Fellow of Distinction Requirements. Of the. American Osteopathic College of Dermatology

Transcription

1 Fellow of Distinction Requirements Of the American Osteopathic College of Dermatology The Candidate must: a. Be a member of good standing of the AOA for a period of not less than 7 years. b. Be a member in good standing of the AOCD for a period of not less than 7 years. c. Be a Diplomate of the AOBD for a period of not less than 7 years. d. Be recognized as a leader among his or her peers by being active in the AOA, AOCD, and AOBD for at least 7 years. e. Have obtained at least 100 service points by working in an administrative or educational capacity of the AOA, AOCD, and/or the AOBD. f. Have obtained 200 cumulative service points prior to fellowship consideration.

2 APPLICATION FOR FELLOW OF DISTINCTION American Osteopathic College of Dermatology This application must be typewritten or neatly printed. Incomplete applications will be returned. Applications must be received in the AOCD office, P.O. Box 7525, Kirksville, MO no later than May 1 in order to be voted on by the general membership at the fall Annual Business Meeting. Please refer to pages 12 and 13 to determine the points to enter for each activity. Only submit your application if you have earned at least 200 service points, of which at least 100 points have come from section I and II. Name Office Address City State Zip Office Telephone ( ) Birth date LICENSURE* State License # Date Issued Has your license ever been revoked, restricted, suspended, or placed on probation through governmental direction or voluntary surrender? If you answered yes, please attach an explanation to this application. AOA MEMBERSHIP Date joined Membership # AOCD MEMBERSHIP Date joined BOARD CERTIFICATION* Name of Certifying Board Date Certificate Number RESIDENCY and FELLOWSHIP TRAINING* Location/Specialty Dates 2

3 I. National AOA and AOCD Appointments AOA* Activity or office held* Dates Points AOCD Offices Held* Dates Points Committees* Position (chairman, member, etc.) Dates Points AOCD Program Chairman* Meeting Place Dates Points 3

4 AOCD Conventions* Please list all AOCD Mid year and Annual conventions attended after dermatology residency was completed. AOCD Meeting Location (City, State) Year Points I. National AOA and AOCD Appointments: Total Points 4

5 II. Education Residency Training Establishment of an AOA approved Residency Program* Institution Date Points Program Director of an AOA approved Residency Program* Institution Dates Points Participating Trainer in an AOA approved Residency Program* Institution Dates Points Faculty Faculty, full-time, Osteopathic College* Name of Osteopathic College Official Title Dates Points Faculty, part-time, Osteopathic College* Name of Osteopathic College Official Title Dates Points Preceptor of medical students, interns, or non-dermatology residents* Name of person Dates Points 5

6 Lectures Lecturer at Annual or Mid-year AOCD meeting* Date Points (Required resident lectures are not to be included) Lecturer at local or state CME conferences* Date Points 6

7 Publications and Research Author or major contributor of published medical text* Text / Title Date Points Primary/Contributing author of article in a major journal* Title Primary/Contributor Publication Date Points Primary author of article in other state/local journal or publication* Title Publication Date Points Research Projects (with article being reviewed for publication)* Subject Dates Points 7

8 Primary exhibitor of scientific poster display at CME meeting* (Dual credit not given for articles and displays based on the same research project) Subject Dates Points Occlason Award recipient* Title of Lecture Date Points II. Education: Total Points 8

9 III. State and Local Appointments/Contributions State and Local Positions Member of State Medical Licensing Board* Name of Organization Dates Points Member of Area-Wide Health Planning Organization* Name of Organization Dates Points Appointments to State/County Health Commission/Review Boards* Name of Organization Dates Points Member of College of Osteopathic Medicine Alumni Board* Name of College/Medical School Dates Points Member of Medical School Governing Board* Name of College/Medical School Dates Points Officer/Trustee of State Osteopathic/Allopathic Medical Association* Name of Organization Position Dates Points Officer/Trustee of State Osteopathic/Allopathic Medical Association* Name of Organization Position Dates Points 9

10 Program Chairman of State/Local AOA accredited CME program* Name of Program Location Dates Points Demonstrated Community Activity/Service Medical Mission Trip* Name of Organization Location Dates Points List community activities and services such as: paramedic education, student premedical education, cancer society, speaker to a non-medical group, school board member, health fair, skin cancer screening, camp health volunteer, etc.* Name of Activity Location Dates Points III. State and Local Appointments/Contributions: Total Points 10

11 I. National AOA and AOCD Appointments: Total Points II. Education: Total Points III. State and Local Appointments/Contributions: Total Points Grand Total: Signature of applicant Date *Please provide any additional information on a separate sheet and attach to this application. 11

12 Point System for Fellow of Distinction Designation I. National AOA and AOCD Appointments AOA Delegate to AOA AOA committee membership Chairman of AOA State Delegation AOA Residency Program Inspector AOA Certification Exam Points 2 per year 3 per inspection AOCD AOCD President AOCD Secretary-Treasurer Program Chairman for Annual AOCD meeting Program Chairman for Mid-year AOCD meeting AOCD Trustee AOCD Chairman of the Education Evaluation Committee AOCD Chairman of the In-Training Examination Committee AOCD Committee Chairman of other committee Member of AOCD Education Evaluating Committee Member of other AOCD committee AOCD conventions 20 per year per year 10 per year 2 per year 2 per convention II. Education Residency Training Establishment of an AOA approved Residency Training Program Program Director of AOA approved Training Program Participant Trainer in an AOA approved Residency Training Program 15, one time 10 per year Faculty Faculty, full-time, Osteopathic college Faculty, part-time, Osteopathic college Preceptor of medical students, interns, or non-dermatology residents 1 1 per person 12

13 Lectures Lecturer at Annual or Mid-year AOCD meeting (Required resident lectures are not to be included) Lecturer at local or state CME conferences Points 5 per lecture hour 2 per lecture hour Publications and Research Author or major contributor of published medical text 15 per publication Primary author of article in a major journal 7 per publication Contributing author of article in a major journal 5 per publication Primary author of article in other state/local journal or publication 5 per publication Research project (with article being reviewed for publication) 4 per project Primary exhibitor of scientific poster display at CME meeting 7 per display (Dual credit not given for articles and displays based on the same research project) Occlason Award recipient III. State and Local Appointments/Contributions State and Local Positions Member of State Medical Licensing Board Member of Area-Wide Health Planning Organization Appointment to State/County Health Commission/Review Board Member of College of Osteopathic Medicine Alumni Board Member of Medical School Governing Board Officer of State Osteopathic/Allopathic Medical Association Trustee of State Osteopathic/Allopathic Medical Association Officer of local Osteopathic/Allopathic Medical Association Trustee of local Osteopathic/Allopathic Medical Association Program Chairman of State/Local AOA accredited CME program 2 per year 2 per year 7 per program Demonstrated Community Activity/Service Medical mission trip 5 per week, max. of 20 per year Other activities are awarded 1 point each, up to a maximum 10 points per year. Examples include: Paramedic education, student premedical education, local/state cancer society, speaker to non-medical groups, school board member, health fair, skin cancer screening, camp health volunteer, etc. 13