AOA Standard 2.2.4.2, ACCME Criterion 7 (SCS 6), CPME 8.0

Completion of this form is required for each course you teach.

Des Moines University (DMU) was selected by the American Osteopathic Association (AOA) as a Preferred Provider of post-graduate education. DMU must ensure balance, independence, objectivity, and scientific rigor in all its educational activities. This form must be completed by all individuals who have influence over the content of an educational activity (i.e., activity director(s), planning committee, faculty, etc). 

The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as “any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients." The ACCME does not consider providers of clinical service directly to patients to be commercial interests.

All persons who may impact the content of a CME activity, including faculty and planners, are required to fully disclose current and recent financial relationships with commercial interests. A conflict of interest may be considered to exist if such person or their spouse or partner has financial relationships with the grantor or any commercial interest(s) that may have a direct impact on the content of the program. Financial relationship is defined as being a shareholder, consultant, grant recipient, research participant, employee, and/or recipient of other financial or material support. Recent is defined as the past 12 months.

This disclosure policy is intended to protect all parties involved from any potential conflict of interest that may arise. The students participating in this program must be made aware of any such financial relationship(s) or the lack of a financial relationship. Example disclosure statements are below. 

  • No Relevant Financial Conflicts: Relevant to the content of this course, I do not relevant financial conflicts with commercial interest companies to disclose.
  • Self: Relevant to the content of this course, I am a consultant for ABC Pharma Company. 
  • Spouse or Partner: Relevant to the content of this course, my spouse or partner is an advisory board member for XYZ Pharma Company. 

How can I determine if my organization is a commercial interest?

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(e.g. MHA O625, etc.)
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Relevant financial relationships are those in which an individual (including the individual’s spouse/domestic partner) in the last 12 months has had a personal financial (any amount) relationship with a commercial interest who produces, markets, re-sells, or distributes health care goods or services consumed by, or used on, patients and/or who also has control over educational content (planning or presenting) about this activity.
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Principal investigator or working directly for company or the company’s agent
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Self-managed only.
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Providers of clinic services directly (i.e., clinics, hospitals, etc.) are NOT commercial interests.
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If at any time during my presentation I discuss an off-label use of a commercial product/device, I understand that I must provide disclosure of that intent.
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I will uphold Des Moines University’s continuing medical education standards and guidelines to ensure balance, independence, objectivity, and scientific rigor in my role in the planning, development or presentation of this activity. I understand that continuing education accreditation guidelines prohibit me from accepting any reimbursement (financial, gifts, or in-kind exchange) for this presentation from any source other than the accredited CME provider or its educational partner. Additional information may be requested to address any perceived conflict of interest. All identified conflicts of interest will be managed and resolved in advance of the activity and disclosure information will be shared with the activity participants. By signing this box with my electronic signature, I attest that all information above is true and correct.