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APPLICATION FORM AND IMPORTANT INFORMATION FOR THE 2019 ROWAN NICKS UNITED KINGDOM & REPUBLIC OF IRELAND FELLOWSHIP
INSTRUCTIONS
• Read the following information and make sure you meet the eligibility criteria• Complete ALL boxes in the Application Form• Attach a copy of your current Curriculum Vitae• Attach a certified copy of your basic medical degree• Attach a certified copy of your post-graduate qualification• Attach a copy of your proof of Fellowship of the UK or Irish Colleges• Attach a certified copy of your current Medical Registration• Attach a copy of the completed Application Checklist• Send an email with a scanned, signed, copy of this form and all attachments to
[email protected] OR a signed, hard copy of this form and all attachments to:
Secretariat, Global Health Scholarships Committee Royal Australasian College of Surgeons College of Surgeons’ Gardens250 – 290 Spring StreetEast Melbourne, Victoria 3002AUSTRALIA
Applications must be submitted by no later than 5pm Australian Eastern Standard Time on Friday, 1 June 2018
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ABOUT THE ROWAN NICKS UNITED KINGDOM & REPUBLIC OF IRELAND FELLOWSHIP
The Royal Australasian College of Surgeons (the College) offers the Rowan Nicks United Kingdom (UK) and Republic of Ireland Fellowship each year. The Rowan Nicks Scholarships and Fellowships are the most prestigious of the College’s international awards and are directed at qualified surgeons who have the potential to be leaders in their countries.
The UK and Republic of Ireland Fellowship is offered to a surgeon from the UK or Republic of Ireland to take up the Fellowship in Australia or New Zealand. The Fellowship program aims to promote international surgical interchange at the levels of practice and research; raise and maintain the profile of surgery in Australia and New Zealand and increase interaction between the surgical communities of Australia, New Zealand and the UK and Republic of Ireland.
The aim of each of the Rowan Nicks Fellowships is to ‘teach the teacher to teach others’ and all Fellows must come with a sense of responsibility to the needs of their home country. The intention is to develop their skills to enable them to:
• Manage a department• Become competent in the teaching of others• Gain experience in clinical research and the applications of modern surgical technology, and;• Obtain further advanced exposure in general or specialist surgery
Applicants should demonstrate:
• A high calibre in surgical ability, ethical integrity, and qualities of leadership.• A commitment to teach and promulgate high standards in the development of surgery in their
country.
The Fellowship is usually tenable in a major hospital (or hospitals) in Australia or New Zealand, and will be awarded for a period of up to 12 months.
The Fellowship will provide funds for return economy class travelling expenses between the home country and hospital attachment for the Fellow as well as support to attend the Royal Australasian College of Surgeons’ Annual Scientific Congress (ASC) or equivalent conference (if in Australia or New Zealand at the relevant time). Funds to attend the ASC will be supplied to cover the cost of registration, travel and accommodation for the Scholar only. The Scholarship will provide a living allowance of up to AUD$40,000 for a 12-month attachment plus up to $10,000 to cover administrative and settling-in expenses.
The value of the Fellowship may be reduced if the Fellow will receive a salary or funding from another source while undertaking the Fellowship program. Candidates are obligated to declare to the Committee any additional funding obtained or applied for at the time of application, after the submission of the application and at any stage during the selection process and during the tenure of the Fellowship.
The Fellowship does not cover any costs associated with the Fellow’s family members. Fellows are welcome to be accompanied by family members at their own cost.
The Fellow will be encouraged to visit other appropriate institutions in Australia and New Zealand or appropriate other country during their attachment. Funds required for travel for this purpose will be considered on an individual basis.
The Fellow must provide a progress report half-way through a 12-month Fellowship and also at the conclusion of the Fellowship. The final report should be no less than 1000 words in length. When the Fellowship is for 6-months or less, one report only will be required.
