• Domain 1: Commitment to Specialty * (Option list (choose one))
  • A - Greater than one significant exposures to the work of a radiology department
  • B - One significant exposure to the work of a radiology department
  • C - Presented at a radiology course or conference
  • D - Attended a radiology related conference
  • E - None of the above

You are able to upload 2 pieces of evidence for your response to this domain. (Conditional)

• Please provide the total number of significant exposures you have had * (Text · Conditional)
• Title of evidence for domain 1 * (Text · Conditional)
• Date of evidence for domain 1 * (Date · Conditional)
• Title of first piece of evidence for domain 1 * (Text · Conditional)
• Date of first piece of evidence for domain 1 * (Date · Conditional)
• Title of second piece of evidence for domain 1 * (Text · Conditional)
• Date of second piece of evidence for domain 1 * (Date · Conditional)
• Please provide details of any other additional significant exposures, excluding the above * (Text box (long answer) · Limit: 250 words · Conditional)
• Domain 2: Leadership and Management * (Option list (choose one))
  • A - Hold/have held a national level leadership or managerial role involving radiology
  • B - Hold/have held a national level leadership or managerial role not involving radiology, but relating to healthcare OR hold/have held a local/regional level leadership or managerial role involving radiology
  • C - Hold/have held a national level leadership or managerial role outside healthcare OR hold/have held a local/regional leadership or management role not involving radiology but relevant to healthcare
  • D - Hold/have held a local/regional leadership or management role outside healthcare
  • E - None of the above
• Title of evidence for domain 2 * (Text · Conditional)
• Date of evidence for domain 2 * (Date · Conditional)
• Domain 3: Teaching and Training * (Option list (choose one))
  • A - Hold a formal teaching qualification awarded at postgraduate level, for example: masters, CILT, PGDip, PG Cert
  • B - Have made a major contribution to a national or international teaching programme, with evidence
  • C - Evidence of other training in teaching methods after study of at least 2 days (such as Train the Trainers)
  • D - Have evidence of regional teaching
  • E - None of the above
• Title of evidence for domain 3 * (Text · Conditional)
• Date of evidence for domain 3 * (Date · Conditional)
• Domain 4: Audit and Quality Improvement * (Option list (choose one))
  • A - I have led 2 or more audits or quality improvement projects relating to radiology which can be shown to have resulted in changed practice or evidence that current practice met the required standard (with no change needed)
  • B - I have led an audit or quality improvement project relating to radiology which can be shown to have resulted in changed practice or evidence that current practice met the required standard (with no change needed)
  • C - I have led one or more non-radiology audit/s or quality improvement project/s, shown to have resulted in changed practice or evidence that current practice met the required standard (with no change needed)
  • D - I have contributed to, but not led, an audit or quality improvement project
  • E - None of the above

There is an exception for the amount of evidence to upload for your response to this question. You should upload the evidence for the best 2 audits/QiPs, and provide the titles and dates for these, but in the last box you have an opportunity to detail all other Audits/QiPs excluding the 2 you will be evidencing. (Conditional)

• Please state the total number of audits you have led * (Text · Conditional)
• Please state the total number of Quality Improvement Projects you have led * (Text · Conditional)
• Title of evidence for domain 4 * (Text · Conditional)
• Date of evidence for domain 4 * (Date · Conditional)
• Title of first piece of evidence for domain 4 * (Text · Conditional)
• Date of first piece of evidence for domain 4 * (Date · Conditional)
• Title of second piece of evidence for domain 4 * (Text · Conditional)
• Date of second piece of evidence for domain 4 * (Date · Conditional)
• Please provide details of any other additional QI projects, excluding the above * (Text box (long answer) · Limit: 250 words · Conditional)
• Domain 5: Academic Achievements * (Option list (choose one))
  • A - I hold a postgraduate research degree or research Masters (PhD, MD, MDRes) OR I have at least 1 peer-reviewed publication relating to radiology as first author
  • B - I have at least 1 peer-reviewed publication relating to radiology not as the first author OR I have at least 1 peer-reviewed publication not relating to radiology but as a first author OR A case report related to radiology as first author OR At least 1 oral or poster presentation relating to radiology at a national or international level, as first author
  • C- I have at least one peer-reviewed publication, not relating to radiology, not as first author OR A case report not related to radiology, as first author, OR At least one oral or poster presentation relating to radiology at local/regional level, as first author
  • D - An author (not first author) of at least one published case report OR An author (first or subsequent) of at least one oral or poster presentation not relating to radiology at either local, regional, national or international level OR involvement in a research team as part of an elective, intercalated degree, extended student research and enterprise project, academic foundation programme, academic summer school or other research taster OR I have at least one peer-reviewed publication as a consortium author with any credit
  • E - None of the above
• Title of evidence for domain 5 * (Text · Conditional)
• Date of evidence for domain 5 * (Date · Conditional)

You have scored yourself E on all 5 Domains. As per our guidance your application will not progress if submitted. Please review your responses or consider whether you want to submit. (Conditional)