Evidence (1 of 2)
1. Additional Undergraduate Degrees and Qualifications
Please list any additional completed undergraduate qualifications with dates. Include intercalated BSc/ equivalent degree here, if you have one. Do not include details of your pre university school education/ exam results.
Some posts limit it to a maximum number of qualifications, some do not have a limit. For each one they require:
- Qualification
- Place of Study
- Grade/Honours
- Date Completed
2. Postgraduate Degree and Qualifications
Please give details of any completed postgraduate medical qualifications/ other degrees/ diplomas/ certificates (e.g. MD, MRCP etc.). Where a qualification is partly completed please state your exam status e.g. MRCP (Part 1) etc. State whether this is linked to your primary medical qualification or the result of an independent research thesis. Please include here any relevant qualifications listed as desirable on the person specification.
Some posts limit it to a maximum number of qualifications, some do not have a limit. For each one they require:
- Subject/Qualification
- Place of Study
- Grade/Result
- Date Completed/Qualification Awarded
3. Additional Achievements – Prizes, Awards and Distinctions
Prizes, awards and other distinctions (please include specialty and qualifying distinction). Please indicate whether these were awarded to you as an undergraduate or postgraduate.
Some posts limit it to a maximum number of prizes, awards and distinctions, some do not have a limit. For each one they require:
- Prizes/Award/Distinction [Words allowed: 50]
- Awarding Body [Words allowed: 50]
- Undergraduate or Postgraduate
- Date Awarded
4. Training Courses Attended
Include in this section the most relevant training courses to this specialty that you have attended and details of courses that you are currently undertaking. Please include any Advanced Life Support or similar courses mentioned in the Person Specification.
Some posts limit it to a maximum number of courses, some do not have a limit. For each one they require:
- Course Title [Words allowed: 50]
- Training Provider [Words allowed: 50]
- Duration of Course [Words allowed: 50]
- Date Completed
5. Grades and CCT Dates
What date are you expected to progress to the next grade of training (assuming satisfactory ACRP outcome)
For trainees training LTFT or are otherwise out of sync, please ensure you state the date you will go up to the next training grade, not the usual rotation date for your specialty.
What grade will you be on the date you have stated above?
What date will you complete your training programme (e.g. CCT date or date of completion of core training)
Supporting (2 of 2)
1. Achievements Outside of Medicine
Please give details of outstanding achievements outside the field of medicine [Words allowed: 100]
2. Presentation and Publications
In this section please provide details of your most relevant publications in journals or presentations to local bodies, regional or national societies. Please state whether the presentation was oral or a poster. Please give full citation details of any published work (please provide PubMed link or alternative in your answer). Please give a statement about your personal contribution to the work (e.g. first author, lead investigator)
Presentations at Local or Regional level [Words allowed: 600]
Presentations at National level [Words allowed: 600]
Presentations at International level [Words allowed: 600]
Publications in peer review journals as a co-author [Words allowed: 600]
Publications in peer review journals as a first author [Words allowed: 600]
Other publications – conference extracts etc. [Words allowed: 600]
3. Teaching and Audit
Teaching Experience
In this section please provide details of teaching and clinical audit experience. Please give full details including a statement about your personal contribution to the audit work
What experience do you have of delivering teaching? [Words allowed: 600]
Have you undertaken a teaching skills course or a formal qualification in teaching? (Yes/No)
Clinical Audit
What experience of clinical audit do you have? Please state clearly where and when this was undertaken and state specifically your role in each of the projects. [Words allowed: 600]
4. Suitability for Specialty
Describe how you believe you meet the person specification for the programme you are applying for. Include the particular skills and attributes that make you suitable for a career in this specialty [Words allowed: 200]
5. Commitment to the Specialty – Achievements and Activities
Please provide evidence of activities and achievements which demonstrate your commitment to a career in this specialty and/or have led to the development of skills relevant to career in this specialty [Words allowed: 200]
6. Management, leadership, teamworking and communication skills
Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in this specialty [Words allowed: 200]
7. Research Skills
Please give brief details of all research projects, and/or relevant research experience that you have undertaken or are undertaking, including methods used. Indicate your level of involvement and your exact role in the research team detailing when this took place, your time commitment, your contribution/involvement and source of funding. If you have been awarded a higher degree as a result of research, this must be detailed additionally in the appropriate section above. Detail your academic career plans, if applicable. [Words allowed: 600]
Please describe in more detail one of the research projects above [Words allowed: 300]
Please say why you want this particular Academic Clinical Fellowship, indicating your medium and long term career goals in relation to an academic career in this specialty area. [Words allowed: 300]
An ACF post comes fully funded from NIHR for 3 years and is not transferable to another doctor after the post has commenced. The specialty is also not transferable. If a doctor does not complete the ACF the funding is lost. Please describe how you benefit from a 3 year ACF to progress your academic career in your chosen specialty [Words allowed: 300]
8. General
(If the post is advertised with multiple specialty options available you may be asked to select which specialty you are applying for.)
Please indicate which specialty you are applying to from those available for this themed vacancy.