Local WBA Coordinator Application

Before completing this application, please familiarise yourself with the Local WBA Coordinator Position Description.

If you do not meet or need clarity around the below eligibility criteria, please contact the Training Services team on 61+3 9320 0404 or via training@acem.org.au for assistance.

Do you meet each of the criteria below?*

Currently have an appointment of a minimum of 0.25 FTE at the relevant ACEM-accredited ED, working a minimum of one (1) clinical shift per week, and a minimum of one (1) hour of Clinical Support Time (CST) per trainee per month within that ED.Be a current FACEM or, if appointed as Local WBA Coordinator in a Paediatric Emergency Department, a current certified FRACP or Fellow as defined by the FACEM Training Program Accreditation Requirements. (Note* Please find a hyperlink to this document below)Not be a Director of Emergency Medicine Training (DEMT), Director of Emergency Medicine (DEM) or coordinator of a local mentoring program, or must be able to relinquish such a role if appointed as Local WBA CoordinatorBe in Good Standing with the College (i.e. is financial , is not subject to any disciplinary or other investigations by the College, and has met all recertification requirements)Have completed the ACEM Core Values ModuleHave completed the three (3) Assessing Cultural Competency Modules: (Foundations of Assessing Cultural Competence Module, Assessing Cultural Self-Awareness & Cultural Adaptability Module, and Assessing Cultural Literacy & Cultural Bridging Module.

FACEM Training Program Accreditation Requirements

Name*

First NameLast Name

ACEM ID

Email*

example@example.com

Hospital where Local WBA Coordinator Role to be undertaken*

Qualification*

FACEMFRACP PEM Specialist

Date appointment effective*

Date

Are you replacing an existing Local WBA Coordinator?*

YesNo

Name of Exiting Local WBA Coordinator*

If you will be working in a Co-Coordinator model, please list the name/s of other Local WBA Coordinators at the site.

A requirement of being a Local WBA Coordinator is having an active engagement in workplace-based assessments within the emergency department in which they work. Please give a brief explanation of the how the WBA system works at your site e.g roster, trainee responsibility, scheduled days etc. How effective are these processes?*

Please detail any prior experience you have in the delivery of medical education activities, particularly in relation to mentoring, supervision and/or assessing junior doctors; including the provision of honest, appropriate and timely feedback. *

DEM Name*

DEM Contact Email*

DEMT Name*

DEMT Contact Email*

I confirm that I understand my rights and responsibilities as set out in the Local WBA Coordinator Position Description.*

I confirm