APPLICATION FOR FACULTY APPOINTMENT (Physician) CLINICAL SCIENCES DIVISION.

Transcription

1 APPLICATION FOR FACULTY APPOINTMENT (Physician) CLINICAL SCIENCES DIVISION

2 Dear Physician, The Northern Ontario School of Medicine, a joint venture partnership of Laurentian University, Sudbury and Lakehead University, Thunder Bay may be recruiting based on the need in some areas, health care professionals for academic appointments and instructional positions. The NOSM curriculum and philosophy is premised on the provision of quality medical education in a case based, facilitated, non-didactic style of teaching. Faculty members are responsible in aiding learners in the development of critical thinking, clinical skills, and independent learning skills as well as showcasing northern practice as a viable and attractive future practice consideration. This package includes: Application information form Letter of Intent request Local Education Group (LEG) questionnaire Faculty appointment reference form The office is here to assist you in becoming a faculty member. For assistance, please contact the at or by at divclinsci@nosm.ca. This is a truly exciting time for health care education and the communities of Northern Ontario. Your participation is appreciated and I welcome any comments or questions. Yours sincerely, Dr. Robert Smith, BA, MD, FRCS Assistant Professor Division Head, Clinical Sciences Faculty Affairs Northern Ontario School of Medicine (705)

3 Faculty Appointment (Physician) Application Checklist Please utilize the following checklist to facilitate in submitting your application. Application Information Form (Physician) Letter of Clinical/Teaching Intent (Mandatory) Local Education Group (LEG) questionnaire Personal Curriculum Vitae Faculty Appointment Reference Form Note: To avoid processing delays, please ensure your application includes all the above requirements and is properly submitted with your application. Please return the above information in one of the following ways. Fax: Mail: Northern Ontario School of Medicine ATTN: 935 Ramsey Lake Rd Sudbury, ON P3E 2C6

4 Application Information Form (Physician) * NOTE: If completing this form electronically, please save this document before exiting or your inputted information will be lost. SURNAME: GIVEN NAME(S): TITLE: Dr. Mr. Mrs. Ms. DATE OF BIRTH: HOME: MAILING ADDRESS: CITY/PROV: POSTAL CODE: BUSINESS: MAILING ADDRESS: CITY/PROV: POSTAL CODE: WHICH OF THE ABOVE ADDRESS IS PREFERRED? Business Home HOME PHONE: BUSINESS PHONE: EXT: PREFERRED FRENCH TEACHING: ARE YOU ABLE AND WILLING TO INSTRUCT IN FRENCH? YES NO OPTIONAL: ABORIGINAL FRANCOPHONE Application Information Form: page 1 of 3 Continued on page 2

5 Application Information Form (Physician) CPSO #: Surname: FAMILY MEDICINE DESIGNATION: CCFP CCFP(EM) DATE REC D: PRIMARY AREA OF TEACHING/CLINICAL INTEREST: ROYAL COLLEGE DESIGNATION: RCPSC FRCSC FRCPC DATE REC D: CITY PREFERRED TO TEACH IN: CLINIC NAME or HOSPITAL DEPARTMENT: ACADEMIC APPOINTMENT(S): MEDICAL SCHOOL OR UNIVERSITY: RANK: MEDICAL SCHOOL OR UNIVERSITY: RANK: Important: If you currently hold an academic appointment at another institution, a letter of good standing will be required from your direct supervisor, Department Chair, Director, Dean etc., at that institution. The letter of good standing should include how long you have been at the current rank, if you have been promoted and the date of the promotion if applicable.

6 Application Information Form (Physician) Letter of Clinical/Teaching Intent (Mandatory) Surname: It is mandatory that a letter of Clinical /Teaching Intent be included within your application to assist your NOSM Section Chair and the NOSM Division Head of Clinical Sciences in assessing your application for a faculty appointment. The following items should be briefly described within your letter of intent: Past academic experience Areas of interest Please click here to view the Clinical Faculty Opportunities Brochure that lists the various opportunities that may apply to your areas of interest Intent to provide academics /clinical teachings, administrative/research involvement Please click here to view a list of academic, clinical, administrative and research contributions that may apply to your clinical /teaching intent. Local Education Group (LEG) Questionnaire: (Please complete the following, where applicable.) Are you a member of a Local Education Group (LEG)? * Yes No Do you currently have an application pending to become part of a Local Education Group (LEG)? * Yes No Please provide the name of the LEG s lead Physician:* Important: It should be noted that the area(s) of your interest may currently be fully subscribed and we may not need your services at this time and may not make an academic appointment. We will however notify you if this is the case and should needs change in the future contact you regarding an academic appointment. Application Information Form: page 2 of 3 Continued on page 3

