MITE Academy Fellows Application Name* First Last Email* Degree(s): Department: Institution (MMC or an Educational Partner)Department: Clinical Specialty: Current Academic Appointment: Role(s) in Medical Education: Nominator’s Name: Narratives (One Page Each)Description of Your Accomplishments in Direct TeachingThis one page narrative should describe your involvement in direct teaching of medical students, residents or other professionals (e.g., CME). This can include lectures, seminars, mentoring, clinical teaching on rounds, etc. These can be local, regional or national. Please be specific about the types of direct teaching and any honors you have received. Describe your philosophy of teaching and how your teaching engages your students and facilitates their learning. Drop files here or Select files Accepted file types: pdf, docx, doc, Max. file size: 128 MB. Description of your accomplishments in the second area (see Academy Criterion Matrix in Application Instructions)This one page narrative should complement your narrative on teaching by describing your accomplishments in a second area: Instructional development, course or curriculum design; mentoring; Scholar activity; Education research; Education administration and leadership. See the application instructions for detailed descriptions for each area. As for your teaching narrative, this narrative should describe your accomplishments and your education philosophy. It should not be simply a listing of items from your CV. Drop files here or Select files Accepted file types: pdf, docx, doc, Max. file size: 128 MB. Additionial DocumentsLetter of Nomination Drop files here or Select files Max. file size: 128 MB. The letter of nomination should be from a member of the academy (Master or Fellow) or an education leader at MMC (or its educational partners). The letter should have four separate sections: Your relationship with the nominee (e.g., colleague, supervisor, mentor, etc) and how long you have known and worked with the nominee (in what capacities). Why you believe the nominee has met the criteria for excellence in direct teaching. Include a description of the opportunities you have had to directly observe her/his teaching and why you think his/her teaching has improved the clinical practice of students, residents, fellows and practicing physicians. The nominee has selected one other area of demonstrated excellence. Please provide evidence of why you think the nominee has demonstrated excellence in this area. Please provide any other information you think that makes the nominee eligible for being a Fellow of the Academy. List of courses, certificates and degrees related to medical education that you have completed. Drop files here or Select files Max. file size: 128 MB. Curriculum Vitae Drop files here or Select files Max. file size: 128 MB. Education portfolio (most important materials you have used in your teaching) Drop files here or Select files Max. file size: 128 MB. Please attach materials that you have used in teaching. This could include AV material that you have used for lectures or seminars (e.g., PowerPoint presentations, videos, etc), hand outs that you have used, curriculum you have designed. Please only attach the two of three items that you think best illustrates your teaching.Letters of support from colleagues (2 required) Drop files here or Select files Max. file size: 128 MB. These letters, similar to your nomination letter, should include four paragraphs that address: Your relationship with the nominee (e.g., colleague, supervisor, former student, etc) and how long you have known and worked with the nominee. Why you believe the nominee has met the criteria for excellence in direct teaching. Include a description of the opportunities you have had to directly observe her/his teaching and why you think his/her teaching has improved the clinical practice of the students. The nominee has selected one other area of demonstrated excellence. Please provide evidence of why you think the nominee has demonstrated excellence in this area. Please provide any other information you think that makes the nominee eligible for being a Fellow of the Academy. Letters of support from former or current students or protégés (2 required) Drop files here or Select files Max. file size: 128 MB. These letters should address explicitly the following in four paragraphs: Your relationship with the nominee when you were his/her student/resident/fellows and how much contact you had. What is your current relationship? How would you characterize the nominees teaching style and commitment to your learning. Describe what you learned from the nominee and how this has influenced your care of patients. CommentsThis field is for validation purposes and should be left unchanged. Δ Application Instructions
