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. For an MD please 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.

For each qualification:

• Subject/Qualification
• Place of Study
• Grade/Result
• Date Completed

Prizes, awards and other distinctions (please include specialty and qualifying distinction). Please indicate whether these were awarded to you as an undergraduate or postgraduate.

For each Prize/Award/Distinction:

• Prize/Award/Distinction
• Awarding Body
• Undergraduate or Postgraduate
• Date Awarded

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.

For each course:

• Course Title
• Training Provider
• Duration of Course
• Date Completed

Please give details of outstanding achievements outside the field of medicine (Words allowed 100)

In this section please provide details of your most relevant publications in journals or presentations to local bodies, regional, national or international 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 international level (Words allowed 200|600|No wordcount limit)

Presentations at national level (Words allowed 200|600|No wordcount limit)

Presentations at regional or local level (Words allowed 200|600|No wordcount limit)

Publications in peer review journals (Words allowed 200|600|No wordcount limit)

Other publications - conference extracts etc. (Words allowed 200|600|No wordcount limit)

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.

TEACHING EXPERIENCE

What experience do you have of delivering teaching? Have you undertaken a teaching skills course or a formal qualification in teaching? (Words allowed 200|600|No wordcount limit)

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 200|600|No wordcount limit)

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)

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 a career in this specialty. (Words allowed 200)

Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in this specialty. (Words allowed 200)

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 300|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)

Specialty and Research

In this section, please provide details of commitment to specialty choice and research experience. Please give full details, include a statement about your personal contribution to research work.

Describe how you believe you meet the person specification for the programme you are applying for. Include the evidence of skills and attributes that demonstrate your commitment to a career in this specialty.

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.

Please describe in more detail one of the research projects above where you have made a significant contribution.

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.

Please tell us what you consider to be the most important advance in research in the last 5 years in your chosen specialty and why?

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)

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)

Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in this specialty (Words allowed 200)

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)

 

Please note you should only complete this if you are in a UK National training programme eg not a trust grade resident doctor. If you are not clear if you are in this programme please contact us before you submit your application for clarification via the applicant enquiries portal.

Please indicate your current training grade as of today (e.g. ST1)

Are you training Less Than Full Time (LTFT) or would you be classed as an “out of sync” trainee (e.g. you started later in the training year than usually expected and rotate to the next training grade at a different month than usually expected)

Please indicate the date you are expected to rotate to the next grade of training (assuming satisfactory ARCP outcome). If you are in the final year of a core training programme, please indicate the date on which you will complete this.

If you are 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. If you don’t know the exact date, select the first Wednesday of the month you are expected to progress to the next grade.

Please indicate the grade you will be when you rotate to the next grade of training (assuming satisfactory ARCP outcome) (e.g. ST2). If you are in the final year of a core training programme, please indicate the grade at which you intend to take up this ACF.

This section is for all degrees you have completed including: intercalated degrees/BSc/ BA/MSc/MRes/Masters/MPhil/PhD/MD or equivalent, if you have one.

Please include any person specification (essential or desirable) relevant exams/degrees eg MRCP Part 1 and date awarded.

Do not include details of your pre university school education/exam results.

Where you have nothing to add, please tick the box below.

For each qualification:

• Qualification
• Grade
• Date completed
• Place of study

Please tick this box if you have intentionally not added information to the table above - Degree in a relevant subject area, Qualifications and Postgraduate degrees [tickbox]

Prizes, awards and other distinctions (please include specialty and qualifying distinction). Please indicate whether these were awarded to you as an undergraduate or postgraduate.

Where you have nothing to add, please tick the box below.

For each prize/award/distinction:

• Prize/Award/Distinction (Words allowed 50)
• Awarding Body (Words allowed 50)
• Undergraduate or Postgraduate
• Date awarded

Please tick this box if you have intentionally not added information to the table above - Prizes, Awards and Distinctions [tickbox]

In this section please provide details of formal teaching roles experience or higher education teaching qualifications such as FHEA.

What experience do you have of delivering teaching? (Words allowed 600)

If you have nothing to add, please input “N/A”

Have you undertaken a teaching skills course or a formal qualification in teaching? [yes/no]

In this section please provide details of your most relevant publications in journals.

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)

Where you don’t intend to provide any, please enter a single line titled “N/A”

Abstracts published as a co-author (Words allowed 600)

Abstracts published as a first author (Words allowed 600)

Publications in journal/s as a co-author (Words allowed 600)

Publications in journal/s as a first author (Words allowed 600)

Other publications - conference extracts etc. (Words allowed 600)

In this section please provide presentation to local / regional bodies, national or international societies.

Please state whether the presentations are oral or a poster.

Presentations at Local or Regional level (Words allowed 600)

Presentations at National level (Words allowed 600)

Presentations at International level (Words allowed 600)

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)

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)

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)

Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in this specialty (Words allowed 200)

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.

Where you have nothing to add, please tick the box below.

