Educational Proposal (RFP) Worksheet

Thank you for your interest in developing a proposal for the 2024 ASHP Midyear Clinical Meeting in New Orleans, Louisiana, December 8–12, 2024.

Your proposal must be submitted no later than Wednesday, February 1, 2024, 11:59 p.m. PT. Review the Guidelines for a Strong Educational Proposal to see how the Educational Programming Committee will evaluate each proposal. To create a dynamic proposal, please consider “How to Avoid Education Session Pitfalls.” NOTE: If your proposal is accepted for presentation, you must be a current full active member of ASHP (non-pharmacists excluded) through the time of the presentation at the meeting. ASHP will not consider submissions by a third-party representative acting on behalf of another. Use this form to plan your session. To submit your proposal, all information on this form must be entered online at www.ashp.org/Meetings-and-Conferences/Get-Involved-in-a-Meeting/Midyear-Clinical-Meeting-and-Exhibition

Only proposals submitted online via the website will be considered for presentation.

Submitter Account Profile

Please fill out the information completely as you would like it to appear in print – no nicknames or abbreviations. Fields with an asterisk (*) are required.

Profile And Business Address

You must provide the address of your primary position/employer. ASHP will not send you anything in the mail to your business address. The information will be used in meeting publications only.

First:*	Middle:	Last:*
Prefix/Salutation* (e.g., Mr. Ms. Dr. etc.):	Suffix (e.g., Jr., Sr.):
Position/Title*
Employer/Organization:*
Degrees/Credentials:*	Not applicable
Address Line 1* (Company/Organization):
Address Line 2 (Street Address):
Address Line 3 (Apt, Suite, Bldg (optional):
City:*	State/Province:*
Zip/Postal Code:*	Country:*

Contact Details

Consider providing your personal email address to ensure receipt of communications from ASHP. Many health systems use firewalls which may block these communications.

Email:*	Daytime Phone:*
Cell Phone:*	Fax:

Alternate Contact (optional)

If provided, your administrative assistant will be copied on all communications.

Full Name:	Telephone:	Email:	N/A

Create a New Proposal

Proposal Title*

A proposal must have a short, specific presentation title (containing no abbreviations) that indicates the nature of the presentation.

Submission Type* (Select ONE)

Task 1: Proposal

Submission Topic* (Select ONE)

Select one topic area that best describes your proposal. This helps to match your proposal to the appropriate reviewer.

Choose an item.

Level designation not applicable to this session Educational Level of Content* (Select ONE)

Basic knowledge of the specific content area is suggested but extensive experience is not necessary.

General working knowledge of the specific content is suggested; information will be provided to expand current expertise.

Activity Category* (Select ONE)

Designed primarily for participants to acquire factual knowledge.

Designed primarily for participants to apply the information learned in the allotted timeframe.

Target Audience* (Select ALL that apply)

Pharmacist

New Practitioner Pharmacist

Student Pharmacist

Pharmacy Technician

Nurse

Nurse Practitioner

Physician

Physician Assistant

Other (please specify):

Interprofessional Team Education

Interprofessional education (IPE) is education planned by the team, delivered by the team, for the team. Is your planned educational session planned for an interprofessional audience (e.g., physicians or nurses)? If so, please describe the benefit (outcomes) of your educational session to the interdisciplinary team.

What is the current practice? (Maximum 60 words)

What is the ideal practice? (Maximum 60 words)

Describe the practice gap(s) that this session will address below.

A practice gap is the difference between actual/current and ideal/desired performance and patient outcomes. What is the problem or gap that you intend to fix through this educational session? The need for this session is validated because there is a practice gap that must be closed in order to attain desired or ideal practice.

Description and Overall Purpose (Maximum 400 words)

Brief description, justification, and overall purpose of this educational session that will entice your audience to attend and set realistic expectations of the content:

What supplemental educational materials (such as outlines, forms, background materials, bibliographies, etc.) will you provide to be distributed to attendees in addition to copies of your slides? (Maximum 200 words)

A good educational session provides the learner with more than just copies of slides. To make your session more valuable to the attendees, what supplemental educational materials (such as practice examples, outlines, forms, background materials, bibliographies, etc.) will you provide to be distributed to attendees (electronically) in addition to your slides.

Briefly describe what attendees will be doing in your session. (Maximum 200 words)

Preference will be given to proposals where the attendees are actively engaged beyond lecture with polling questions. Case-based and scenario-based formats are preferred. The more interactive and engaging a session, the more likely a proposal may be accepted.

Briefly describe how you are going to 'wow' your audience: (Maximum 100 words)

Task 2: Acknowledgment

By submitting your proposal, and in the event your proposal is accepted for presentation, you understand and agree that your presentation will be made by you in person and onsite at the meeting. In the event the meeting is held on solely a virtual basis, your presentation will be provided virtually. In the event the meeting is held on a hybrid basis (both in-person and virtual), then you understand and agree that your presentation will be made by you in person and onsite at the meeting for the live audience as well as via video for a virtual audience.

