EDAIC Part II examiner application form
Please note that applications can be rejected when information is lacking. Giving a maximum of information before submitting your form is therefore highly recommended.
Name
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Title
First Name
Last Name
Email
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Please use the same email address as your myESAIC account.
ESAIC Identification Number
6 digits
Phone Number (mobile)
*
-
International code
Phone Number
Professional address
*
Name of hospital
Street Address
City
Country
Postal / Zip Code
Private Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Picture
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a. All medical qualifications. Please do not forget to mention EDAIC, FRCA or FCAI and send us a copy of your FRCA or FCAI. Date of first medical diploma and specialisation are required as you must have qualified as a specialist in anaesthesiology at least three years before applying as an EDAIC examiner.
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Present employment
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b. Language skills: I feel comfortable to examine in:
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English
French
German
Polish
Portuguese
Romanian
Scandinavian
Spanish
Turkish
Other
Past employment
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c. Formal Pedagogical Training last five years
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d.Publications/Research activity last five years
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e. Implication with the teaching of trainees.
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f. Examination related experience (national exam, EDAIC...)
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g. Participation or organization of ESAIC activities
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h. State your motivation to become an examiner.
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Max 150-200 characters
i. Open question 1: What will be your greatest strengths as an examiner?
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Max 150-200 characters
i. Open question 2: What do you think will be most challenging for you as an examiner?
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Max 150-200 characters
i. Open question 3: How do you plan to cope with those challenges?
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Max 150-200 characters
i. Open question 4: How do you keep up to date with new knowledge in anaesthesia and intensive care?
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Max 150-200 characters
j. Recommendation letter 1
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Letters should be signed (manually or electronically) and dated within 6 months of the application.
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j. Recommendation letter 2
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Letters should be signed (manually or electronically) and dated within 6 months of the application.
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j. Recommendation letter 3 (optional)
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Letters should be signed (manually or electronically) and dated within 6 months of the application.
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CV: 1 page (optional)
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Your personal data will be processed by ESAIC for the sole purpose of the examination in accordance with the ESAIC privacy policy.If you have any questions about your data, please contact privacy@esaic.org
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