For each course:

• Course Title (Words allowed 50)
• Training Provider (Words allowed 50)
• Duration of Course (Words allowed 50)
• Date Completed

I have left this section blank because I have nothing to add [tickbox]

Please give details of outstanding achievements outside the field of medicine (Words allowed 100)

Please note you should only complete this if you are in a UK National training programme eg not a trust grade resident doctor. If you are not clear if you are in this programme please contact us before you submit your application for clarification.

Trainees with an NTN/DRN in the same training programme as this post must also provide evidence that they are on track to continue their core/specialty training.  

For those currently in a training post within the same region as this post, acceptable evidence includes most recent ARCP. 

For those currently in a training post outside of the same region as this post, acceptable evidence includes the ‘Support for Continuing Specialty Training in Another Region’ form. This can be found in the Resource Bank.

Please select which of the following describes your status and upload the relevant documentation to your Oriel application.

• A) I am currently training within the advertised region and will provide my most recent ARCP.
• B) I am currently training within the advertised region but I am in my first year of training and don’t yet have an ARCP. I confirm that I am on track to progress satisfactorily.
• C) I am currently training outside the advertised region and will provide a ‘Support for Continuing Specialty Training in Another Region’ form.

As stated above, applicants without a Deanery Reference Number (DRN) or National Training Number (NTN) in the GMC core/specialty training programme and level to which they are applying must be found appointable at the core/speciality training interviews in the 2026 Recruitment Round 1/Round 2 (where applicable). This is called clinical benchmarking. Click here for the timeline. If no national recruitment is available at the core/specialty training programme and level to which they are applying, applicants without a DRN/NTN are ineligible. Please click here for more information.

If the above applies and you do not apply to clinically benchmark, we will not be able to progress your application.

Please note that additional documentation may be required, dependant on the NIHR Person Specification and the Person Specification for the specialty to which you are applying.

Applicants with an NTN based outside of the region to which they are applying must provide a ‘Support for Continuing Specialty Training in Another Region’ form.

Applicants who have previously relinquished a specialty training programme must provide a ‘Support for Reapplication to Specialty Training’ form.

I confirm I have provided the documentation that is required both by the NIHR Supplementary Person specification (located in the documents page of this vacancy) and within the person specification for the specialty to which I am applying. [tickbox]  

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.

For each qualification:

• Qualification
• Place of study
• Grade
• Date completed

Please give detail 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 (Part1) State whether this is linked to your primary medical qualifications or the result of an independent research thesis. Please include here any relevant qualifications listed as desirable on the person specification

For each qualification:

• Subject/Qualification
• Place of Study
• Grade/Result
• Date qualification awarded

Prizes, awards and other distinctions (please include specialty and qualifying distinction). Please indicate whether these were awarded to you as an undergraduate or postgraduate.

For each achievement:

• Prize/Award/Distinction (Words allowed 50)
• Awarding Body (Words allowed 50)
• Undergraduate or Postgraduate
• Date awarded

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.

For each course:

• Course Title (Words allowed 50)
• Training Provider (Words allowed 50)
• Duration of Course (Words allowed 50)
• Date Completed

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)

Please give details of outstanding achievements outside the field of medicine (Words allowed 100)

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 a peer review journal as a first author (Words allowed 600)

Other publications - conference extracts etc. (Words allowed 600)

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

Teaching Experience 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)

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)

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)

Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in this specialty (Words allowed 200)

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)

Additional question asked on North East form: 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)

 

Please give details of outstanding achievements outside the field of medicine )Words allowed 100)

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 national level (Words allowed 200)

Presentations at local or regional level (Words allowed 200)

Publications in peer review journals (Words allowed 200)

Other publications - conference extracts etc. (Words allowed 200)

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

TEACHING EXPERIENCE

What experience do you have of delivering teaching? Have you undertaken a teaching skills course or a formal qualification in teaching? (Words allowed 200)

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 200)

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 300)

Please describe in more detail one of the research projects above (Words allowed 300)

Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in this specialty (Words allowed 200)

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)

ACTIVITIES AND ACHIEVEMENTS

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)

ACADEMIC GOALS

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 200)

Please list any additional completed undergraduate qualifications with dates. Include intercalated BSc or equivalent degree here, if you have one. Do not include details of your pre university school education/exam results.

For each qualification:

• Qualification
• Place of Study
• Grade
• Date completed

Please give detail 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 (Part1) State whether this is linked to your primary medical qualifications or the result of an independent research thesis. Please include here any relevant qualifications listed as desirable on the person specification

For each qualification:

• Subject/Qualification
• Place of Study
• Grade/Result
• Date qualification awarded

Prizes, awards and other distinctions (please include specialty and qualifying distinction). Please indicate whether these were awarded to you as an undergraduate or postgraduate.

For each achievement:

• Prize/Award/Distinction (Words allowed 50)
• Awarding Body (Words allowed 50)
• Undergraduate or Postgraduate
• Date awarded

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.

For each course:

• Course Title (Words allowed 50)
• Training Provider (Words allowed 50)
• Duration of Course (Words allowed 50)
• Date Completed