1. UEMS Advisory Council on Continuing Medical Education Brussels, 1st December 2012

2. The New Application Form for the accreditation of Live Educational Events (LEEs)

3. Outline of the new application form Section I – Description of the Live Educational Event Section II – The programme Section III – Details of the provider Section IV – The Scientific and/or Organising Committee Section V – The Faculty Section VI – Funding of the LEE Section VII – Promotional material Section VIII – Review by learners Section IX – Contact and billing information

4. Section I: Description of the LEE Event title Event website Venue Start date End date Duration of the event Target audience Main specialty of the event Number of participants Educational needs Expected educational outcome(s) Clear description of the nature of the event Methods to promote active learning Confirmation of learner engagement Compliance with all relevant regulatory and legal requirements International audience Main language of the event Simultaneous translation

5. Item to be completed Event title (criterion iv, paragraph 14) Type of info Text Visible info Please note that the use of a sponsors name in the event title will lead to automatic rejection of your application. Invisible info Pop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload- Section I: Description of the LEE

6. Item to be completed Event website Type of infoText Visible info- Invisible info- Upload-

7. Section I: Description of the LEE Item to be completed Venue (criterion iv, paragraph 14) - City - Country - State/province (Italy and Germany only) Type of info Text for City Drop-down list for Country and State/province Visible infoMultiple venues for the same educational event require separate applications. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

8. Section I: Description of the LEE Item to be completed Start date (criterion iv, paragraph 14) Type of infoDrop-down list Visible infoOnly one date or set of dates is permitted for each event. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

9. Section I: Description of the LEE Item to be completed End date (criterion iv, paragraph 14) Type of infoDrop-down list Visible infoOnly one date or set of dates is permitted for each event. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

10. Section I: Description of the LEE Item to be completed Duration of the event (criterion vii, paragraph 17) Type of infoText Visible info Please provide detailed information on the duration of the event. This must be a minimum of one educational hour, with each hour of educational time expected to count as one ECMEC, up to a maximum of 3 ECMECs for a half day and 6 ECMECs for a full day. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload

11. Section I: Description of the LEE Item to be completed Target audience (criterion ii, paragraph 12) Type of infoText Visible infoSpecify the speciality and seniority of the doctor(s) most likely to benefit. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

12. Section I: Description of the LEE Item to be completed Main specialty of the event Type of infoDrop-down list Visible info- Invisible info- Upload-

13. Section I: Description of the LEE Item to be completed Number of participants (criterion xxi, paragraphs 32 & 51 ) Type of infoDrop-down list Visible info Grossly or significantly inaccurate attendance declarations will lead to automatic rejection of the application and/or any future applications. Invisible info The fee for an application to the EACCME® for the accreditation of LEEs is determined in accordance with the expected total attendance of Learners and is not dependent on the number of ECMECs awarded. As with any contractual agreement, all invoices must be paid. The EACCME® scale of fees is: From zero to 250 participants: 350 Euros From 251 to 500 participants: 650 Euros From 501 to 1000 participants: 950 Euros From 1001 to 2000 participants: 1250 Euros From 2001 to 5000 participants: 2450 Euros More than 5000 participants: 4250 Euros Upload-

14. Section I: Description of the LEE Item to be completed Educational needs (criterion i, paragraph 11) Type of info Text and/or upload document Visible info Please demonstrate that a needs assessment process has been completed, how that process was performed, and how relevant educational needs have been derived from that process. Invisible info Needs assessment: An evaluation of the learning needs of a group of individuals who are likely to be representative of the intended target audience. UploadYes

15. Section I: Description of the LEE Item to be completed Expected educational outcome(s) (criterion iii, paragraph 13) Type of infoText Visible info These must be explained in terms of the expected educational impact in knowledge, skills, attitudes or behaviours, or ethical lessons, and where in a doctors practice this will have an impact. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

16. Section I: Description of the LEE Item to be completed Clear description of the nature of the event (criterion iv, paragraph 14) Type of infoText Visible info Please indicate whether the event will involve lectures, discussions, workshops and/or other educational methods, single or multiple sessions, and whether these will be sequential or in parallel. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

17. Section I: Description of the LEE Item to be completed Methods to promote active learning (criterion vi, paragraph 16) Type of infoText Visible info Please state how this will be achieved (for e.g.: multimedia presentations; protected question and answer sessions; opportunities for audience participation; key-pad votes and discussion; etc). Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload

18. Section I: Description of the LEE Item to be completed Confirmation of learner engagement (criterion viii, paragraph 18) Type of info Text Visible info Please indicate the mechanism(s) by which it will be verified that the Learner has engaged with the LEE in order to fulfil the educational objective(s). Invisible info As a minimum this must involve a mechanism for confirmation of attendance at the LEE. The UEMS encourages the use of more sophisticated methods, such as smart cards confirming attendance at specific sessions, requiring the Learner(s) to complete questions based on the LEE material, requiring the Learner(s) to complete feedback forms, etc. Upload-

