Clone of Clone of EOI Form: Emergency Department Clinical Quality Registry Steering Group (EDCQRSG)

Expression of Interest Form: Community Member

The Australasian College for Emergency Medicine (ACEM; the College) is inviting Expressions of Interest (EOIs) for appointment to up to five (5) Community Member positions on its newly established Research Prioritisation Steering Committee (RPSC). The RPSC has been established to lead an emergency medicine research prioritisation exercise in partnership with the James Lind Alliance, supported financially by the ACEM Foundation. The objective is to identify and prioritise knowledge gaps in emergency care from both consumer and clinical perspectives in Australia and Aotearoa New Zealand. To be eligible, individuals must not be a College member, must not be enrolled in an ACEM training program, and must not be otherwise ineligible under College regulations or the ACEM Constitution. ACEM Community Members currently serving on a College entity are eligible to apply.

Applications must be received by the College by not later than 9:00am (AEST) on 12 June 2026.

1. Applicant Details

Please provide your details below.

ACEM ID (if applicable)

Name:

TtileFirst NameLast Name

Email:

example@example.com

Address:

Street Address

Street Address Line 2

CityState / Territory

Postal / Zip Code

Phone number:

Please indicate your gender identity:

Are you Aboriginal, Torres Strait Islander or Māori? (please select all boxes that apply):

2. Available Positions

The purpose of the RPSC is to provide expertise and direction to the conduct of an ACEM Clinical Trials Network research prioritisation exercise. The RPSC will identify unanswered questions about emergency care from consumer and clinical perspectives in Australia and Aotearoa New Zealand and develop a list of the top ten research priorities for the next five years. The RPSC reports to the ACEM Research Advisory Committee and will operate for the duration of the two-year project.

The top ten research priorities will be used to inform ACEM strategic priorities for research and advocacy, decision-making on what research projects to support, and awareness among clinician researchers of strategic priorities for grant development. The RPSC will also support the publication and promotion of the top ten priorities to emergency care policy makers, clinicians, and research funders.

The RPSC is seeking Community Members who can contribute the lived experience of patients, carers, or members of the public in relation to emergency care in Australia and Aotearoa New Zealand. Five (5) community member positions are available, including one position for a person who identifies as Aboriginal and/or Torres Strait Islander, one position for a person who identifies as Māori, and three general community member positions.

3. Supporting Statements

a) Statement of Intent

Please provide a brief statement that describes the contribution that you feel you could make to the Research Prioritisation Steering Committee (RPSC) and addresses the requirements of the role and relevant experience (not exceeding 500 words):

0/500

b) Statement on the ACEM Core Values

The ACEM Core Values of respect, integrity, collaboration, and equity define the organisation’s guiding principles, and underpin the way ACEM works in order to meet its vision and mission of ensuring the highest standards are maintained in the training of emergency physicians, and in the provision of emergency care to the communities of Australia and Aotearoa New Zealand.

Please describe how you demonstrate a commitment to the ACEM Core Values (not exceeding 500 words):

0/500

4. ACEM Core Values Module

All appointees to ACEM roles and entities are required to have completed the ACEM Core Values module. Please indicate if you have completed the module or confirm your undertaking to complete the module if appointed.

ACEM Core Values module status:

5. Curriculum Vitae

The Curriculum Vitae provided will be made available to members of the Steering Group, ACEM Recruitment and/or their delegates for consideration of appointment. Please ensure any personal details are omitted, as required.

Please upload a copy of your current Curriculum Vitae:

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6. Conflicts of Interest

ACEM requires all entity members to disclose any conflicts of interest (perceived or actual) in line with the Conflict of Interest Policy (COR139). Please indicate any conflicts of interest to be considered in the context of potential appointment to the Research Prioritisation Steering Committee (RPSC). If there are none, then please leave this field blank.

Conflicts of Interest:

7. Declaration

I declare that the information provided in this application is true and accurate to the best of my knowledge. I confirm that I provide the perspective of non-clinical individuals on emergency medicine care to the Research Prioritisation Steering Committee (RPSC) being that I am not a College member, not enrolled in an ACEM training program, and not otherwise ineligible for appointment pursuant to College regulations or policies. I also acknowledge that my Curriculum Vitae and Supporting Statements will be made available to members of the committee, ACEM Recruitment and/or their delegate for consideration of appointment.

Signature (please make your mark on screen)