EmailMeForm
FMEC 2026 Call For Submission Form
Opens December 5, 2025
Closes January 30, 2026
USE THIS FORM TO SUBMIT A:
Workshop
Seminar
Research Paper
Quality Improvement (QI) Project
Lecture Discussion
Paper
Breakfast Table Discussion
Clinical Success Story
Speed Presentation
DO NOT USE THIS FORM TO SUBMIT POSTER SUBMISSIONS. A separate form for poster submissions will open May 15, 2026, and close July 1, 2026.
Review the session requirements in the Session Description document BEFORE starting your submission. Highlight this link and open:
https://fmec.memberclicks.net/assets/2026%20FMEC%20Session%20Descriptions%20Final%202.pdf
READ THIS BEFORE STARTING YOUR SUBMISSION.
• Recommended browser is Google Chrome due to some organizational firewalls blocking communications from outside organizations. Receiving Annual Meeting updates and information may be difficult to receive if using your organization's system.
• Write out your submission and save it before completing this form.
• Choose the appropriate category for your submission. Pay attention to program lengths (which range from 5 to 60 minutes) and do not outline a submission that is longer than the category of submission. Do not submit a proposal that is primarily didactic as a Workshop, which must be experiential or “hands-on.” Do not reuse proposals you’ve submitted for other meetings without adapting them to the FMEC format(s).
• Research or QI projects may submit if they are now in process. Complete the results and conclusions sections as best you can.
• Do not list yourself as First Author on more than one submission in any category. For instance, if you list yourself as First Author on two Lecture Discussions, the FMEC will remove one from consideration.
• Do not list yourself as First Author on more than four (4) proposals total.
• Be prepared to upload the first author’s CV in PDF format.
• Collect complete contact information for all authors BEFORE starting your submission. You must include names, degrees, institutions, email addresses, and phone numbers for ALL AUTHORS on your submission.
• Each author must provide their preferred email address. Authors receive important information pertaining to scheduling, meeting registration, housing, presentation and handout preparation, and more. Do not use your Coordinator's email for all authors.
• Each submission is limited to five (5) authors. No exceptions. Our system accepts a maximum of five (5) authors per submission. Include those who intend to do the presentation at the meeting.
• Use this online form. The FMEC will not consider submissions received by email or other formats. You can save and come back to your submission within 24 hours of starting it. If you do not come back to and complete that submission within that 24-hour period, it will be deleted, and you will need to resubmit.
• All presenters attending the Annual Meeting are expected to register and pay a full registration fee (except those on medical student scholarships; see below). By submitting this proposal, you agree that at least one author listed will register and pay to attend the Annual Meeting. Full meeting registration is required.
• The FMEC does not offer a one-day registration fee.
• No payment is due with this submission form.
• Do not submit a proposal that requires more than a standard AV set up (laptop, projector, screen). The FMEC will provide a standard AV set up for all sessions except Breakfast Table Discussions and Posters. We will provide manipulation tables for osteopathic sessions that require them. We will not approve submissions that require video conferencing or other additional technology. If your submission requires props or supplies, you are responsible for providing them.
• FMEC’s Annual Meeting is an opportunity for family medicine faculty and residents as well as medical students to present. Only current full-time medical students are eligible to present at the FMEC meeting.
• All Submissions from RESIDENTS MUST INCLUDE AT LEAST ONE FACULTY CO-AUTHOR. The faculty co-author is strongly encouraged to attend and co-present when the submission is from a resident. Submissions received without one clear faculty co-author will be returned to the resident author.
• All submissions from MEDICAL STUDENTS MUST INCLUDE AT LEAST ONE FACULTY CO-AUTHOR. The faculty co-author is strongly encouraged to attend and co-present when the submission is from a medical student. Submissions received without one clear faculty co-author will be returned to the student author.
• Scholarships are available to approved medical students. Some medical students are required to register for the Annual Meeting. Please contact jennifer.stamper@fmec.net for details and questions about your eligibility before continuing your submission.
• After submission, your proposal will be reviewed and rated by family medicine faculty throughout the northeast US. During review, the FMEC reserves the right to accept your proposal under another category, and/or that it be combined with submissions on similar topics. We will communicate those and other required changes before final acceptance.
Session ID # (Office Use Only)
Location (FMEC Use Only)
Select Only One (1) Category to Submit
*
Click here to select your category
Workshop (60 minutes with 30 minutes of hands-on skills building)
Seminar (60 minutes didactic/instructional)
Research Paper Presentation (30 minutes)
Quality Improvement Presentation (30 minutes)
Lecture Discussion (20 minutes)
Paper Presentation (15 minutes)
Scholarly Breakfast Discussion (60 minutes)
Clinical Success Story (5 minutes)
Speed Presentation (5 minutes)
A First Author may submit only one (1) submission per category.
