1 Start 2 Complete

The following form is for faculty presenters at the 2024 Pediatric Critical Care Regional Meeting. 

Please carefully review and complete this form.

You may save your progress and return to the form at a later time using the "Save Draft" button at the bottom of the page. If you have any questions please contact, help@icep.wisc.edu


All faculty are required to submit 1-2 learning objectives for their presentation. 

Learning objectives must be measurable. 

  • Please see the document below for guidance on creating measurable objectives. 
  • This is what you want the learner to achieve, not what you as a speaker hope to achieve in your presentation. 

PDF icon Guidelines For Writing Learning Objectives v. 6-14-23.pdf

By participating in this activity, members of the healthcare team will be able to...
By participating in this activity, members of the healthcare team will be able to...

Faculty are required to submit 1 assessment question for your session. 

Use multiple-choice questions only.  

  • No other formats are allowed--no true/false, no open-ended answers, etc.
  • Provide four or five answer choices.
  • Only the single best correct answer may be selected. Do not require the learner to select multiple answers.  
  • “All of the above” or “None of the above” responses are not permitted.
  • Ideally, questions will include a clinical vignette to move beyond testing for knowledge.

Feedback must be provided.  

  • In 2-3 sentences, use evidence or data presented in your talk to explain why the correct answer is correct without telling learners explicitly what the answer is.  
  • References can be included in the feedback as well as mention of the slides that covered the material. 

Additional guidance and examples can be found here: PDF icon Writing Assessment Questions Feedback 12-1-22.pdf

Indicate the correct answer here

As part of your participation as faculty for this conference, you will receive a free registration for the conference. Please respond to the following questions regarding your registration. You will receive registration notification once you have completed this form and your financial disclosure.

If you have any dietary restrictions, please list them here: