Notification of Program Completion Form - Emergency Medicine Associateship Training Programs

Notification of Program Completion Form - Emergency Medicine Associateship Training Programs
Complete the following form to declare that you have completed the requirements of your training program as outlined in ACEM Regulation D.

Note: Please download all WBAs and meeting documentation from your Assessment Summary that you wish to keep, as once this form is submitted you will no longer have access.
Your Name*

First NameLast Name
ACEM ID*
Select the training program that you are enrolled in.*

FEMTPIEMTP Entry Pathway 1IEMTP Entry Pathway 2AEMTP Entry Pathway 1AEMTP Entry Pathway 2AEMTP Entry Pathway 3
FEMTP Assessments*

5 Mini-CEX6 DOPS2 CbDFEMTP Procedural ChecklistALS2 CertificationIndigenous Health & Cultural Competency Modules
FEMTP Training Time*

I confirm that I have completed 6 full time equivalent months of emergency medicine training time.
FEMTP Online MCQ Examination*

I confirm that I have passed the FEMTP Online MCQ Examination.
Final Declaration*

I confirm that I have completed all requirements, and all my assessment have been entered into my Online Assessment Portal for the FEMTP Training Program.
FEMTP Assessments*

5 Mini-CEX6 DOPS2 CbDFEMTP Procedural ChecklistALS2 Certification (or NZ equivalent)Indigenous Health & Cultural Competency Modules
FEMTP Training Time. I confirm that I have completed:*

6 full time equivalent months of emergency medicine training time.The required Start of Placement and Reflection Meetings as indicated by the College.
FEMTP Online MCQ Examination*

I confirm that I have passed the FEMTP Online MCQ Examination.
FEMTP Graduate Survey*

I can confirm that I have completed and submitted the FEMTP Graduate Survey.
FEMTP Graduate Survey
Final Declaration*

I confirm that I have completed all requirements, and all my assessments have been entered onto my Assessment Summary site for the FEMTP Training Program.
IEMTP Entry Pathway 1 Assessments*

10 Mini-CEX11 DOPS4 CbDFEMTP Procedural ChecklistIEMTP Procedural ChecklistALS2 Certification (or NZ equivalent)APLS CertificationEMST or ETM CertificationIndigenous Health & Cultural Competency Modules
IEMTP Entry Pathway 1 Training Time. I confirm that I have completed:*

12 full time equivalent months of emergency medicine training time.The required Start of Placement and Reflection Meetings as indicated by the College.
IEMTP Entry Pathway 1 Online MCQ Examinations. I confirm that I have passed the:*

FEMTP Online MCQ ExaminationIEMTP Online MCQ Examination
IEMTP Graduate Survey*

I can confirm that I have completed and submitted the IEMTP Graduate Survey.
IEMTP Graduate Survey
Final Declaration*

I confirm that I have completed all requirements, and all my assessments have been entered onto my Assessment Summary site for the IEMTP Entry Pathway 1 Training Program.
IEMTP Entry Pathway 2 Assessments*

5 Mini-CEX5 DOPS2 CbDEMD Procedural ChecklistAPLS CertificationEMST or ETM CertificationIndigenous Health & Cultural Competency Modules
IEMTP Entry Pathway 2 Training Time. I confirm that I have completed:*

6 full time equivalent months of emergency medicine training time.The required Start of Placement and Reflection Meetings as indicated by the College.
IEMTP Entry Pathway 2 Online MCQ Examination*

I confirm that I have passed the IEMTP Online MCQ Examination.
IEMTP Graduate Survey*

I can confirm that I have completed and submitted the IEMTP Graduate Survey.
IEMTP Graduate Survey
Final Declaration*

I confirm that I have completed all requirements, and all my assessments have been entered onto my Assessment Summary site for the IEMTP Entry Pathway 2 Training Program.
AEMTP Entry Pathway 1 Assessments*

13 Mini-CEX14 DOPS4 CbD1 Direct Observation of Communication Skills2 Clinical Lead Shift Reports1 Quality Assurance Improvement ActivityFEMTP Procedural ChecklistIEMTP Procedural ChecklistAEMTP Procedural ChecklistALS2 Certification (or NZ equivalent)APLS CertificationEMST or ETM CertificationUltrasound CourseACEM Clinical Supervision CourseIndigenous Health & Cultural Competency Modules
AEMTP Entry Pathway 1 Training Time. I confirm that I have completed:*

18 full time equivalent months of emergency medicine training time.At least 8 weeks FTE in a multi-FACEM site.The required Start of Placement and Reflection Meetings as indicated by the College.
AEMTP Entry Pathway 1 Online MCQ Examinations. I confirm that I have passed the:*

FEMTP Online MCQ ExaminationIEMTP Online MCQ ExaminationAEMTP Online MCQ Examination
AEMTP Graduate Survey*

I can confirm that I have completed and submitted the AEMTP Graduate Survey.
AEMTP Graduate Survey
Final Declaration*

I confirm that I have completed all requirements, and all my assessments have been entered onto my Assessment Summary site for the AEMTP Entry Pathway 1 Training Program.
AEMTP Entry Pathway 2 Assessments*

8 Mini-CEX8 DOPS2 CbD1 Direct Observation of Communication Skills2 Clinical Lead Shift Reports1 Quality Assurance Improvement ActivityIEMTP Procedural ChecklistAEMTP Procedural ChecklistAPLS CertificationEMST or ETM CertificationUltrasound CourseACEM Clinical Supervision CourseIndigenous Health & Cultural Competency Modules
AEMTP Entry Pathway 2 Training Time. I confirm that I have completed:*

12 full time equivalent months of emergency medicine training time.At least 8 weeks FTE in a multi-FACEM site.The required Start of Placement and Reflection Meetings as indicated by the College.
AEMTP Entry Pathway 2 Online MCQ Examinations. I confirm that I have passed the:*

IEMTP Online MCQ ExaminationAEMTP Online MCQ Examination
AEMTP Graduate Survey*

I can confirm that I have completed and submitted the AEMTP Graduate Survey.
AEMTP Graduate Survey
Final Declaration*

I confirm that I have completed all requirements, and all my assessments have been entered onto my Assessment Summary site for the AEMTP Entry Pathway 2 Training Program.
AEMTP Entry Pathway 3 Assessments*

3 Mini-CEX3 DOPS1 Direct Observation of Communication Skills2 Clinical Lead Shift Reports1 Quality Assurance Improvement ActivityAEMTP Procedural ChecklistUltrasound CourseACEM Clinical Supervision CourseIndigenous Health & Cultural Competency Modules
AEMTP Entry Pathway 3 Training Time. I confirm that I have completed:*

6 full time equivalent months of emergency medicine training time.At least 8 weeks FTE in a multi-FACEM site.The required Start of Placement and Reflection Meetings as indicated by the College.
AEMTP Entry Pathway 3 Online MCQ Examinations*

I confirm that I have passed the AEMTP Online MCQ Examination.
AEMTP Graduate Survey*

I can confirm that I have completed and submitted the AEMTP Graduate Survey.
AEMTP Graduate Survey
Final Declaration*

I confirm that I have completed all requirements, and all my assessments have been entered onto my Assessment Summary site for the AEMTP Entry Pathway 3 Training Program.
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