Workshop Proposal Submission Form

Thank you for your interest in proposing a workshop with ISMRM. If you have any questions about the process or this form, please contact Anne-Marie Kahrovic, ISMRM Executive Director.

The ISMRM encourages accreditation of its programs wherever appropriate. The Central Office is available to guide you through extra steps required for the accreditation process. Please contact Melissa Simcox, ISMRM Director of Education, for any questions on accreditation.

"*" indicates required fields

Your Member ID Number*

Your Name*

First Last

Your Email*

Workshop Title*

Do you plan to produce a white paper with regard to the subject of this event?*

Yes

The ISMRM embraces and values the diversity of all its community regardless of age, race, ethnicity, nationality, culture, gender, gender identity, sexual orientation, disability, religion and socioeconomic status. It is our mission to ensure that everyone working in our field has equal and fair opportunities to contribute. The ISMRM, incorporated and operating as a nonprofit in the USA, is committed to meeting and exceeding any and all California State and US Federal legislative requirements in this regard. For full details of pertinent California legislation, please read AB1195 and AB241.

Organizing Committee*

Organizing committee members must be Full Members of the ISMRM or ISMRT. In line with the value statement above, we ask organizers to be inclusive in selecting members of the organizing committee as well as faculty/invited speakers.
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First Name

Last Name

Institution

Proposed Date Range - First Choice*

Proposed Date Range - Second Choice*

Do not select the same date range as your other choices.

Proposed Date Range - Third Choice*

Do not select the same date range as your other choices.

What days of the week would you like your event to fall on?*

Example: For Friday to Sunday, select Friday, Saturday and Sunday.
If all days are acceptable, please only select "No Preference".

No Preference

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

If all days are acceptable, please only select "No Preference".

Are there any events or conferences that would potentially negatively impact attendance?*

Proposed Location*

Please include venue, city, state (if applicable), and country.

Please list any commercial support you plan to contact or have contacted for this activity.*

If none, please enter "N/A".
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Please note that contact with ISMRM industrial partners is only authorized after Board approval.

Name of commercial supporter

Amount of funding, or type of donation requested

Our standard workshop automatically includes breaks and lunches in our budget. If you wish to include breakfast or dinner off site, etc. this will increase registration fees greatly, unless commercial support is found. Please make note of any additional meals you would like attendees to have, listing where you would like the funds to come from, either registration or a specific commercial support.

Additional Meals

If you do not intend to include additional meals, leave this row blank.
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Meal Requested

Funds will come from (i.e. Registration, or funds from Tier IV sponsor)

Please list a few topics that you believe will draw attendees, and what the attendees will learn on these topics.*

What is your expected number of presenters?*

For a 2½-day workshop, we suggest 15 presenters.
ISMRM reminds organizers to include diverse & international faculty.

Will this workshop be for CME?*

Further questions will appear below based on your answer to this question.

Yes

Declaration Statement

Disclosure is required of the proposed chair before the workshop can be approved.

Please complete this disclosure form after submitting your proposal.

1. Target Audience*

Please give a brief description of who this activity is being designed for. Why is this topic a relevant area for this audience?

2. Attributes*

CME Activities must be designed around desirable physician attributes. Please indicate the attributes supported or enhanced by this activity (choose all that apply).

a. Deliver patient centered care

b. Practice-based learning and improvement

c. Professionalism

d. Work in interdisciplinary teams

e. Apply quality improvement

f. Medical knowledge

g. Interpersonal and communication skills

h. Systems-based practice

i. Employ evidence-based practice

j. Utilize informatics

3. Overview*

Please write a 200-300 word description of the activity. This information will be listed online and on marketing materials to give prospective participants enough information to decide whether or not to attend.

4. Practice Gaps

4a. Current State*

What is the current state of knowledge, skills, competence, practice, patient outcomes, etc.
What is happening?
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E.g. "Practitioners… are not using/cause problems when/have been shown to be unaware/still perform x instead of y in n% of cases…"

4b. Desired/Ideal State*

What is the desired/ideal state?
What is achievable?
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E.g. WE have the ability to/ we can…

4c. References & Supporting Documents*

What sources were used to identify the gap(s) for this activity?
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Ex.: Planning Committee Meeting Notes or Minutes, Clinical Practice Guidelines, Literature Search, Peer-reviewed scientific/clinical publications, etc.

5. Needs*

What knowledge, skills or abilities are necessary to improve/overcome the problem?
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For your reference, please follow the link to California's Business & Profession's Code 2190.1 definitions of "Cultural and Linguistic Competency, Implicit Bias, and Diversity" (as required by California legislation).
https://www.cmadocs.org/Portals/CMA/CLC%26IB%20Definitions.pdf

6. Learning Objectives*

Please list at least three objectives for your activity. If you require assistance in making objectives please see our guide here.
Click the (+) icon to add more rows. Give at least three objectives.

Upon completion of this activity, participants should be able to:

7. What potential barriers may prevent attendees from making the desired changes?

Brainstorm: What could prevent a learner from incorporating this education? Is it cost prohibitive? Are the language barriers? Are additional skills or training needed?

8. What, if anything, can we do to address these barriers?

9. How will the information be communicated or distributed to the audience, and what are the benefits of this approach?

Formats that reflect Adult Learning Principles: Case-based, or in other ways linking what you are learning to real practice|Lots of time for learner interaction – with the teacher and other colleagues |Opportunities to think about or review what you are doing in practice, how you might improve, and support for making changes

Upload Your Proposed Program*

Please upload your preliminary program here.

A preliminary budget is not required at this time. A revenue-positive but no less than a revenue-neutral budget will be developed by ISMRM staff working with the organizers once the workshop has been approved.

We suggest 2½-day long workshops, but any length schedule can be accepted.

To download a suggested program template, please click here.

Accepted file types: xls, xlsx, doc, docx, rtf, pdf, Max. file size: 24 MB.