19. Section I: Description of the LEE Item to be completed Compliance with all relevant ethical, medico-legal, regulatory, industry-based and legal requirements (criterion ix, paragraph 19) Type of infoText Visible info This must be in accordance with the laws that apply for the country in which the LEE will take place. Invisible info For example, this should include: confirmation of confidentiality for patients and other participants, or consent to inclusion of non-identifiable details within LEE presentations, compliance with research ethics requirements, compliance with data-protection legislation, and copyright arrangements. It is essential to ensure that patients are not, and cannot be identified in any of the materials presented. Upload-

20. Section I: Description of the LEE Item to be completed International audience (criterion v, paragraph 15) Type of infoText Visible infoThe remit of the EACCME is only for LEEs that will attract an international audience. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

21. Section I: Description of the LEE Item to be completed Main language of the event Type of infoDrop-down list Visible infoThe primary language should be determined by the composition of the audience. Invisible info- Upload-

22. Section I: Description of the LEE Item to be completed Simultaneous translation Type of infoText Visible infoPlease describe facilities available for interpretation. Invisible info- Upload-

23. Section II – The Programme Upload the programme

24. Section II: The Programme Item to be completed Please upload the latest version of the programme (criterion xviii, paragraph 28) Type of infoUpload of a document or several documents Visible info For large events with parallel sessions, please upload an overview in addition to the detailed programme of the event Invisible info The information provided must include: - the required details of Faculty members - the titles of lectures, etc. that they will be delivering - start and end time of individual lectures, workshops and sessions - the expected learning outcomes. UploadYes, detailed programme, possibly overview

25. Section III Details of the provider Short description of the provider organisation(s) Lead person(s)/organisation(s) responsible for the preparation, planning and administration of the LEE Medical practitioner who will take responsibility for the application Upload of Directors Declaration

26. Section III: Details of the Provider Item to be completed Short description of the Provider organisation(s) (criterion x, paragraph 20) Type of infoText Visible info The Provider must submit a short description of their own organisation, and any other(s) with which they are working. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

27. Section III: Details of the Provider Item to be completed Lead person(s)/organisation(s) responsible for the preparation, planning and administration of the LEE First name: Last name: Organisation: Address: E-mail address: Tel.: (criterion xi, paragraph 21) Type of infoText + multiple boxes for provider to complete Visible infoExplain the duties/responsibilities of these people in terms of the preparation of the LEE. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

28. Section III: Details of the Provider Item to be completed Medical practitioner who will take responsibility for the application First name: Last name: Organisation: Address: E-mail address: Tel. Registration no.: Regulatory Authority: (criterion xii, paragraph 22) Type of infoText + click Visible info This doctor must be registered with a Medical Regulatory Authority, and his/her registration details must be provided. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

29. Section III: Details of the Provider Item to be completed Upload of Directors declaration by medical practitioner who will take responsibility for the application (criterion xii, paragraph 22) Type of infoDocument Visible info This declaration must be by the medical practitioner who will take responsibility for the application (see paragraph 22). Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 UploadYes

30. Section IV: The Scientific and/or Organising Committee Head of the Scientific and/or Organising Committee Members of the Scientific and/or Organising Committee Upload of written declaration of potential or actual conflicts of interest of the members of the S/O Committee Explain how any actual conflicts of interest involving members of the S/O Committee have been resolved

31. Section IV: The Scientific and/or Organising Committee Item to be completed Head of the Scientific and/or Organising Committee Professional title: First name: Last name: Organisation: Address: E-mail address: Tel.: (criterion xiii, paragraphs 23 & 24) Type of infoText Visible info- Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

32. Section IV: The Scientific and/or Organising Committee Item to be completed Upload of written declaration of potential or actual conflicts of interest of the head of the Scientific and/or Organising Committee (criterion xiv, paragraph 27) Type of infoText + click Visible info Please upload completed and signed form of COI of the head of the Scientific and/or Organising Committee using the EACCME COI template form Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 UploadUpload of COI form

33. Section IV: The Scientific and/or Organising Committee Item to be completed Members of the Scientific and/or Organising Committee First name: Last name: Organisation: Address: E-mail address: Tel.: (criterion xiii, paragraphs 23 & 24) Type of infoText (multiple boxes) Visible info- Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

34. Section IV: The Scientific and/or Organising Committee Item to be completed Upload of written declaration of potential or actual conflicts of interest of the members of the Scientific and/or Organising Committee (criterion xiv, paragraph 27) Type of infoDocument Visible info Please upload completed and signed form of COI of the head of the Scientific and/or Organising Committee using the EACCME COI template form Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 UploadUpload of COI form after each name entered

35. Section IV: The Scientific and/or Organising Committee Item to be completed Please explain how any actual conflicts of interest involving members of the Scientific and/or Organising Committee have been resolved (criterion xv, paragraph 25) Type of infoText Visible info- Invisible info Where there is an actual conflict of interest involving a member of the Scientific and/or Organising Committee, the EACCME® must be informed of how this has been resolved. The EACCME® considers it a responsibility of the head of the Scientific and/or Organising Committee to ensure that actual conflicts of interest are addressed. Upload-

