CANADIAN HEMOPHILIA SOCIETY
PRECEPTORSHIP PROGRAM /

Purpose of the preceptorship program

The purpose of this preceptorship program is to expand the knowledge base for existing practitioners and/or increase exposure to bleeding disordertreatment centres and the various disciplines.

Two, 2-week preceptorships in Canada will be available in 2017/2018 in the amount of $6,500 each to cover honorarium, meals, lodging and travel ($4,000 sent as an initial payment and the remaining amount distributedupon completion and upon presentation of receipts).

Criteria

  • Applicants must be Canadian citizens or permanent residents.
  • Participants will be allied health professionals (registered nurses,physiotherapistsor social workers) employed with a bleeding disorder treatmentcentre (HTC).Consideration will be given to two main groups of candidates:
  1. Employees new to a position with a tenure of less than three years.
  2. Experienced clinicians with 10 years or more of clinical experience in bleeding disorder management.
  • Training must take place at a Canadian bleeding disorder treatment centre (HTC).
  • A request must be made by a HTC for a clinician to participate in their centre’s practice.

Other criteria

  • Each applicant needs to provide a budget related to the location where he/she is seeking to complete his/her preceptorship.
  • Each applicant must include a proposed schedule of his/her two-week preceptorship that lays out the number of combined clinics that will take place, number of patients who will be seen, nature of specific assessment and treatment sessions, and educational sessions between the preceptor and preceptee.
  • A prelearning (objective) statement along with a post-learning reflection needs to be submitted to the HTC and to the CHS.
  • Each application should be endorsed by the medical director or operations leader at the applicant’s HTCand from the host site. It must also be endorsed by the discipline-specific person at the host site that would be directly working with the preceptee.
  • Successfulapplicants will be required to submit a poster, moderated poster or make a presentation to the World Federation of Hemophilia or the International Society on Thrombosis and Haemostasis.

Application process

Applicants must forward a paper copy of the completed application form along with supporting documents to:

Canadian Hemophilia Society

Preceptorship Program

301-666 Sherbrooke Street West

Montreal, Quebec

H3A 1E7

Applications must be postmarked no later than October 15, 2017.

APPLICATION FORM

Part A: Personal information

Name:First name:

Date of birth:

(yyyy-mm-dd)

Address:

City:Province: Postal code:

Telephone (home):Telephone (work):

E-mail:

Mailing address:

(if different from above)

City: Province:

Postal code:

Name of applicant:

Part B: Name of bleeding disorder treatment centre (HTC) where preceptorship will be undertaken

Name:

Address:

City: Province: Postal code:

Department:

Part C: Applicant’s prelearning objective statement

Name of applicant:

Part D: Endorsement by the directors or operational leaders from the applicant’s HTC as well as from the host site.

The program is open to Canadian allied health professionals (registered nurses,physiotherapists or social workers) employed with a bleeding disorder treatment centre with tenure less than three years and experienced clinicians with ten years or more of clinical experience in bleeding disorder management.

I confirm that this person meets one of the above criteria:

Name and title of medical director or operational leader at the applicant’s HTC:

Institution or location of practice:

E-mail address:

Signature: ______

Date:

(yyyy-mm-dd)

I confirm that this person meets one of the above criteria:

Name and title of medical director or operational leader at the host site:

Institution or location of practice:

E-mail address:

Signature: ______

Date:

(yyyy-mm-dd)

Name of applicant:

Part E: Endorsement by the discipline-specific person at the host site

I confirm that I am the preceptor/mentor/discipline-specific person at the host site:

Name and title of discipline-specific person:

Institution or location of practice:

E-mail address:

Signature: ______

Date:

(yyyy-mm-dd)

Name of applicant:

Part F: Schedule for the two-week preceptorship

Approximate number of clinics:

Approximate number of patients who will be seen:

Nature of specific assessments and treatment sessions:

Number of educational sessions between the preceptor and preceptee:

Name of applicant:

Part G:Budget

Honorarium (maximum of $250/day):$

Meals:$

Lodging:$

Flight:$

Ground transportation:$

TOTAL: $

Name of applicant:

The applicant’s checklist

Application form:

Signed endorsements:

Budget:

In the event that I should be the recipient of a preceptorship under the CHS Preceptorship Program, I agree that my biography and photo can be used on the CHS website, in the CHS newsmagazine, Hemophilia Today, and in the CHS annual gratitude report, Thanks to You.

Upon concluding the preceptorship,I will complete a post-learning questionnaire.

I will also compile a three-to-five-page review of my experience which will be shared with the host site. This review will include:

  • SWOT analysis (strength, weakness, opportunities and threats)
  • The clinic’s breakdown of staffing and possible additions
  • The nature of administration within the clinic
  • Patient support programs (if not offered, how can this be addressed?)
  • Outreach clinics, staff education and the documentation system (electronic/paper)

Upon completing the preceptorship,I will produce a PowerPoint presentation to be shared in a webinar for all HTC staff (but more specifically for allied health clinicians). Anattempt will be made to have a face-to-face meeting in order to disseminate information including a question/answer period (e.g. CHS or AHCDC AGMs).

SignatureDate

The CHS Preceptorship Program is supported by

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