Aoa Director of Medical Education Change Form

AOA DIRECTOR OF MEDICAL EDUCATION CHANGE FORM

AOA Director of Medical Education Change Form (rev. 06/2012)

I.UINTRODUCTIONU

New Director of Medical Education appointments for AOA postdoctoral training programs must be approved by the AOA Internship Evaluating Committee (IEC) and acknowledged by the AOA Division of Postdoctoral Training. The AOA Program and Trainee Review Council (PTRC)is advised of all such acknowledgements. The AOA Basic Document for Postdoctoral Training (rev. 07/2011) Section VI, A, 6.4states that, “The base institution must notify the AOA Division of Postdoctoral Training of any change in appointment of DME within 30 days, with copy to the OPTI. A change in DME may result in an immediate re-inspection of the internship. The IEC will review and approve appointments and DME changes are reported to the PTRC.”

II.UINSTRUCTIONSU

Please complete Section III and IV below and submit this form to the AOA Division of Postdoctoral Training along with an appointment letter signed by the CEO and a copy of the candidates current Curriculum Vitae. This form and required documents should be sent toThe AOA Division of Postdoctoral Training142 East Ontario Street, Chicago, IL 60611. You may also submit the request through your OPTI via FileWorks. Contact your OPTI representative for more information. The AOA Division of Postdoctoral Training will copy the IECupon receipt. Programs must notify their OPTI representative of the proposed change.

III.UBASIC INFORMATION

Name of Proposed DME / Base Institution Name / Effective Date of Appointment

IV.UQUALIFICATIONSU

The following are minimum qualifications for the position of Director of Medical Education as listed in the AOA Basic Document for Postdoctoral Training (rev. 07/2011) Section VI, A, 6.1. The Basic Document may be found on the AOA osteopathic.org website by selecting “Education” in the menu bar at the top left corner of the home page and then clicking “Postdoctoral Training” in the drop-down-menu that appears. Next choose “Basic Documents for Postdoctoral Training Programs.”

Please mark the corresponding check box to indicate that the candidate meets the qualification

1. Be AOA Board certified or obtain AOA board certification within three (3) years (if board
certified by the American Boards of Medical Specialties [ABMS]) through a recognized
AOA pathway. / Yes No
2. Member in good standing of both the AOA and Association of Osteopathic Directors and
Medical Educators (AODME). / Yes No
3. Possess a minimum three years practice experience. / Yes No
4. Possess a minimum three years experience as teaching faculty member in an OGME
program or college of osteopathic medicine (COM). / Yes No
5. The AOA Basic Document for Postdoctoral Training Programs (rev. 07/2009) states that, “The DME shall only function in this capacity at one Base Institution.” Please mark the box to the right to verify that if approved the DME will only serve as DME for the Base Institution named in Section III of this form. / Yes No
Signature of CEO / Printed Name and Title

AOA Director of Medical Education Change Form (rev. 06/2012)