3rd SingHealth Duke-NUS Education Conference

Call for Proposals: Symposium/Workshop
Deadline for submission: 3rd March 2017

(A)DETAILS OF MAIN PRESENTER

Note:Thisproposal must be submitted by the main presenter. The information will be used for contact and publicity purposes.

Salutation:
Please tick accordingly / ☐Prof☐Assoc Prof☐Asst Prof☐Dr☐Mr
☐Mrs☐Ms ☐Mdm
Profession: / ☐Doctor ☐Nurse ☐Allied Health ☐Resident
☐ Students (please indicate programme):
☐ Others:
Full Name:
Please underline your family name
Organisation:
Primary ACP:
Department:
Designation:
ContactDetails: / (Mobile) / (Office)
Email Address:

(B)MAIN PRESENTER: BRIEF INTRODUCTION

In less than 100 words, please provide a short write-up of yourself.

(C)DETAILS OF CO-PRESENTERS

Pleaseprovide the particulars of the other presenters in your symposium/workshop.

Full Name(includingsalutation):
Please underline your family name / Organisation: / Department: / Designation:

(D)PROGRAMME PROPOSAL DETAILS
You may usethe sample proposal submission on our website as a reference.

Programme Type:
Please tick accordingly / ☐Symposium (discussion-based)
Symposiums provide an opportunity for the presentation and discussion of ideas pertaining to healthcare education.
☐Workshop (skill-based)
Workshops are interactive, hands-on and participative sessions that allow participants to develop their skills.
Please indicate your preferred1 date:
☐Pre-Conference (25-27 Sep 2017)
☐During the Conference (29-30 Sep 2017)
☐Post-Conference (2-4 Oct 2017)
Programme Title:
Programme Duration:
Please tick accordingly / Symposium:☐60-min☐120-min
Workshop:☐120-min☐180-min
Motivation for Programme:
E.g. Rationale, personal work experience, new & innovative idea/literature, etc. (within 50 words)
ProgrammeDescription:
Please address the following guidelines ONLY where applicable
(1)Programme Outline(within 300 words, as you would like it listed in the conference programme):
(2)Learning Objective(s):
(3)How achievement of objectives will be measured2:
(4)Intended Audience3:
(5)Programme Format4:
(6)Detailed Programme Schedule (within the above-selected duration):
(7)Maximum number of participants:

1 Assigned workshop schedule may not necessarily be made according to your preference.

2For example: classroom based worksheets; pre-post-test; informal qualitative discussions etc.

3Please include their prerequisite level of knowledge/experience in the topic, if necessary.

4 For example: teaching methods, activities, key discussion questions, take-home messages

(A)SUBMISSION

Email the completed form to the secretariat at
by3rd March 2017. You will receive an acknowledgement email upon submission.

(E)CONSENT

By submitting this form, youhereby consent to:

  • the Secretariat of the 3rdSingHealth Duke-NUS Education Conference collecting, using and/or disclosing your personal data in compliance with the Singapore Personal Data Protection Act (PDPA) and all subsidiary legislation for the purpose of the Conference, subsequent registration to and all other actions necessary in relation to the event.
  • the Secretariat of the 3rd SingHealth Duke-NUS Education Conference and its related corporations and its service providers taking your photographs during this Conference for use in promotional brochures, publicity and other related purposes.

3rd SingHealth Duke-NUS Education Conference| 29 & 30 September 2017Page 1