• Description of achievement and explanation of relevance to paediatric application (50 words max) Example 1 * (Text · Limit: 50 words)
• Reflection on how this demonstrates your suitability for a career in paediatrics (50 words max) Example 1 * (Text · Limit: 50 words)
• Description of achievement and explanation of relevance to paediatric application (50 words max) Example 2 (Text · Limit: 50 words)
• Reflection on how this demonstrates your suitability for a career in paediatrics (50 words max) Example 2 (Text · Limit: 50 words)
• Description of achievement and explanation of relevance to paediatric application (50 words max) Example 3 (Text · Limit: 50 words)
• Reflection on how this demonstrates your suitability for a career in paediatrics (50 words max) Example 3 (Text · Limit: 50 words)
• Description of achievement and explanation of relevance to paediatric application (50 words max) Example 4 (Text · Limit: 50 words)
• Reflection on how this demonstrates your suitability for a career in paediatrics (50 words max) Example 4 (Text · Limit: 50 words)
• Description of achievement and explanation of relevance to paediatric application (50 words max) Example 5 (Text · Limit: 50 words)
• Reflection on how this demonstrates your suitability for a career in paediatrics (50 words max) Example 5 (Text · Limit: 50 words)

• Which of the following best describes your QI/Audit project? Example 1 * (Drop-down)
  • Audit
  • QI project
  • QI project/Audit with multiple cycles
• Describe your role in the audit/QIP project. (50 words max.) * (Text · Limit: 50 words)
• Describe how/where you presented the audit/QIP and any change in practice that happened as a result. (50 words max.) * (Text · Limit: 50 words)
• Which of the following best describes your QI/Audit project? Example 2 (Drop-down)
  • Audit
  • QI project
  • QI project/Audit with multiple cycles
• Describe your role in the audit/QIP project. (50 words max.) (Text · Limit: 50 words)
• Describe how/where you presented the audit/QIP and any change in practice that happened as a result. (50 words max.) (Text · Limit: 50 words)

• Description of the research/academic achievement (50 words max.) Example 1 (Text · Limit: 50 words)
• Which of the following apply to the example of research/academic achievement you have chosen? (Drop-down)
  • Some involvement in a research project/piece of academic work
  • Led on a research project/piece of academic work
  • Significant contribution to recruitment
  • Significant contribution to data collection
  • Significant contribution to data analysis
  • Presentation at local meeting
  • Presentation at regional meeting
  • Presentation at national/international meeting
  • Publication as co-author
  • Publication as first or last author
• Describe the nature of your research project/academic work, your role and what your role involved. (50 words max.) (Text · Limit: 50 words)
• Description of the research/academic achievement (50 words max.) Example 2 (Text · Limit: 50 words)
• Which of the following apply to the example of research/academic achievement you have chosen? (Drop-down)
  • Some involvement in a research project/piece of academic work
  • Led on a research project/piece of academic work
  • Significant contribution to recruitment
  • Significant contribution to data collection
  • Significant contribution to data analysis
  • Presentation at local meeting
  • Presentation at regional meeting
  • Presentation at national/international meeting
  • Publication as co-author
  • Publication as first or last author
• Describe the nature of your research project/academic work, your role and what your role involved. (50 words max.) (Text · Limit: 50 words)

• Describe an example of education/teaching session(s)/programme you have been involved in (50 words max.) Example 1 (Text · Limit: 50 words)
• Describe your involvement, including any evaluation and subsequent modifications that you carried out (50 words max.) (Text · Limit: 50 words)
• Describe an example of education/teaching session(s)/programme you have been involved in (50 words max.) Example 2 (Text · Limit: 50 words)
• Describe your involvement, including any evaluation and subsequent modifications that you carried out (50 words max.) (Text · Limit: 50 words)

I confirm I do not exceed 24 months (2 years) whole time equivalent experience in Paediatrics (excluding foundation modules) at point of application as evidenced in my employment history.

• Confirm experience * (Tick box)