I Agree

Task 3: Health & Safety

In keeping with ASHP’s duty of care and responsibility as meeting host, ASHP strongly encourages all participants at ASHP events whether a presenter, attendee, exhibitor, staff, guest, or vendor to be fully vaccinated.

I have read and understand the above statement

Task 4: Needs Assessment Documentation

* Needs Assessment Documentation: (Select at least two from the list below)

Expert Opinion	National Guidelines
Government / Regulatory Requirement	New Technology/Methods
Peer-Reviewed Literature (List 2 citations)	Needs Assessment Survey (ASHP or Other)
Board/Recertification Requirements	Other

Identify the name of expert, guideline, research, etc. for your needs assessment choices from above (Maximum 60 words)

What does the expert, guideline, research or other says that supports the need. (Maximum 25 words)

Task 5: Learning Objectives

Provide learning objectives that are clear, measurable, and achievable.

You must have at least three learning objectives with corresponding active learning strategies and learning assessments.

See Example: for Application-based Session

Learning Objective: Given a description of a specific patient, develop a medication regimen that reflect application of the best evidence and current guidelines.

Learning Assessment: Solution to the case study with evidence-based references and current guidelines being applied.

Active Learning Strategy: Interactive case study describing a patient with a specific condition and how to develop a medication regime based on symptoms and lab test results.

Please Note: ACPE requires active learning and learning assessment for each session objective. Only proposals with these elements will be considered by the programming committee.

The Session Development Guide will give you information on writing learning objectives, creating instructional strategies, and developing mechanisms to assess learning according to activity type.

For more information on active learning, Click Here.

*Learning Objective 1

Learning Objective

Learning Assessment & Feedback

Active Learning

Select one strategy that will help assess the learning.

Choose an item.

*Learning Objective 2

Learning Objective

Learning Assessment & Feedback

Active Learning

Select one strategy that will help assess the learning.

Choose an item.

*Learning Objective 3

Learning Objective

Learning Assessment & Feedback

Active Learning

Select one strategy that will help assess the learning.

Choose an item.

Learning Objective 4

Learning Objective

Learning Assessment & Feedback

Active Learning

Select one strategy that will help assess the learning.

Choose an item.

Learning Objective 5

Learning Objective

Learning Assessment & Feedback

Active Learning

Select one strategy that will help assess the learning.

Choose an item.

Task 6: Additional Required Information

As a pharmacist or pharmacy technician, I agree to have an active ASHP membership if my proposal is accepted and continue my membership through delivery of the program at the meeting.*

If you are not a pharmacist or pharmacy technician and requesting an exception, please specify:

Submitter Planning Experience* (Maximum 400 words)

Previous experience in planning educational programs is required.

Submitter Expertise and Qualification* (Maximum 400 words)

Describe your expertise and qualifications in the topics(s) you are proposing; submitters generally are subject matter experts in the topic.

Will you be a presenter?*

If this proposal is accepted, I agree to NOT present it at any other meeting until after the Midyear Clinical Meeting.*

I Agree

Submitter’s Attestation*

I attest that I have submitted this proposal on my own behalf and not as a third-party representative acting on behalf of another. If this educational program is accepted, I agree to serve as the program chair.

I Agree

Task 7: Length of Session

ACPE credit is given in 15-minute increments only. Shorter sessions are preferred by meeting attendees. ACPE no longer allows partial attendance, to claim CE an attendee must stay for the entire duration; thus, shorter sessions are desirable.

If you selected Application-Based, your session must be at least 30 minutes.

Length of Entire Session*

If you selected Other Lengths to the above question, detailed description of interactive session required to justify length beyond 1 hour 30 minutes. (maximum 100 words)

Task 8: Session Outline

Prepare a proposed outline of your educational session, include a description and proposed speaker for each topic, and include the time allocated to each topic. It is understood that the speakers you list are those you will pursue upon acceptance of this proposal. Do not confirm your speakers at this time.

Online you will need to follow the instructions to create a table with 4 columns and a minimum of 5 rows to enter your session outline.

Click Here to view an example session outline.

Topic	Description	Proposed Speaker	Time Allotted
Welcome	Rationale for session/announcements	PC/Moderator	5 minutes

Task 9: Proposed Faculty

Add the list of faculty members for your proposal. Please add yourself as the first faculty member.

Proposed Faculty Member 1 (Submitter)

Name:	Degree(s) and/or Credentials(s):
Position title:	Employer:
Role(s): Faculty Member Moderator Facilitator Panelist
Mailing Address: (Include organization if using business address) Street:
City:	State:
Zip:	Country:
Daytime Phone:	Email:
Expertise/qualification in the topic(s) you are proposing (Maximum 400 words).

