FSIS Application

FSIS Applicaiton

Application Deadline: January 15, 2025

Contact admin@sisna.org with any questions.
The Fellow of the Surgical Infection Society (FSIS) is a designation given to those who have demonstrated commitment to and expertise in surgical infections. The FSIS is dedicated to fostering excellence in research, education, and clinical practice for surgical infections. This prestigious program equips healthcare professionals with advanced skills and resources to lead in this critical field.
FSIS Criteria

1. Need a minimum of 85 points

2. Must have points in at least 4 domains

3. Although accomplishments may count in more than 1 domain, each accomplishment can only be used once

4. There are a maximum number of points that can be achieved in each domain

*If the applicant meets all above criteria and is eligible for FSIS, a one-time processing fee of $100 will be charged.

*The final designation of point totals is subject to review by the SIS Fellowship committee and the applicant may be requested to provide additional documentation.
Name*

First NameLast Name
Email*
example@example.com
Curriculum Vitae*

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Cover Letter*

Please provide a brief (<1 page) summary of your contributions to and expertise in the field of surgical infections.
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Expertise

(max of 30 points) - Select the applicable criteria and upload or provide the required documentation.
Recognized Leader in Infection:
Past president of SIS - (Automatic)
Editor-in-chief of Surgical Infection Journal - 30 points
Editor/Co-Editor of an infection-focused book - 30 points
Title:*
Publisher:*
Publication Year:*
ISBN (International Standard Book Number):*
Editorial board of Surgical Infection journal or other infection journal - 10 points
Journal Name:*
Current Editor-in-Chief:*
First and Last Name*
Chair of a SIS Committee - 10 points
Past President of an infection society (SIS-E, IDSA, etc) - 30 points
Name of Society:*
Years of Presidency Term:*
Officer of SIS or other infection society - 20 points
Participation on at least 1 societal infection-related guideline panel - 10 points
Name of the guideline panel:*
Name and email of the panel chair at that time:*

First and Last NameEmail
Invited Grand Rounds or Keynote Speaker lecture on surgical infection topic - up to 10 points. (1 point per)
*Max 10 points - Use the drop down to indicate the number of Grand Rounds and/or Keynote Speaker lectures you are submitting.
Indicate the Name of the Lecture(s), Organization(s), and Date(s): *
Knowledge:
Contribution to the SIS curriculum / update symposium - 5 points
Name of Lecture/Topic*
Date:*
Author/Co-Author of at least 1 infection-related book chapter - 5 points
Expertise Total Points:
Research and Scholarly Productivity

(Max of 30 points) - Select the applicable criteria and upload or provide the required documentation.
Infection-Related Publications - up to 10 points (1 point per peer-reviewed journal article):
*max 10 points -- Use the drop down to indicate the number of Infection-Related Publications you are submitting.
List the PMID (PubMed Identifier(s)):*
Infection-Related Research Presentations (outside home institution) - up to 10 points (1 point per podium presentation):
*max 10 points -- Use the drop down to indicate the number of Infection-Related Research Presentations (outside home institution) you are submitting.
For the number of Podium Presentation indicated above, provide the title, meeting organization, and date for each.*
Infection-Related Grants (past or present):
PI on 1 or more government funded grants (NIH, DOF, AHRQ, PCORI, etc) - 20 points
Grant Number and Granting Institution:*

Grant NumberGranting Institution (i.e., Department of Defense, National Institutes of Health, etc.)
PI on 1 or more non-federally funded grants - 10 points
Please upload the award letter or similar documentation (a simple confirmation email is permissible):*

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Infection-Related Research:
PI for one or more multi-center trials - 20 points
Please upload the award letter or similar documentation (a simple confirmation email is permissible)*

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PI for one or more single-center trials - 10 points
Please upload the award letter or similar documentation (a simple confirmation email is permissible)*

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Site PI for multi-center trial - 5 points
Please upload the award letter or similar documentation (a simple confirmation email is permissible)*

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Serves as a reviewer for federal grant study section - 5 points
Provide email confirmation or other verifying documentation:*

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Research and Scholarly Productivity Total Points:
Teaching and Mentoring

(max 15 points) - Select the applicable criteria and upload or provide the required documentation.
Teaching:
Director/Co-Director of an infection-related Workshop/Course (including program committee) - 10 points
Title:*
Organization:*
Date:*
Audience:*
Didactic lecture or CME-accredited lecture - up to 10 points (1 point per)
*max 10 points -- Use the drop down to indicate the number of Didactic lectures or CME-accredited lectures you are submitting.
For each lecture (up to 10), provide the title, organization, date, and audience associated with the lecture:*
Mentoring:
At least 1 trainee who is a recipient of a grant - 10 points
Grant award letter:*

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Letter of Support:*

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Publication with trainee as first author (1 point per):
*Max 10 points -- Use the drop down to indicate the number of publications you are submitting.
List the PMID or other identifying number for each publication (up to 10) (or upload a PDF of each publication in the file upload area below):
PDF of each publication:

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Teaching and Mentoring Total Points:
SIS and Societal Engagement

(max 15 points) - Select the applicable criteria and upload or provide the required documentation.
Required:*

At least 5 years of SIS membershipAt least 3 SIS (including SIS-Europe) meetings attendedAttendance at 3 or more SIS Update Symposia
Attendance at SIS meetings beyond 3:
*Max 10 points
Member of 2 or more SIS committees - 10 points
Member of 1 SIS committee - 5 points
Member of other infection-related society(s) - 5 points
Name of Society:*
Years Active in Society:*
Reviewer for Surgical Infections - 2 points
Participation as abstract Discussant or session Moderator at a SIS meeting - (1 point each):
*Max 5 points
For each participation (up to 5), list the name of the abstract or session and the date:*
SIS and Societal Engagement Total Points:
Institutional Engagement

(max 10 points) - Select the applicable criteria and upload or provide the required documentation.
Member of at least 1 infection-related institutional committee - 5 points
Society Name:*
Years Active in Society:*
Chair of 1 or more infection-related institutional committees - 10 points
Society Name:*
Years Active in Society:*
Lead of at least 1 infection-related QI project - 5 points
Provide a brief summary of the QI project that includes the problem identified and the metric of success:*
Institutional Engagement Total Points:
Total Application Points:

1. Need a minimum of 85 points

2. Must have points in at least 4 domains

3. Although accomplishments may count in more than 1 domain, each accomplishment can only be used once

4. There are a maximum number of points that can be achieved in each domain
Expertise Total Points:
Research and Scholarly Productivity Total Points:
Teaching and Mentoring Total Points:
SIS and Societal Engagement Total Points:
Institutional Engagement Total Points:
Grand Total:
Should be Empty:

Expertise

Research and Scholarly Productivity

Teaching and Mentoring

SIS and Societal Engagement

Institutional Engagement