Ethics Committee
Chair Application Form
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example@example.com
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example@example.com
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I'm an anaesthesiologist, not working in ICU.
I'm an intensivist or an anaesthesiologist working primarily in ICU
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1. Scientific Profile and Expertise
1.1 Please describe your core scientific focus and specific expertise in ethical matters related to ethical decision-making in anaesthesiology, pain and intensive care medicine:
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0/2500
1.2 List up to five key publications from the past five years that are most relevant to the Committee:
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1. 2. 3. 4. 5.
0/3000
Indicate your Hirsch Index (h-index) obtained via SCOPUS only.
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1.3 Describe your experience in contributing to national or international scientific meetings, courses or educational programmes:
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Applicants must have an established international network in the field they are applying for. Please provide details.
0/2500
Ethics Committee Members must be apt to serve as speakers in relevant scientific and educational programmes organised by the ESAIC, including Euroanaesthesia.
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I hereby confirm my full proficiency in spoken English and my capability to deliver lectures on an international stage.
Share a link to a short video of a presentation you’ve delivered in English.
This can be from any context (academic, professional, or other).
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2. Motivations and Added-Value for the Committee
2.1 What are your motivations for applying for this position? What new perspectives, skills or approaches would you bring to this Committee?
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0/2500
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3. Contribution to ESAIC and Engagement
3.1 What do you consider your most valuable contribution to ESAIC?
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If you have not previously held a formal ESAIC role, please describe other contributions that demonstrate your engagement with another society and its mission.
0/2500
3.2 Availability and engagement: Please confirm and briefly explain your ability to commit sufficient time to this role and how you ensure follow-through alongside clinical duties?
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0/2500
3.3 List all the roles you CURRENTLY hold in other ESAIC Committees and/or other scientific societies:
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4. Collaboration and Values
Working within ESAIC values:
ESAIC Code of Conduct
4.1 Describe how you ensure that your contributions align with the ESAIC Code of Conduct, particularly with regard to collaboration, managing conflicts of interest and inclusiveness:
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0/2000
4.2 Please declare any conflict of interest, i.e. relationship or arrangement with a commercial company, direct or indirect, that could be reasonably considered to affect the work in the EthicsCommittee.
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I have no potential conflict of interest to report.
I, or my spouse/partner, have the following potential conflict of interest(s) to report:
Receipt of grant/research support
Receipt of honoraria or consultation fee
Participation in a company sponsored speaker’s bureau
Stock shareholder
Other support (please specify)
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Finalise your application
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I have read and agree to comply with the ESAIC Code of Conduct
I confirm that I will declare and manage any conflicts of interest according to ESAIC policies.
I understand that insufficient engagement or breach of ESAIC principles may result in non-renewal or termination of the mandate.
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