CSHP Fellows Application Form

The candidate has practiced pharmacy for at least 10 years (at least five have been in an organized health care setting, such as a hospital). The total pharmacy practice experience excludes time to complete a residency program or full-time graduate studies, such as a Master's or PhD degree.

List in reverse chronological order, including dates, the positions that document your pharmacy practice.  Include a brief description of your responsibilities and accomplishments in each of these positions:  

The candidate has demonstrated support and leadership for the profession through at least 10 years of CSHP membership and voluntary participation in CSHP activities for at a minimum of five years (or a combination of five years of service to CSHP and A.P.E.S.).

Candidates show consistent involvement, including leadership, in the activities of either or both organizations.

Using the scoring rubric as a guide, describe your involvement/contributions.  Note that contributions are not needed in each category, as long as the total number of points are achieved for the criterion.

List in reverse chronological order, including dates, the leadership positions and offices held with CSHP and/or A.P.E.S.. (Positions will be considered according to the National or Provincial Branch manual’s official committees and positions.) Using the scoring rubric as a guide, describe your involvement/contributions.

Executive committee - committee conseil d’administration

Committee, Task Force, Board, or Affiliated Board – comities et groups de travail:

Appointee of CSHP or APES to an affiliated organization such as CCCEP, PEBC, or a provincial organization

List involvement in the Journal CJHP or Pharmactuel.

Speakers at a CSHP/APES provincial or national educational activity (in-person or webinar).

The candidate has demonstrated sustained practice focus (patient care or leadership) and has implemented progressive pharmacy program(s).

Criterion 3A: Sustained Practice

The candidate has demonstrated sustained practice focus (patient care or leadership) and has implemented progressive pharmacy program(s). “Sustained” is interpreted as a consistent and committed effort to maintain practice focus/excellence on behalf of the profession over a period of at least five consecutive years. The purpose of this is to ensure ongoing contributions to the profession rather than sporadic, infrequent contributions. Please refer to the scoring rubric as a guide.

Document any additional training that applies to the area of sustained practice, the number of years in this area, and what measures demonstrate how practice excellence has been achieved:

Criterion 3B: Example of a Progressive Pharmacy Program

In the following section, provide one example of a progressive, innovative project or program that you have led. or a specific area of sustained practice focus that you have undertaken in addition to your professional responsibilities.  Some examples of projects may include the following:  

·       New or expanded role for the pharmacist (e.g., Antibiotic Stewardship)

·       New Seamless Care, Med Rec, Community Care or Home health care service 

·       Modernization of drug distribution system (e.g., Oncology Compounding Facility) 

·       Medication Safety Pharmacist (Institutional, Regional or Provincial) 

·       Innovative management system for pharmacy (e.g., Senior Technician Role) 

Submit one detailed example of the progressive pharmacy program you led.  Describe the implementation of the program that resulted in an improved level of pharmacy practice: 

Upload your project description using these headings (up to 1000 words, not including references; noting that anything beyond 1000 words will not be reviewed):

1.       Project or program title

2.       Supporting background (include the rationale for the program)

3.       Objectives

4.       Methods (include the project design and data collection methods)

5.       Results or outcome

6.       Knowledge translation (provide a brief summary as specific details will be included below)

7.       Your role in the project

Evidence of Knowledge Translation 

Provide evidence of knowledge translation (KT) activities related to your specific project, such as presentations, reports, practice implications, social media, newsletters, etc.

Criterion 3C: Other Volunteer Leadership Activities

The candidate has demonstrated involvement in additional voluntary leadership activities with other professional organizations that have a broad impact on pharmacy practice in hospitals, other collaborative healthcare settings, or on pharmacy education.

The candidate has contributed to pharmacy knowledge through publications, presentations, proposals, education, or research.

Present a complete list of publications, presentations, proposals, and research reports that indicate your contributions to the profession. In this section, you will have a choice toeither select and complete two items options in Criterion 4A OR Criterion 4B. 

 Criterion 4A: 

(i) The candidate is the author or co-author of at least five papers/articles on pharmacy practice in national or international peer-reviewed or refereed journals. A peer-reviewed or refereed journal is one which asks a selection of experts to pass judgment on a paper prior to publication (a journal which uses only editorial staff or the same one or two reviewers for all papers is not considered refereed).

Include a list of all publications; exclude non-refereed papers such as editorials, letters to the editor, and abstracts. If the article is in-press, please provide confirmation of acceptance.  For listings of multiple papers/articles, please highlight or list separately those in peer-reviewed or refereed journals. Do NOT send copies of publications.

Alternately, the candidate is the author or co-author of chapters in a textbook on an aspect of pharmacy, including those which are widely used throughout the province/territory or the country; exclude manuals, formularies, or guidelines created for a practice setting. 

Provide the complete details for this type of publication, including the publisher and date of publication. Do NOT send copies of books/chapters.

(ii) The candidate has delivered at least five oral presentations on different topics. Oral presentations must be at provincial/territorial, national, or international professional meetings; exclude local or hospital presentations and poster presentations.

Provide a list below of all oral presentations that you have delivered.  For each presentation, indicate the title, date, meeting location, and the audience or group to whom the presentation was made (e.g., CSHP Professional Practice Conference).

(iii) The candidate was the principal investigator on a research project. The principal investigator is the lead researcher responsible for a research project or clinical trial, accessing funding, and overseeing the research from the initial proposal and ethical review to data analysis and final reporting.

(iv) The candidate successfully obtained five peer-reviewed grants (research or educational).

(v) The candidate successfully led at least three business plans or project proposals that were approved and were related to pharmacy practice or advancing quality of patient care or safety.

Criterion 4B:

The candidate has delivered at least 10 presentations on different topics at provincial/territorial, national, or international meetings; exclude local or hospital presentations and poster presentations. Do NOT send copies of presentations.

For each presentation, indicate the title, date, meeting name and location, the audience or group to whom the presentation was made (e.g., CSHP Professional Practice Conference), your role in the presentation..

The candidate has demonstrated ongoing commitment to educating health care practitioners, patients and the public through a variety of knowledge transaltion activities.

Describe your involvement in the areas/activities outlined in the scoring rubric. At least three (3) areas must be met:

Applicants are required to disclose whether generative AI tools were used in the preparation of the application. Generative AI includes tools used to draft, edit, summarize, organize, or refine written content.

CSHP recognizes that generative AI technologies may support applicants in preparing clear and well-organized materials. However, applicants remain fully responsible for the accuracy, originality, completeness, and integrity of all submitted content. The use of generative AI must not result in plagiarism, misrepresentation of experience or achievements, fabrication of information, or the inclusion of inaccurate or misleading content (in this is suspected, the application may be disregarded).

The use of generative AI will not negatively affect the review of an application, provided that its use is disclosed and the submitted materials accurately reflect the applicant’s own professional experience, contributions, and accomplishments.

By submitting this application, I confirm that I have disclosed any use of generative AI in the preparation of my application materials. I further confirm that all information submitted is accurate, truthful, and representative of my own work, experience, and achievements.

If you used generative AI in the preparation of this application, please disclose:

The candidate has provided the names of two recommenders who support this application and can attest to their contributions as a practitioner.

Recommenders must complete the Fellow Program Recommendation Form.

If you would like more information or clarification, please contact fellows@cshp.ca.