Authors: I certify that all photographic material presented is done so with the appropriate medical/patient releases for photography, and subsequent use in presentations. Further, I certify that any material provided by me for this educational activity has been obtained with the proper permission for reprint/duplication (solely for use in the activity listed above) from the original publication copyright holder, and such reprint permission will be maintained in my files for a period of four (4) years.

  • I will provide presentation/handout/materials prior to the activity, as appropriate, for CME review (content validation, peer-review for resolution of conflict of interest, or other CME purposes).

  • I will inform learners when I discuss or reference unapproved or unlabeled uses of therapeutic agents or products.
  • All the recommendations involving clinical medicine in a CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindication in the care of patients. All scientific research referred to, reported or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis. Within my role(s) in this activity, I will ensure balance, independence, objectivity, and scientific rigor.

    I attest that I have read the above responsibilities and will comply; the information I submit is accurate.
    Required Signature (First and Last Name): *

     
    JOURNAL SUBMISSIONS
    I understand CSPS will submit my abstract to Annals of Plastic Surgery for publication in the California Society of Plastic Surgeons supplement.
    I intend to submit my manuscript to Annals of Plastic Surgery for publication in the California Society of Plastic Surgeons supplement. Manuscript submission deadline: July 1, 2022.

    For full information on Journal Submissions, please reference the Author Instructions.
     
    JOURNAL SUBMISSIONS
    I attest that I have read the above responsibilities and will comply; the information I submit is accurate.
    Required Signature (First and Last Name): *


     
     
    California Society of Plastic Surgeons
    500 Cummings Center, Suite 4400, Beverly, MA 01915
    Phone: 978-927-8330 | Fax: 978-524-0498