CONDITIONS OF THE ROWAN NICKS UK & REPUBLIC OF IRELAND SCHOLARSHIP
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Applicants must:
1. Be a citizen of the country from which the application is made2. Be between the ages of 25-45 years inclusive on the closing date of applications.3. Provide evidence they have passed the exit exam of his/her country’s course of post-graduate
training in surgery and obtained a Fellowship of the UK or Irish Colleges by the time selectiontakes place. This is essential. The Fellowship is NOT available to candidates in training. Recipients mustprovide evidence that they have satisfactorily completed their training program by the time they takeup their Rowan Nicks Fellowship.
4. Be fluent in the English language. Applicants must provide evidence that they meet the Englishlanguage requirement for registration with the Medical Board of Australia or Medical Council of NewZealand.
5. Provide the names and full contact details of the referees as outlined in the application form. Failure toinclude the names of referees may adversely affect the application in the selection process
Referees:
Following the closing date for applications the College will contact the persons listed to obtain written references. Persons must not be listed more than once in a single application form. Please do not supply written references with your application form. The references the College will be seeking are in a standard format and additional references will not be considered.
For each of these referees the following guidelines must be met:
PROFESSIONAL REFEREES - These are 2 referees such as surgical colleagues or supervisors who are able to comment on you in a professional capacity. To ensure that the College is able to collect a comprehensive reference from the referees, please include referees who are able to comment on areas of your performance such as your experience, reputation and surgical skills. It is compulsory that full contact details for 2 referees be supplied.
ELIGIBILITY FOR THE ROWAN NICKS UNITED KINGDOM & REPUBLIC OF IRELAND FELLOWSHIP
Applicants will only be considered if they meet the eligibility requirements of the Fellowship as stipulated above and have completed the Application Form in its entirety following the instructions supplied. Applications must be received by 5pm AEST on Friday, 1 June 2018 at the following address:
Secretariat, Global Health Scholarships CommitteeRoyal Australasian College of Surgeons College of Surgeons’ Gardens250-290 Spring StreetEast Melbourne, Victoria 3002Australia
Telephone: + 61 3 9249 1211Email: [email protected]
Applications received after this date will not be considered.
The Global Health Scholarships Committee will undertake the review and selection of the Scholars. The Committee will primarily consider the potential of the applicant to become a leader in the country of origin, and/or to supply a much-needed service in a particular surgical discipline. The Committee must be convinced that the applicant is of high calibre in surgical ability, ethical integrity, and qualities of leadership, and the references collected by the College from the referees support the applicant as one who will teach and promulgate high standards in the development of surgical experience in their country.
The Selection Committee will make the final recommendations to the College Council in November 2018. Once an official decision is made all applicants will be officially notified of the outcome via email by 31 December 2018. The view of the Council will be final.
SELECTION PROCEDURE FOR THE ROWAN NICKS FELLOWSHIP
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APPLICATION FORM FOR THE 2019 ROWAN NICKS UNITED KINGDOM AND REPUBLIC OF IRELAND FELLOWSHIP
1. Personal Details
Title
Family Name (as shown on Birth Certificate)
Married Name (if different from name on Birth Certificate)
Given Names (as shown on Birth Certificate)
Country of Citizenship
Gender Male Female
Date of Birth(must be between 25-45 years by closing date of applications. Proof of age may be requested)
2. Contact Details
Current Residential Address:
Address Line 1
Address Line 2
Address Line 3
Town/City Postal Code (if any)
State/Province
Country
Home Phone number Work Phone number
Mobile number
Email4
Mailing Address (only if different from your current residential address):
Address Line 1
Address Line 2
Address Line 3
Town/City Postal Code (if any)
State/Province
Country
3. Proposed Program Activity
a. Please provide the full contact details of your sponsor in Australia or New Zealand:
Name:
Position
Institution
Contact Address
Telephone
Length of proposed Program: From To (if known)
b. Will you receive a salary, scholarship, or funding from any other source while undertaking this program?
Yes AU $
No
Source of funding:
Contact details of source:
c.
Yes AU $
No
Source of funding:
Contact details of source:
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Have you applied for funding to undertake this program from another source for which you are awaiting an outcome, or do you intend to apply for funding to undertake this program from another source?
If you have applied for more than one source of funding please include these details in a separate attachment
d.
e.