7 Application Information Form (Physician) Surname: I am submitting my application for a NOSM faculty appointment and authorize NOSM to use the information contained in this application for NOSM purposes. Print Name: Signature: Date Completed: Reminder: If completing this form electronically, please save this document before exiting or your inputted information will be lost. Note: this form must be completed in full in order for your application to be processed. Applications should be submitted to: Northern Ontario School of Medicine Attention: Clinical Sciences 935 Ramsey Lake Road, Sudbury, ON P3E 2C6 Fax: divclinsci@nosm.ca For information on faculty appointments and initial rank determination please refer to the NOSM Policy and Procedure for Faculty Appointment and Promotion which can be found at the following link: All qualified candidates are encouraged to apply; however, Canadian citizens and permanent residents will be given priority. The Northern Ontario School of Medicine (NOSM) is committed to employment equity, welcomes diversity and encourages applications from all qualified applicants, including women, individuals within visible minorities, Aboriginal persons, and those with disabilities. Notice of Collection The Northern Ontario School of Medicine (NOSM), as the Faculty of Medicine for Laurentian University and Lakehead University, collects personal information for the purpose of faculty and program evaluation at NOSM including faculty appointment, renewal, promotion, committee work, and program improvement etc. In addition, information may be shared with Lakehead University, Laurentian University AND THE Northern Ontario Academic Medicine Association as required to administer learner programs. We respect your privacy and at all times your information will be protected in accordance with the Freedom of information and Protection of Privacy Act. Direct any questions regarding this collection to the Planning and Risk Director, Grace Vita at (807) , 955 Oliver Road, Thunder Bay, Ontario, or grace.vita@nosm.ca. Application Information Form: page 3 of 3

8 Faculty Appointment Reference Form (Physician) Surname: The following Faculty Appointment References list should include: 1) Minimum of three references 2) Clinicians or regulated health professionals within your profession and that have direct supervision of your clinical practice. 3) Two of your three references, must be members of the NOSM, if applicable. Please click here to view a list of current faculty members. For recent graduates, the Faculty Appointment References list should include: 1) Minimum of three references 2) Clinicians or regulated health professionals within your profession and that have direct supervision of your clinical practice. 3) References may be individuals involved in your training (e.g. Program Director) Note: Your NOSM Section Chair and the NOSM Division Head of Clinical Sciences will be assessing your application for a faculty appointment and should not be used as references. Please click here to view a list of current Section Chairs. 1. Name: Title/position and reporting relationship: Organization: Mailing Address: Phone Number: address:* 2. Name: Title /position and reporting relationship: Organization:

9 Mailing Address: Phone Number: address:* 3. Name: Title/position and reporting relationship: Organization: Mailing Address: Phone Number: address:* Faculty Appointment Reference Form page 2 of 2

10 Clinical Teacher - Instructional Position Description The Clinical Teacher is a qualified health care professional and faculty member who practices in a clinical setting in which the learner will learn. The Clinical Teacher provides experiences and opportunities for observation, which allow the learner to meet learning objectives. The Clinical Teacher also acts as a resource person during the learner s placement. Criteria: 1. Licensed health care professional. This includes Health Science Professionals, to view a complete list, please click here. 2. Qualified to assist the learner in meeting learning objectives in the clinical setting. 3. Qualified by the faculty according to practice experience, clinical expertise, and educational expertise. Responsibilities: 1. Become acquainted with the objectives of the Medical School s clinical placement/clerkship. 2. Become familiar with the learner's individual learning objectives. 3. With the learner, determine and arrange clinical experiences that will help the learner meet their personal learning objectives. 4. Provide the School with a list of skills and/or procedures that the learner may observe or perform and specify which may require some advance preparation. 5. Orient the learner to the clinical environment s personnel, physical facilities, policies, and procedures. 6. Assume supervisory responsibility for the learner's practice. 7. Provide periodic written assessments of the learner's progress in meeting the learning objectives and the learner's behavior and responsibility in demonstrating a professional commitment to patients, staff, the Clinical Teacher, and the clinical setting. 8. Maintain verbal and/or written communication with a designated School faculty or staff member. 9. Assist the learner in becoming acquainted with the people and activities of the community. * All Clinical Educators should have a Northern Ontario School of Medicine faculty appointment. For more detailed information on the various Clinical Educator positions at NOSM please view the Faculty Opportunities Brochure.