Select up to two (2) content tracks for this submission:
ACGME ACGME/Guidelines and Standards
ADSU Addiction/Substance Use
ADV Advocacy
ART Art/Narrative Medicine
CE Community Engagement/Involvement
DEI Diversity, Equity and Inclusion
DMCC Disease Management/Clinical Care
F Faculty
GER Geriatric/Palliative Care
GH Global Health/Immigrants/Refugees
IMM Immunizations
INN Innovation
MCH Maternal and Child Health
MH Mental Health
NT Nutrition
OSTEO Osteopathic
POCUS Point-of-Care Ultrasound
PRO Procedures
PT Program Coordinator
PTSIP Preparing to Succeed in Practice
R Resident
REPRO Reproductive Health
RESQI Research/Quality Improvement
RM Rural Medicine
S Student
SDOH Social Determinants of Health
TECH Artificial Intelligence/Technology
WELL Wellness
WPC Whole Person Care/Integrative Medicine
Date (FMEC Use Only)
Start (FMEC Use Only)
End (FMEC Use Only)
Title of Submission
*
Title is limited to 200 characters or fewer. FMEC reserves the right to shorten titles as needed to fit into the app.
Tagline: In 10 words or fewer, describe your submission
*
Author Information: Up to Five (5) Authors will be printed in the final program
First Author Name
*
First
MI
Last
First Author Credentials
*
Select:
MD Medical Doctor
MD Medical Doctor Faculty Member
DO Doctor of Osteopathic Medicine
DO Doctor of Osteopathic Medicine Faculty Member
Fellow
PGY1 Resident Year 1
PGY2 Resident Year 2
PGY3 Resident Year 3
MS1 Medical Student Year 1
MS2 Medical Student Year 2
MS3 Medical Student Year 3
MS4 Medical Student Year 4
Other
If "Other" was selected, enter it here:
First Author Institution Name
*
First Author Department Name
First Author Contact Information:
* 2 Character ST abbreviation only
* 5 Digit zip code required
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
First Author Preferred Email to receive communications and mobile app information. This email must be unique to this author. Do not use this email address for more than one author.
*
First Author Preferred Phone
*
###
-
###
-
####
I am a Medical Student or Resident First Author and have a Faculty Advisor who assisted with this submission.
*
Yes
Not Applicable to Faculty First Authors
Faculty Advisor Name
*
First
MI
Last
Faculty Advisor Credentials
*
Please select:
MD Medical Doctor
MD Medical Doctor Faculty Member
DO Doctor Osteopathy
DO Doctor Osteopathy Faculty Member
Fellow
PGY1 Resident Year 1
PGY2 Resident Year 2
PGY3 Resident Year 3
MS1 Medical Student Year 1
MS2 Medical Student Year 2
MS3 Medical Student Year 3
MS4 Medical Student Year 4
Other
If "Other" was selected, enter it here:
Faculty Advisor Institution Name
*
Faculty Advisor Department Name
Faculty Advisor Contact Information:
* 2 Character ST abbreviation only
* 5 Digit zip code required
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Faculty Advisor's Preferred Email to receive communications and mobile app information.
Do not use this email address for more than one author.
*
Faculty Advisor Preferred Phone
*
###
-
###
-
####
Is there a Second Author in your submission?
*
Yes
No
Second Author Name
*
First
MI
Last
Second Author Credentials
*
Select:
MD Medical Doctor
MD Medical Doctor Faculty Member
DO Doctor Osteopathy
DO Doctor Osteopathy Faculty Member
Fellow
PGY1 Resident Year 1
PGY2 Resident Year 2
PGY3 Resident Year 3
MS1 Medical Student Year 1
MS2 Medical Student Year 2
MS3 Medical Student Year 3
MS4 Medical Student Year 4
Other
If "Other" was selected, enter it here:
Second Author Institution/Affiliation Name
*
Second Author Department Name
Second Author Contact Information:
* 2 Character ST abbreviation only
* 5 Digit zip code required
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Second Author Preferred Email to receive communications and mobile app information.
Do not use this email address for more than one author.
*
Second Author Preferred Phone
*
###
-
###
-
####
Is there a Third Author in your submission?
*
Yes
No
Third Author Name
*
First
MI
Last
Third Author Credentials
*
Select:
MD Medical Doctor
MD Medical Doctor Faculty Member
DO Doctor Osteopathy
DO Doctor Osteopathy Faculty Member
Fellow
PGY1 Resident Year 1
PGY2 Resident Year 2
PGY3 Resident Year 3
MS1 Medical Student Year 1
MS2 Medical Student Year 2
MS3 Medical Student Year 3
MS4 Medical Student Year 4
Other
If "Other" was selected, enter it here:
Third Author Institution/Affiliate Name
*
Third Author Department Name
Third Author Contact Information:
* 2 Character ST abbreviation only
* 5 Digit zip code required
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Third Author Preferred Email to receive communications and mobile app information
Do not use this email address for more than one author.
