Department of Continuing Medical EducationGrand Rounds Speaker Confirmation FormThank you for agreeing to participate in our Pediatric Grand Rounds Series. Complete the form below as soon as possible so that we can prepare for your session. Presentation Details Date of your presentation * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202520262027 Presentation Title/Topic * Select your presentation format * - I will be presenting... - In person (in front of a live audience) Virtually (through Zoom) Learning ObjectivesList a minimum of three (3) learning objectives in terms of: "At the conclusion of this activity, participants should be able to…" Objective 1 * Objective 2 * Objective 3 * Additional objectives? Yes Objective 4+ * Enter any additional objectives below, separated by periods or numbers. Presentation Accommodations My presentation will require/include... * Audio or Video Playback (music or video with/without sound) Audience Response System (like PollEverywhere, or other) Gamification System (like Kahoot, or other) Web Browser Access Presentation platform other than PowerPoint ( like Google Slides or Canva) Other... My presentation will require/include... Other... My virtual presentation will require/include... * Polling (Via Zoom) Polling (Via Poll Everywhere) Break Out Rooms (Via Zoom) Gamification (Kahoot, etc.) Video/Audio Playback Other... My virtual presentation will require/include... Other... I will need the following when recording my presentation... * Assistance with Zoom set-up/installation Recording to be scheduled outside reg. business hours (M-F, 8am -5pm EST) A quiet location to record (unable to record in the office or at home) Other... I will need the following when recording my presentation... Other... Presentation CategoriesUsers can use the following categories & keywords to filter and find relevant sessions when searching for available activities in our course search. Please select AT LEAST ONE related subspecialty, and any optional keyword(s) below as it relates to your presentation. Related Subspecialties * Adolescent Medicine Allergy and Immunology Anesthesiology Child Abuse Pediatrics Child Life Dermatology Developmental-Behavioral Pediatrics Family Medicine General Pediatrics Hospice & Palliative Care Medical Genetics Medical Toxicology Neonatal-Perinatal Medicine Neurological Surgery Nursing Nutrition Obstetrics and Gynecology Occupational Therapy Ophthalmology Orthopedic Surgery Otolaryngology Pathology Pediatric Cardiology Pediatric Critical Care Medicine Pediatric Dentistry Pediatric Emergency Medicine Pediatric Endocrinology Pediatric Gastroenterology Pediatric Hematology-Oncology Pediatric Hospital Medicine Pediatric Infectious Diseases Pediatric Nephrology Pediatric Neurology Pediatric Pulmonology Pediatric Rheumatology Pediatric Transplant Hepatology Pharmacy Physical Medicine and Rehabilitation Physical Therapy Plastic Surgery Psychiatry Psychology Radiology Sleep Medicine Speech Therapy Sports Medicine Surgery Thoracic Surgery Urology Optional Keywords COVID-19 Health Equity Health Disparities Pain Management Practice Management Preventive Medicine Quality Improvement Research Risk Management Treatment of Opioid/Substace Use Disorders Professional Wellness Other...(list additional key-words) Optional Keywords Other...(list additional key-words) Speaker AttestationBy entering my name below I agree to submit my presentation slides at least 72 hours before my session and complete any requested forms via the iLearnPeds.com platform or otherwise. * name * email * Your iLearn user email will be entered as default. If you are not logged in or do not have an iLearnPeds.com account yet, please enter the email you intend to use when registering. Leave this field blank
