From: CUSEC EXECUTIVE 2015
Please address questions to: fshamji@ottawahospital.on.ca
Checklist for The John Provan Outstanding Undergraduate Surgical Educator
Award application process
1. Three letters of support from:
 Chair of Surgery sending the nomination
 Faculty member with knowledge of the candidates achievements
 Education leader or Associate Dean of Undergraduate Medicine
Program
2. Letter of support from the Departmental Director of Undergraduate Surgical
Education in case the candidate is not the director himself/herself
3. Documents indicating important contributions made to the Undergraduate
Surgical Education at the medical school
4. Effectiveness Teaching Score from the office of Vice-Dean of Undergraduate
Medical Education and Department of Surgery
5. Faculty appointment exceeding 5 years
6. Membership in the Undergraduate Surgical Education Committee of the
Department of Surgery
7. Involvement in National Medical Organizations (CUSEC, ASE, CAME)
8. National and/or international involvement and recognition for innovations
in surgical education
9. Recipient of teaching awards (University based and/or national)
10. Evidence to support important surgical contribution made to curriculum
development and LCME accreditation at the medical school
11. Evidence of research in undergraduate surgical education and publications
relating to surgical education.
12. Concrete evidence of surgical education excellence – student assessments,
previous awards, publications
13. Current Curriculum Vitae with statement of teaching philosophy
14. Teaching dossier of the candidate