Samir Shah, MD, MSCE, MHM

Professor of Pediatrics
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States

Disclosure of Financial Relationship
Do you (your spouse/partner) have (or have had within the past 12 months) a relevant financial relationship with commercial interests to disclose.
No. I (my spouse/partner) do not have (or have not had within the past 12 months) any relevant financial relationship with commercial interests to disclose.

Agreement to Participate in a CME Activity

Agreement to Participate in a CME Activity

1. I understand that circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has (or has had) a relevant financial relationship.
2. I understand that if I refuse to disclose relevant financial relationships with commercial interests, I will be disqualified from any role involved in the planning, management, presentation, or evaluation of this activity.
3. I agree to abide by the content development mechanism adopted by the Division of Continuing Professional Development (DCPD), the administrative unit delegated oversight and responsibility for the overall program of CME activities at BCM, to manage/resolve conflicts of interest:
   • Content will comply with the ACCME’s Content Validation Statements
   • All clinical recommendations for patient care will be based on best available evidence (practice guidelines, practice parameters, consensus statements/ recommendations, etc.)
   • A balanced view of therapeutic options will be given
   • Benefits/risks/alternatives for drugs/devices will be given
   • When possible, only scientific or generic names (not trade names) will be used when referring to products
   • Any unlabeled/off-label or investigational use of any drug/device, and any limitation on the information, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion, will be disclosed to learners.
4. I understand that in some situations other mechanisms might be used to manage identified conflicts of interest. These mechanisms include, but are not limited to, altering an individual’s control over content or financial relationships with commercial interests. I agree to comply with all requirements as requested, e.g., submit educational materials in advance for peer review for balance and objectivity.
5. I understand that if I (my spouse/partner) have relevant financial relationships with commercial interests or have had within the past 12 months, the commercial interests and nature of the relationships must be disclosed to the learners prior to the beginning of the educational activity. I understand learners must also be informed that no relevant financial relationships exist.
6. I understand that presentations and/or activity materials will be evaluated by participants for fair balance, and that the activity Director or designee can intervene at the activity to address any bias issues.
7. I understand that the DCPD may conduct random, unannounced, on-site visits of this activity for compliance with ACCME and BCM policies and procedures, and take action as required, including credit withdrawal.
8. I certify that I have fully and accurately disclosed any relevant financial relationships that I (my spouse/ partner) have with any commercial interests or have had within the past 12 months, and that if any of the relationships I have reported change, or should I become involved in a new relationship that poses a potential conflict of interest, I will notify the Activity Director and revise my disclosure information.

Presentation(s):

• Fundamentals of Quality Improvement- How to Do QI

  Friday, April 30, 2021
  1:45 PM - 2:30 PM US CT

• Editor-in-Chief, Journal of Hospital Medicine

  Monday, May 3, 2021
  2:15 PM - 2:30 PM US CT