Educator, Trainer and Staff Awards 2015

Citation to nominate someone for an Award

Please read all four pages of this form before you start, and check the informationin the Nomination Instructions document if there is any uncertainty. Please ensure that BOTH SECTIONS ARE COMPLETED as any missing information will result in your nomination being eliminated

Your name
Your contact details
(work email and / or telephone number)
Your role in healthcare (e.g. student nurse, specialty trainee ST3 etc)
Nominee’s name
Nominee’s normal place of work
(and contact details)
Nominee’s role in healthcare education / training delivery (clinical supervisor, tutor, mentor, practice educator etc)
Which category are you making the nomination in?
There are 13 and you MUST choose ONE
You cannot use the same citation in two or more categories / 
Best newcomer to education
Open to someone with less than five years of experience in delivering or administering education / training programmes
[To be nominated by a senior colleague]
Education or training ‘Innovation of the Year’
[To be nominated by a near peer or manager]
Contribution to the learning environment
(e.g. hub and spoke development, simulation, contribution to enhance learning)
[To be nominated by a near peer or manager]
Administrator contribution to healthcare education or training
(such as staff working in Postgraduate or Trust Education Centres or Trust Medical Staffing, HETV staff)
[To be nominated by a near peer or manager]
Team award
(either an established team delivering education or training, or an ad hoc team tasked to deliver a specific project)
[To be nominated by a near peer or manager – cannot be a member of the same team]
Education or Training project by a health professional less than five years since qualification
Self submission of an abstract: if invited, display a poster at the Educator Day on 2 December
Patient New Safety Initiative involving education of either/ both the clinical team or patients
[To be nominated by a near peer or manager – cannot be a member of the same team]
The following categories are PROFESSIONAL GROUP SPECIFIC:
Allied health professionals (excluding nursing / midwifery/ dental and medical):
Allied health professional teacher in a clinical placement.
[To be nominated by one or more of their learners (under or postgraduate)]
Nursing and Midwifery staff only:
Nurse or midwife as a clinical teacher/ practice developer
[To be nominated by one or more of their learners (under or postgraduate)]
Dental professional only:
Dental training programme director
[To be nominated by the dental dean, associate dental deans, dental school administrators]
Dental professional (dentist, hygienist, technician) as a clinical teacher
[To be nominated by one or more of their learners]
Medical professionals only:
Medical training programme director
[To be nominated by Head of School or HETV staff only]
Medical professional as a clinical teacher
[To be nominated by one or more of their learners]
SECTION 1
Please describe the activities / initiatives / contribution made by the nominee. Include examples where possible, but please do not name third parties individually (such as the name of a colleague who may have received particular help / support from the nominee). Refer to the Q&A in the Nominating Instructions if more help is needed.(note: this box can be enlarged)
SECTION 2
Please describe the impact this nominee/ project has made on healthcare education.
Describe any changes to performance at trust, regional or national level from this work, or benchmark outcomes to local, regional or national standards if they exist. (note: this box can be enlarged)
SECTION 3 for ABSTRACTS ONLY
Abstract of project completed by a health professional of less than five years’ standing.
What year did you gain your first qualification as a health professional? / 20..
In no more than 400 words, please describe the project, explaining what you did, why, how and the outcomes / recommendations. In addition, please list the names and roles of any colleagues who have contributed significantly to design, delivery or evaluation of this work.

Please save your citation form with the heading ‘ Nomination for an Educator or Training Award 2015’ and email it to Monika Lemanska at

You will receive an acknowledgement of receipt.

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