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, [email protected]. Name * Email * A copy of your responses will be emailed to the email listed. Presentation Title * Live Stream Permission * Yes, I hereby grant the University of Wisconsin Interprofessional Continuing Education Partnership (ICEP) permission to live stream my presentation via the internet. No, I do not grant the University of Wisconsin Interprofessional Continuing Education Partnership (ICEP) permission to live stream via the internet my presentation. Special Instructions Copyright * Yes, I own all rights, title and interest in the material used in my presentation, including but not limited to intellectual property rights, or otherwise have permission to use the material in my presentation and grant any permissions granted above. No, Please check this box if your presentation contains material to which you do not hold the copyright and have not obtained permission to use. If you need assistance determining the steps needed to ensure you have secured the appropriate permissions and/or edited your presentation appropriately, contact your ICEP Accreditation Specialist. 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. Guidelines For Writing Learning Objectives v. 6-14-23.pdf Objective 1 * By participating in this activity, members of the healthcare team will be able to... Objective 2 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: Writing Assessment Questions Feedback 12-1-22.pdf MOC Question Answer Choices Correct Answer Indicate the correct answer here Feedback 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. Dietary Restrictions If you have any dietary restrictions, please list them here: Leave this field blank
