American College of Emergency Physicians

National Emergency Medicine Medical Student Award 2010

Nomination Form

Due Date: February 15, 2010

Please follow instructions closely, and make sure you have included all

requested information listed on the checklist. Electronic submissions only.

Please refrain from sending extraneous information.

American College of Emergency Physicians

National Emergency Medicine Medical Student Award 2010

Application Packet

Please read these instructions carefully. Applications that do not follow these instructions with regard to format and supporting documentation cannot be accepted. If the application deadline has not passed, the application may be resubmitted after deficiencies are addressed. Extension of the deadline will not be granted to allow resubmission in the award cycle.

Also included for your reference are forms used by the reviewers to score and evaluate an application. The procedures for review are outlined below:

1.  Reviews by ACEP staff to ensure all submission instructions have been followed.

2.  Initial review of successful applications by the Academic Affairs Committee Chair and Academic Affairs Teaching Awards Subcommittee Chair to ensure eligibility, suitability, and general competitiveness for this category of award.

3.  Successful reviewed applications by the Academic Affairs Teaching Awards Subcommittee are recommended for an award.

4.  Successful applications will be submitted to the ACEP Board of Directors for a final decision.

General Information

Deadlines

Deadline for receipt of application: February 15, 2010

Notification of award: March 31, 2010

Mail electronic file of application to: ACEP National Medical Student Award

American College of Emergency Physicians

1125 Executive Circle

Irving, TX 75038-2522

Introduction

The American College of Emergency Physicians sponsors a national medical student award to honor outstanding students in emergency medicine who have demonstrated excellence the values important to ACEP.

The award is designed for students who recognize and promote emergency medicine as an essential public service. The student should show commitment to high quality patient care, teaching, leadership, research, and innovation. The award will recognize students that have shown evidence of a high level of humanism, professionalism, and clinical judgment. Students should be involved with community service and research that supports the values of emergency medicine. Students should show commitment to service in medical organizations.

While the documentation required for this award is extensive, the process is designed to mimic the procedure used by university promotion and tenure committees in their tenure deliberations. Recipients of this award will receive national recognition that can be used to document their excellence in humanism and professionalism in medicine.

Scope

The College will recognize up to 10 award winners annually.

Recognition

Award winners will be recognized during ACEP’s Academic Affairs Committee meeting held during the annual Society for Academic Emergency Medicine annual meeting.

Award winners will be recognized during the ACEP Awards Ceremony at the Scientific Assembly meeting.

Award winners will be recognized by the publication of their names in ACEP News or other College publications.

ACEP Academic Affairs Committee has urged recognition of the award winners at their respective medical school graduations. We encourage nominators and departmental directors to suggest that medical school deans include this award in graduation exercises.

Eligibility

To be eligible for the award, the student must:

1.  Be a member in good standing of a US allopathic or osteopathic medical school.

2.  Applying for a position in Emergency Medicine within the National Resident Matching Program (NRMP) match.

Process and Limitations

1.  Students must be nominated by the EM academic chair, residency program director, or clerkship director, and submit a complete official application form. Include a CV as part of the application form.

2.  Nominations are reviewed by a subcommittee of the Academic Affairs Committee. Subcommittee recommendations are presented to the ACEP Board of Directors for approval.

Criteria

The Academic Affairs Committee will evaluate applications in each of the following categories:

1.  Letter of endorsement by the program’s academic chair, program director, or head of emergency medicine declaring the department’s support for the nomination.

2.  Humanism, professionalism, leadership, and clinical judgment as attested to by the nominating individual.

3.  Leadership and service to medical organizations (e.g. AMSA, EMRA, ACEP, EMIG)

4.  Community service (e.g. local clinics, missions, etc.)

5.  Research and publications

6.  Academic excellence

Nominees are scored in each category and numerical results tabulated. Prior to submission of their recommendations to the ACEP Board of Directors, the entire subcommittee reviews final tabulations and all relevant data on each applicant.

Application Instructions

The application must be received on CD-ROM or disk no later than the deadline date indicated under general information, and should also include a hard copy. Electronic files should be in PDF or MS Word format and any printed material not included on CD or disk will not be considered in the review.

All applications must be in English and free of jargon and unusual abbreviations. For terms not universally known, spell out the term the first time it is used with the appropriate abbreviation in parentheses; the abbreviation may be used thereafter. Type the application, single-space; type size should be 12-point font with headings no larger than 14 point. While submission of a CV is required, the CV will not be considered a sufficient response to sections 4-7.

Incomplete or late applications will not be considered.

The application consists of seven sections and should be placed in this order:

1. Title Page

Provide all information requested (template on page 8). Note that the academic chair, program director, or clerkship director must sign the title page. The electronic file must include signatures.

2. Endorsement by the Academic Chair, Program Director, or Head of Emergency Medicine

The applicant must include a letter from the academic chair, program director, or clerkship director outlining their assessment of the applicant’s humanism, professionalism, leadership, and scholarly achievement . Providing examples or supporting information constitute the strongest endorsement. The program director, academic chair or clerkship director is responsible for the verification of the application material by signifying they have reviewed and verified the authenticity of the packet materials, especially with regard to authenticity of leadership and service to medical organizations, community service, and research and publications. This letter should acknowledge the department’s support for the nomination.

3. Endorsement by the Nominator

The applicant must include a letter written by the nominator entailing the humanism, professionalism, leadership, and clinical judgment of the applicant; examples constitute the strongest endorsement. This may include input from the program's residents, the student's peers, or pertinent comments from other faculty.

4. Documentation of leadership and service to medical organizations

The applicant should summarize any leadership positions held within and service to medical organizations (e.g. AMSA, EMRA, ACEP, local EMIG, University or SOM). Include extent and duration of service or leadership position held.

5. Documentation of community service

Applicant should list and briefly describe any type of community service that applicant was involved in during medical school (e.g tutoring, underserved clinics). Include extent and duration of involvement, leadership positions held, and any innovations or improvements directed.

6. Documentation of Research and Publications

The applicant should provide detailed information about any and all research activities related to medicine to include abstracts accepted, oral or poster presentations, and publications. Publications may include editorial letters, case reports, research, book chapters, and educational articles. All current and past research activities during medical school should be listed with attention given to the applicant’s level of participation.

7.  Awards

The applicant should provide detailed information about any awards received during medical school to include AOA membership.

  1. Academic Excellence

Grades during medical school, performance on USMLE step 1 and 2, as well as class rank should be supplied. Include the applicant’s MSPE or Dean’s letter submitted with the ERAS application.

Application Checklist

Before submitting your application, please use this checklist to ensure you have complied with all application requirements.

□ Nominee meets eligibility requirements on page 4

□ Application includes all seven sections in the order given on pages 5 and 6

□ Application includes signed title page (template on page 8)

□ Title page includes electronic signatures

□ Application is being submitted via e-mail as electronic files in PDF or MS Word format

□ Application is being submitted by the deadline


Title Page

Name of Nominee:

Business Address:

Telephone Number:

Fax Number:

E-Mail Address:

Name of Individual completing this application (if different from applicant):

Address:

Is applicant aware of nomination? □‮ Yes □‮ No

Academic Chair / Program Director / Clerkship Director
Date / Date / Date

2 Revised: 3/15/08