4. Supporting Statements
a. What is your motivation for applying for this Fellowship? (100-150 words suggested)
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What program or course of study would you pursue using this Fellowship? (150-300 words suggested)
What are your specific skills and knowledge objectives for your proposed program or course of study?
b.
c. Is there anything else you would like to add in support of your application for this Fellowship?
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How will the broader surgical community benefit from you undertaking this Fellowship program? (100-300 words suggested)
5. Current Hospital/Institution of Employment
Institution Name:
Contact name for inquiries regarding institution/hospital
Telephone
Address Line 1
Address Line 2
Town/City Postal Code (if any)
State/Province
Country
Type of InstitutionPlease select one option only
Government
Military
Private (philanthropic)
Private (non-philanthropic)
Other (please describe)
Please provide a statement describing your current hospital/institution of employment; including its history, funding source/s, mission and objectives. In particular, if your institution has strong philanthropic motivators, please outline these in detail:
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6. Referees
Please provide the names and full contact details of 2 referees who are able to comment on you in a professional capacity.
Reference One
Title
Name
Position
Institution
Address Line 1
Address Line 2
Town/City Postal Code (if any)
State/Province
Country
Telephone
Reference Two
Title
Name
Position
Institution
Address Line 1
Address Line 2
Town/City Postal Code (if any)
State/Province
Country
Telephone
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Declaration
I confirm that the information supplied within at the time of application is correct, and acknowledge that I am obligated to advise the Global Health Scholarships Committee of the Royal Australasian College of Surgeons (the College) of any changes to the information supplied within this application at any stage during the application period, selection process or while undertaking the Scholarship (if successful).
I have read the Conditions of the Rowan Nicks Scholarship of the College and agree to abide by these conditions.
I acknowledge that I am obligated to declare any additional funding obtained or applied for at the time of application, after the submission of the application and at any stage during the selection process and after the commencement of the Scholarship (if successful).
I note that the amount of the Fellowship awarded will be at the discretion of the Committee and may be reduced if I accept a salary or payment from my host institution or if I am successful in raising additional funds at any stage before or after the commencement of the Fellowship.
I consent to the information on this form being used and disclosed as stated.
Signature Date
This application form, completed in its entirety, must reach the Global Health Scholarships Committee Secretariat via post mail, fax or email by Friday 1 June 2018.
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ROWAN NICKS UK & REPUBLIC OF IRELAND FELLOWSHIP APPLICATION CHECKLIST
The below is required for your application. Please make sure you have attached all required documents in their correct form to this application. Please do not send any other documents unless requested.
Copy of basic qualification
Copy of post-graduate qualification
Copy of your proof of Fellowship of the UK or Irish Colleges
Certified copy of current Medical Registration
Full contact details of 2 professional referees
Full contact details of sponsor in Australia or New Zealand
Current CV
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Appendix 1
Candidate: ______________________
Marker: ______________________
Total Mark (out of 70): ______________________ (sum of parts 2 & 3)
1 – Eligibility (Secretariat to Complete) Appropriately Qualified - the applicant has provided basic medical degree + Fellowship
Yes
References received, positively describing the applicant's surgical competence, ability and character
Yes
Fellowship Supervisor – the applicant has identified a Fellowship sponsor/supervisor
Yes
2 – The Application
1. Definition of proposed Fellowship plan /10 2. Definition and merit/value of Fellowship objectives to home country /10 3. Research Plan for Fellowship /5 4. Uniqueness and/or originality of chosen speciality /5 5. Suitability of sponsor/supervisor /5
3 – Evidence from CV
6. Academic Achievements /5 7. Department management / leadership experience /5 8. Teaching – undergraduate / post graduate /5 9. Presentations + Relevant Publications – Peer reviewed journal /5 10. Clinical Research / Audit / Patient Review /5 11. Involvement with new surgical technology / techniques /5 12. Leadership / contribution to wider community /5
ROYAL AUSTRALASIAN COLLEGE OF SURGEONS ROWAN NICKS ANZ & UK and Republic of Ireland Fellowship 2019
MARK SHEET