36. Section V – The Faculty Potential or actual conflicts of interest

37. Section V: The Faculty Item to be completed Potential or actual conflicts of interest (criterion xvii, paragraph 27) Type of infoTick box Visible info Please confirm that all members of the Faculty provide written declarations of potential or actual conflicts of interest. These declarations must be made readily available, either in printed form, with the programme of the LEE, or in electronic form, on the website of the organiser of the LEE. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

38. Section VI – Funding of the LEE Source(s) of all funding Schedule of fees for learners Confirmation that all funding provided is free of any attempt to influence the programme

39. Section VI: Funding of the LEE Item to be completed Source(s) of all funding -Name of sponsor -Type of funding -Details of pending applications for funding (criterion xix, paragraph 30) Type of infoText Visible info Failure by a Provider to disclose the means of funding of a LEE will lead to rejection of its application. Please provide documentation confirming the basis of the funding for the LEE, whether this is by sponsorship, educational grant, or any other means. While all sources of funding must be declared, the actual amounts provided need not be. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

40. Section VI: Funding of the LEE Item to be completed Schedule of fees for learners (criterion xxi, paragraph 32) Type of infoText Visible infoPlease provide information on the registration fees paid by learners. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

41. Section VI: Funding of the LEE Item to be completed Please confirm that all funding provided is free of any attempt to influence the programme, individual sessions, subjects for discussion, content or choice of Faculty members (criterion xx, paragraph 31) Type of infoTick box Visible info- Invisible info The Scientific and/or Organising Committee must confirm that it has determined the content of all aspects of the LEE to be free of any attempt by sponsors to influence the Committees decisions. Upload-

42. Section VII Promotional material Confirmation that all the educational material is free of any form of advertising and bias The LEE complies with national rules, regulations and industry standards regarding exhibition areas

43. Section VII: Promotional material Item to be completed Please confirm that all the educational material is free of any form of advertising and any form of bias (criterion xxii, paragraphs 33 & 34) Type of infoTick box Visible info The EACCME® will reject any application that, in its opinion, includes advertising of any product or company directly related to any educational material. Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

44. Section VII: Promotional material Item to be completed Please confirm that your event complies with the applicable national rules, regulations and industry standards regarding exhibition areas where companies are permitted to present their products (criterion xxiii, paragraph 36) Type of infoTick box Visible info- Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 Upload-

45. Section VIII Review by learners Means for the learners to provide feedback Commitment to send the EACCME an event report

46. Section VIII: Review by learners Item to be completed Means for the Learners to provide feedback on the LEE (criterion xxiv, paragraph 37) Type of info- Visible infoPlease upload the participants evaluation from Invisible info You will need to provide a reliable and effective means for the Learners to provide feedback on the LEE, including the extent to which the educational objectives of the LEE were met. UploadYes, evaluation form

47. Section VIII: Review by learners Item to be completed I commit to making available to the EACCME a report on the learners feedback and on the providers responses to these (criterion xxiv, paragraph 37) Type of infoTick Visible info- Invisible infoPop-up/hot-link referring to paragraph in document UEMS 2012/30 UploadEvent report (after completion of the event)

48. Section IX Contact and billing information Contact person for the application Billing information

49. Section IX: Contact and billing information Item to be completed Contact person for this application Social title: Mr Ms Mrs Professional title: First name: Last name: Organisation: Address: E-mail address: Tel. (criterion xi, paragraph 21) Type of infoText + click Visible info Please note that the contact person is the person who will be in contact with the EACCME and who will receive all communications from EACCME. Invisible info- Upload-

50. Section IX: Contact and billing information Item to be completed Billing information Social title: Mr Ms Mrs Professional title: First name: Last name: Organisation: Address: E-mail address: Tel.: VAT no: (criterion xi, paragraph 21) Type of infoText + click Visible info Please note that the information entered in this field is the information that will appear on your invoice. Invisible info- Upload-

51. Applicants confirmation I confirm that I have submitted a fully completed application, in English (criterion xxv, paragraph 39) I confirm that suitable responses have been provided for each of the essential criteria (criterion xxv, paragraph 39) I confirm that all relevant attachments have been provided (criterion xxv, paragraph 39) I confirm that I have submitted my application no less than fourteen weeks from the planned start date of the LEE (criterion xxv, paragraph 39) I confirm that I will not attempt to influence the decision of the EACCME (criterion xxvi, paragraph 40)

52. Applicants confirmation I confirm that I have read and that I accept the UEMS-EACCME Terms and Conditions (pop-up with Terms & Conditions) I confirm that I have read and that I accept the UEMS-EACCME Confidentiality Clause and Terms (pop-up Confidentiality Clause) I am aware that my application will only be processed upon receipt by EACCME of the payment of the invoice related to this application. The full payment must reach the EACCME no less than fourteen weeks from the planned start date of the LEE (criterion xxv, paragraph 39)

53. UEMS Advisory Council on Continuing Medical Education Brussels, 1st December 2012