Proposed Faculty Member 2

Name:	Degree(s) and/or Credentials(s):
Position title:	Employer:
Role(s): Faculty Member Moderator Facilitator Panelist
Mailing Address: (Include organization if using business address) Street:
City:	State:
Zip:	Country:
Daytime Phone:	Email:
Expertise/qualification in the topic(s) you are proposing (Maximum 400 words).

Proposed Faculty Member 3

Name:	Degree(s) and/or Credentials(s):
Position title:	Employer:
Role(s): Faculty Member Moderator Facilitator Panelist
Mailing Address: (Include organization if using business address) Street:
City:	State:
Zip:	Country:
Daytime Phone:	Email:
Expertise/qualification in the topic(s) you are proposing (Maximum 400 words).

Proposed Faculty Member 4

Name:	Degree(s) and/or Credentials(s):
Position title:	Employer:
Role(s): Faculty Member Moderator Facilitator Panelist
Mailing Address: (Include organization if using business address) Street:
City:	State:
Zip:	Country:
Daytime Phone:	Email:
Expertise/qualification in the topic(s) you are proposing (Maximum 400 words).

Proposed Faculty Member 5

Name:	Degree(s) and/or Credentials(s):
Position title:	Employer:
Role(s): Faculty Member Moderator Facilitator Panelist
Mailing Address: (Include organization if using business address) Street:
City:	State:
Zip:	Country:
Daytime Phone:	Email:
Expertise/qualification in the topic(s) you are proposing (Maximum 400 words).

Proposed Faculty Member 6

Name:	Degree(s) and/or Credentials(s):
Position title:	Employer:
Role(s): Faculty Member Moderator Facilitator Panelist
Mailing Address: (Include organization if using business address) Street:
City:	State:
Zip:	Country:
Daytime Phone:	Email:
Expertise/qualification in the topic(s) you are proposing (Maximum 400 words).

Proposed Faculty Member 7

Name:	Degree(s) and/or Credentials(s):
Position title:	Employer:
Role(s): Faculty Member Moderator Facilitator Panelist
Mailing Address: (Include organization if using business address) Street:
City:	State:
Zip:	Country:
Daytime Phone:	Email:
Expertise/qualification in the topic(s) you are proposing (Maximum 400 words).

Task 10: Financial Relationship Disclosures

Disclosure and Attestation Policy

To comply with the Standards for Integrity and Independence (SII), everyone in a position to control content must disclose all financial relationships with SII-defined ineligible companies, and all relevant financial relationships must be mitigated prior to the educational activity.

A relevant financial relationship arises when an individual controls content related to products or services of an SII-defined ineligible company in any dollar amount in the past 24 months and products or services of the ineligible company are related to the content.

Per the SII, employees and/or owners of SII-defined ineligible companies are significantly restricted regarding the content they may control for ASHP CME and CPE activities.

Disclosure

The existence or non-existence of relevant financial relationships will be disclosed to the audience.

*An SII-defined ineligible company is any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients. Providers of clinical service directly to patients are not defined as ineligible companies unless the provider of clinical service is owned, or controlled by, an ineligible company.

Financial relationships are those relationships in which you benefit from receiving a salary, royalty, intellectual property rights, consulting fee, honoraria for promotional speakers’ bureau, research funding (where the institution receives the grant and manages the funds and you are the principal or named investigator), ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.

Step 1: In the past 24 months, have you had a financial relationship of any kind and in any amount with an SII-defined ineligible company?*

*An SII-defined ineligible company is any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients. Providers of clinical service directly to patients are not defined as ineligible companies unless the provider of clinical service is owned, or controlled by, an ineligible company.

Step 2: If you acknowledged a financial relationship in question 1, provide the name/s of the commercial interest/s by selecting from past financial relationships or clicking on "Add a financial relationship" below.

What is the name of the ineligible company? Limit to one on this form. Online you will be able to add other companies.
What is the nature of the financial relationship (check all that apply) Advisory Committee/Board Member Consultant Contracted Research Employee Research Grant or Support (and you are named as the principle or lead investigator) Speaker’s Bureau Stock – privately held company Stock – publicly held company (excluding mutual/index funds) Other Financial or Material Support If Other, please describe…
Educational Content: Is the content over which you have control related to healthcare products or services of the SII ineligible company you identified above?

Step 4: Acknowledgement

I certify the information I have provided is complete to the best of my knowledge and I accept responsibility for the accuracy of the information in the response to the aforementioned questions.

Signature

Remember: Paper copies will not be accepted. Use the form to plan your session. The online submission site will contain all the information, but the order maybe slightly different. Use the link for the RFP submission site at www.ashp.org/Meetings-and-Conferences/Get-Involved-in-a-Meeting/Midyear-Clinical-Meeting-and-Exhibition