*
Third Author Preferred Phone
*
###
-
###
-
####
Is there a Fourth Author in your submission?
*
Yes
No
Fourth Author Name
*
First
MI
Last
Fourth Author Credentials
*
Select:
MD Medical Doctor
MD Medical Doctor Faculty Member
DO Doctor Osteopathy
DO Doctor Osteopathy Faculty Member
Fellow
PGY1 Resident Year 1
PGY2 Resident Year 2
PGY3 Resident Year 3
MS1 Medical Student Year 1
MS2 Medical Student Year 2
MS3 Medical Student Year 3
MS4 Medical Student Year 4
Other
If "Other" was selected, enter it here:
Fourth Author Institution/Affiliate Name
*
Fourth Author Department Name
Fourth Author Contact Information:
* 2 Character ST abbreviation only
* 5 Digit zip code required
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Fourth Author Preferred Email to receive communications and mobile app information
This email must be unique to this author.
Do not use this email address for more than one author.
*
Fourth Author Preferred Phone
*
###
-
###
-
####
Is there a Fifth Author in your submission?
*
Yes
No
Fifth AuthorName
*
First
MI
Last
Note: No more than five (5) authors will be accepted.
Fifth Author Credentials
*
Select:
MD Medical Doctor
MD Medical Doctor Faculty Member
DO Doctor Osteopathy
DO Doctor Osteopathy Faculty Member
Fellow
PGY1 Resident Year 1
PGY2 Resident Year 2
PGY3 Resident Year 3
MS1 Medical Student Year 1
MS2 Medical Student Year 2
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Documents
Abstract:
All submissions must include a 100-word or fewer summary of your submission that attendees can review prior to attending the meeting and is included in the app. FMEC reserves the right to shorten any abstract over 100 words.
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Limit Abstract to 100 words or fewer. FMEC reserves the right to revise any Abstract over 100 words.
Proposal
ALL proposals must include:
• Learning Objectives
• Content of the presentation
• Methods for and extent of involving participants
• Breakdown of time utilization
Learning Objectives: ("By the end of the session participants will be able to ..."):
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Content of Presentation:
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Methods for and Extent of Involving Participants:
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Breakdown of Time Utilization:
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Upload your CV/Resume in PDF format
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Is this a Research or Quality Improvement submission?
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Yes
No
QUALITY IMPROVEMENT SUBMISSIONS ONLY:
Does your project utilize a run chart?
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Yes
No
RESEARCH PAPERS AND QI SUBMISSIONS ONLY: Statement of problem addressed and its significance:
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RESEARCH PAPERS AND QI SUBMISSIONS ONLY: Background and summary of literature review:
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RESEARCH PAPERS AND QI SUBMISSIONS ONLY: Methodology use and attention to research design and problems of measurement:
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RESEARCH PAPERS AND QI SUBMISSIONS ONLY: Summary of results:
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RESEARCH PAPERS AND QI SUBMISSIONS ONLY: Summary of discussion and conclusions:
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RESEARCH PAPERS AND QI SUBMISSIONS ONLY:
Upload any supporting documentation for your proposal in PDF format:
If this session addresses osteopathic medicine, please confirm the intended audience:
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Osteopathic
Allopathic
Any/All
Not applicable
Does the activity content have a direct impact on patient care?
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Yes
No
Does the activity content relate to non-clinical topic(s) that support the physician's professional role in patient care, including but not limited to the following: (Mark all that apply)
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Medical Ethics
Medico-legal
Patient Centered Advocacy
Physician-patient relations
Professional and/or academic leadership
Teaching and faculty development
Not Applicable
Disclosure Information
Within the past twelve months, I have received support from or have had a relationship with a commercial party related directly or indirectly to the subject of my presentation.
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Yes
No
Please identify the commercial party(ies):
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Will you discuss any off-label uses?
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Yes
No
Please identify the product and the unlabeled uses:
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Will you discuss any investigational uses?
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Yes
No
Please identify the product and the investigational use:
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Have you been asked to promote or market any products?
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Yes
No
What product/s have you been asked to promote or market?
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My participation does not infringe upon any copyright or other intellectual property or proprietary right of any third part. I have obtained appropriate permission to reprint any portion of my presentation.
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Affirm
If patient identifying information is used, I have obtained the necessary patient release signatures.
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Affirm
I agree to FMEC's policy that no attendee will be charged a fee for kit materials used in my presentation.
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Yes
No
I give FMEC permission to record my presentation:
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No
MORE INFORMATION: For questions regarding the receipt of your submission, contact Ms. Lisa Schwieterman, Email: lisa.schwieterman@fmec.net
For questions regarding conference information or to discuss your proposal, contact
Scott Allen, MS
Email: Scott.Allen@fmec.net