Online Application

UB Royal College of Physicians Educator Program

Please complete the following online application for the 2011-2012 UB Royal College of Physicians Educator Program.

The deadline for receipt of applications and supporting documents is Sept. 30, 2011.

Application Checklist

Online Application
NIH Biosketch
Personal Statement
Tuition Agreement

First name

(Required)

Last name

(Required)

Specialty or medical discipline

(Required)

Primary hospital or medical group affiliation

(Required)

CME ID number

(Required)

Your CME ID number will usually be the last four digits of your social security number. If you do not have a CME ID number, please register for one and then return to this page to apply to UB RCP. If you have forgotten your ID number, you can request a reminder from our office.

Your Contact Information

Office address

(Required)

Include your building and room number.

Office phone

(Required)

Email address

(Required)

Your Teaching Experience and Interests

Please briefly describe your teaching experience.

(Required)

Are you responsible for teaching in large group settings?

(Required)

Yes

Are you responsible for teaching in small group settings?

(Required)

Yes

Have you had previous formal teacher training?

(Required)

Yes

If so, please describe it briefly.

Are you willing to participate as an educator at workshops developed for UB medical school faculty in the future?

(Required)

Yes

Rate your interest in the following topics:

General teaching skills

1 - Very interested

2 - Moderately interested

3 - Somewhat interested

4 - Not interested

Teaching in the clinical setting

1 - Very interested

2 - Moderately interested

3 - Somewhat interested

4 - Not interested

Working with challenging residents

1 - Very interested

2 - Moderately interested

3 - Somewhat interested

4 - Not interested

Assessment skills

1 - Very interested

2 - Moderately interested

3 - Somewhat interested

4 - Not interested

Supporting Documents

In addition to completing the above information, you must submit the following documents to be considered for admission:

Please upload an NIH-style biosketch.

(Required)

2. Personal Statement

You will need to prepare a separate document that answers these two questions:

Please describe your medical education interests. What do you hope to accomplish by enrolling in the Royal College of Physician Educator Program? (300 words or less)
How would you characterize your strengths and weaknesses as a teacher? (300 words or less)

Please upload this document below.

(Required)

3. Tuition Agreement

Download and print the following tuition agreement form:

Sign the agreement and obtain a signature from your department chair.

Send your completed form to:

Pat McMillon

Assistant to the Director

Office of Continuing Medical Education

111 Cary Hall, University at Buffalo, Buffalo, NY 14214

Phone: (716)829-3714

Email: pam@buffalo.edu

UB Royal College of Physicians Educator Program

Application Checklist

About You

Your Contact Information

Your Teaching Experience and Interests

Rate your interest in the following topics:

Supporting Documents

1. NIH Biosketch

2. Personal Statement

3. Tuition Agreement

Education and Training