Primary Exam Working Group November 2018

Expression of Interest

Please fill out this form to express your interest in the above role
Name*

First NameLast Name
College of Fellowship*

ACEMACRRMANZCACICMRACGP
Year Fellowship obtained*
College ID*
Your Email*
Phone Number*
Select the entity/ies for which you wish to apply in order of preference. If lodging an EOI for multiple entities, you will be required to compose individual and specific Statements of Suitability for each and address eligibility and/or selection criteria for relevant entities.*

PHRM Written Examination Working GroupPHRM Objective Structured Practical ExaminationPHRM Court of Examiners
Number
Please order your preference below:
In which area do you reside?*

New ZealandAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia
Do you hold Specialist Registration with the Medical Board of Australia (MBA) OR Vocational Registration with the Medical Council of New Zealand (MCNZ)*

YesNo
MCNZ or AHPRA Medical registration number.
Do you have a minimum of three years’ active clinical practice in PHRM immediately preceding this application?*

YesNo
Are you currently working within a PHRM site?*

YesNo
Please specify FTE
Statements

Please provide short statements regarding your involvement in the following (maximum 200 words per section)
Development and/or delivery of relevant curriculum, assessment and training*

0/200
Select Choice Question and/or Short Answer Question development, marking and/or standard setting (please specify)*

0/200
OSPE/OSCE question development *

0/200
Experience in the delivery of PHRM education*

0/200
Please attach a copy of your CV *

Upload a File
pdf, doc, docx only. Cancelof
Please include a short statement of suitability, which should address the eligibility and/or selection criteria in the relevant terms of reference for the entity/ies for which you are applying (maximum 500 words).*

0/500
ACEM Core Values

The ACEM Core Values of respect, integrity, collaboration, and equity define the organisation’s guiding principles, and underpin the way ACEM works in order to meet its vision and mission of ensuring the highest standards are maintained in the training of emergency physicians, and in the provision of emergency care to the communities of Australia and Aotearoa New Zealand.

Completing the ACEM Core Values Module is a requirement for all those in College roles. The module must be completed by close of expressions of interest, otherwise your application will not be considered.
Have you completed the ACEM Core Values module? *

YesNo
Please describe how you demonstrate all four ACEM Core Values within your workplace. *
Should be Empty:

Expression of Interest

Statements