AHNS Session Forms

Please complete the form below for your session. This information will be used to invite faculty, marketing materials, and in the Final Program.
If you have any questions on how to fill out the AHNS Session Form, please contact Christine Sass at christines@ahns.info.

You may start the session form and save & continue to come back later to complete the form (within 30 days). Please note, when the final and complete session form is submitted, you will no longer be able to make changes except for emailing changes to christines@ahns.info.

AHNS Annual Meeting Session Design Form

Your Name*
First (Given) Name Last (Family) Name
Session Title:*
Session Description (Brief 2-Sentence Session Description):*
Practice Gaps
(Your session will address what professional practice gap(s) of the attendees derived from data source(s), such as previous meeting surveys, published studies, MOC requirements, etc.)
What is the problem(s) you are trying to fix?*
How did you determine the problem(s)?*
What do learners need in order to fix this problem(s)?
Why does this problem exist? (check all that apply)*
- Physicians lack knowledge
- Physicians lack strategies to apply knowledge to practice
For what reasons would learners resist fixing this problem? How will you address this in your program?*
i.e. time limitations, staffing resources, additional training required.
Session Objectives
Write your objectives focusing on what the learners will do as a result of this activity. Use ACTION words like:

Write at least three objectives focusing on what the learners will do as a result of this activity. Use ACTION words like:

• Adjust
• Articulate
• Classify
• Convey
• Diagnose
• Distinguish
• Hypothesize
• Infer
• Organize
• Prioritize
• Relate

• Apply
• Assess
• Compare
• Create
• Diagram
• Employ
• Identify
• Integrate
• Plan
• Produce
• Select

• Appraise
• Categorize
• Conduct
• Demonstrate
• Differentiate
• Evaluate
• Illustrate
• Interpret
• Predict
• Recognize
• Solve

• Arrange
• Choose
• Construct
• Develop
• Discriminate
• Formulate
• Implement
• Manage
• Prepare
• Recommend
• Use

At the conclusion of this session, participants will be able to:

1. At the conclusion of this session, participants will be able to:*
2. At the conclusion of this session, participants will be able to:*
3. At the conclusion of this session, participants will be able to:*
Session Outline

Please use the table below to fill out your session outline:*

Include all session moderators in the outline below as well.

Speaker Order	Title of Presentation	Faculty/Presenter Name	Time Alloted (in minutes)

Educational Delivery Method
Check all that apply:*
- Didactic lecture
- Panel or discussions
- Q&A session
- Case presentations
- Simulations/skills lab
- Roundtable discussion
- Webinar
- Self-directed online learning
- Other
Educational Delivery Method Other*
Special AV Requests
Please list any special AV requests for your session here. Any special requests will reviewed and approved by the 2019 AHNS Program Chairs.
Why did you select this type of delivery method?*
- Knowledge conveyed in a short time
- Point/counterpoint for controversial topics
- Complicated topic, extra time for questions
- Application of knowledge to potential practice
- Improve skills or technique
- Discussion of difficult or unusual cases or data
- Other
Delivery Method Other*
ABMS/MOC Competency
What ABMS/MOC competency or competencies are related to this session?*
(Check all that are related)
- Patient Care - Provide care that is compassionate, appropriate and effective treatment for health problems and to promote health.
- Medical Knowledge - Demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences and their application in patient care.
- Interpersonal and Communication Skills - Demonstrate skills that result in effective information exchange and teaming with patients, their families and professional associates (e.g. fostering a therapeutic relationship that is ethically sounds, uses effective listening skills with non-verbal and verbal communication; working as both a team member and at times as a leader).
- Professionalism - Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.
- Systems-based Practice - Demonstrate awareness of and responsibility to larger context and systems of healthcare. Be able to call on system resources to provide optimal care (e.g. coordinating care across sites or serving as the primary case manager when care involves multiple specialties, professions or sites).
- Practice-based Learning and Improvement - Able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their practice of medicine.
- Other
ABMS/MOC Other*
Describe how the above competencies are incorporated into the activity:
Comments
This field is for validation purposes and should be left unchanged.

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American Head & Neck Society | AHNS

AHNS Annual Meeting Session Design Form

Practice Gaps

Session Objectives

At the conclusion of this session, participants will be able to:

Session Outline

Educational Delivery Method

ABMS/MOC Competency

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AHNS Annual Meeting Session Design Form

Practice Gaps

Session Objectives

At the conclusion of this session, participants will be able to:

Session Outline

Educational Delivery Method

ABMS/MOC Competency

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