Atls Registration Information

ATLS REGISTRATION INFORMATION

Name: ______

Title: MD____ DO ____ Other: ______

Resident: (circle one) Y N

Specialty: ______

Previous ATLS Course: Date ______Location ______

Were you rated as having Instructor Potential?

Yes ____ No ____

ATLS ID #:______

Street Address: (course materials will be mailed to this address)

City, State, Zip: ______

Daytime Phone: ______

Fax Number: ______

Email address: ______

Registration

Registration is limited to 9 participants. The fee for the course is $500.00. KU Physicians – We will waive your course fee in exchange for teaching 1 full (2 day) course after you complete your instructor candidacy (student teaching does not count) You will receive course materials, breakfast, and lunch.

Advanced

Trauma

Life

Support®

February 15-16, 2013

Instructor Course Schedule

Course Description

The Advanced Trauma Life Support Instructor Course is designed for physicians who have the qualifications and characteristics of an ATLS Instructor. Incorporated into the Instructor Course are teaching techniques designed to instruct participants in the specific educational philosophies, goals, and methods of teaching your peers in future ATLS Courses. In conjunction with the teaching techniques presented, you will be required to present a mini-lecture, teach specific skills procedures, and critique your colleague’s lecture and /or skills presentation. Medical content is not presented in this course as it is in the Student Course

Prerequisite/Eligibility Requirements

In order for an applicant to enroll in the ATLS Instructor Course, the participant must have taken the Student or Student/Refresher Course within the last three years and must have been identified as possessing instructor potential. The Course Director should have notified you if you were rated as having instructor potential. If you have questions regarding your eligibility, please call us and we can verify your eligibility.

Objectives

Upon completion of the ATLS course, the participant should be able to:

Lead a group discussion.
Possess skills-teaching abilities.
Demonstrate critiquing skills.

**MANDATORY FOR COURSE**:

A copy of your current ATLS® Student card must accompany your enrollment application. Without it, we cannot accept your application.

To enroll, complete the entire course enrollment form and mail with a check payable to University of Kansas Hospital. Course material cannot be sent until the registration fee and enrollment form has been received. Course materials will be sent out 30 days prior to the course.

SORRY, WE DO NOT ACCEPT CREDIT CARDS NOR CAN WE ACCEPT REGISTRATIONS BY PHONE.

University of Kansas HospitalTrauma Services reserves the right to cancel the program due to insufficient enrollment. In this event, you will be notified and your entire registration fee refunded.

Refunds and Cancellations:

No refunds will be issued if participants can not attend the class date they have registered for, however we do allow substitutes in their place. Refunds will only be issued if we cancel the class.

CME Credit:

As an organization accredited for continuing medical education by the Accreditation Council for Continuing Medical Education (ACCME), the American College of Surgeons designates the 1.5 day ATLS Instructor Course as meeting the criteria for 15 credit hours in Category 1.

RETURN WITH FEE TO:

University of KansasHospital

Trauma Services

3901 Rainbow Blvd

Mail Stop 1011

Kansas City, KS66160

Checks must be made out to University of Kansas Hospital

In accordance with the Americans with Disabilities Act, pleas advise Trauma Services if you have any disability that requires special materials and/or services so that appropriate personnel can be advised.

For more information contact the Trauma office:

Office: (913) 945-6933, Fax: (913) 588-5219