Application Form

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APPLICATIONS ARE NOW OPEN!
HETI will again be running the LEAP Future Leaders Development Program in 2016.
LEAP prepares doctors in training for leadership roles within the NSW public health system.
The aim of the LEAP program is to deliver a high quality, innovative, interactive and
inspirational trainee leadership program for current and future clinician leaders in medical
education and training within the NSW health system.
LEAP will give participants an opportunity to meet and learn with a motivational group of
individuals from diverse professional backgrounds all with an interest in medical education
and training. Through interactive workshops, group discussions and self-reflection,
participants will have an opportunity to develop skills through collegiate learning and build
professional networks. LEAP faculty are also from a variety of professional backgrounds
bringing years of experience in both health and corporate sectors.
No other program exists in NSW that is focused on the needs of doctors in training in relation
to medical education and training of leadership skills.
Who is the program for?
Eligibility Criteria
Doctors in training in NSW, PGY1 to
Fellow, Prevocational and Vocational
trainees. The program is designed to
build and develop leadership skills for
trainees with an interest in medical
education and training.
The following eligibility criteria will be considered
when reviewing applications.
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Cost - PGY1 & PGY2: $1,500*
PGY3 and above: $2000*
*Covers accommodation costs of
residential component, travel and
accommodation costs for each
workshop for rural based trainees,
course materials (all available on line)
and conference costs for each
workshop.
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Demonstrated interest in leadership and
engagement in medical education and
training.
Current leadership role in medical education,
e.g. involvement in a committee or group that
deals with medical education and training
such as a HETI committee, State Training
Council or JMO group.
A current prevocational or vocational trainee
in NSW.
Demonstration of potential benefits for the
applicant.
Opportunity to apply skills and knowledge
following the program.
Commitment to attend full program (10
workshop days).
The major component of the program is five face-to-face workshops, a total of 10 days over
nine months (March – November). Workshops are objective driven, focusing on experiential
learning through simulation group exercises, interactive lectures and feedback.
Skills learnt in the workshops will be complemented and further developed by ongoing
program of projects completed in syndicate groups, self-directed and web-based learning,
mentoring opportunities and practical leadership experience in the workplace.
Program Structure
Location
Workshop 1
Crowne Plaza
Terrigal
Workshop Topic
Looking Inwards:
Understand your own personality and
leadership style and that of others.
Date
Thursday 10th,
Friday 11th and
Saturday 12th
March 2016
Friday 6th and
Saturday 7th May
2016
Workshop 2
Randwick Childrens
Hospital Simulation
Centre
Workshop 3
Cliftons, Sydney
Looking Outwards:
Develop skills needed to work effectively
with others.
Looking from Above:
Develop an understanding of the NSW
health system and learn how to get things
done.
Friday 22th and
Saturday 23th July
2016
Workshop 4
Cliftons, Sydney
Looking Forward:
Develop and implement strategies to meet
future needs in medical education for both
the individual and across the system.
Friday 16th and
Saturday 17th
September 2016
Workshop 5
Cliftons, Sydney
Looking Overall – Being a leader:
Focus on drawing together the learning of
the program and what it means to be a
leader in medical education and training.
Friday 11th
November 2016
APPLICATIONS:
Applications are invited from prevocational and vocational trainees in NSW who have an
interest in leadership and medical education and training. Selection into the program will be
merit based with preference given to some participants to ensure there will be a range of
representatives from state-trainee groups, college representatives and peak bodies
representing trainee interests such as AMA-DIT (Australian Medical Association Council of
Doctors-in-Training) and RMOA (Resident Medical Officers’ Association). For 2016, there
will be approximately 25 places available for doctors in training.
If you are interested in being part of the LEAP course in 2016, please complete the application
form on the next page.
Applicant details
Position and Employer for 2016:
(Please type or use ‘Block Letters’ only)
Position: ___________________
Title: _____
Supervisor:____________________
First name: ________________
Last Name: ________________
Address 1:
___________________________________
(Please nominate the Supervisor who will
support your attendance at the workshops and
participation in the course, e.g. DPET, DCT,
DPT)
Employer: _____________________
Address 2:
___________________________________
LHD: _________________
City: ____________State _______
Current role in education and training:
Postcode _________

_______________________________

_______________________________

_______________________________

Rural / Non Rural
Email:
___________________________________
Contact numbers:
Home ___________
Committee membership:
Mob: ___________
Are you a member of any committees or
councils? If yes, please list below:
Work: ___________
Male
Female

_______________________________

_______________________________

_______________________________
Please complete the writing exercise on the next page.
Essay:
In 300 words or less, please tell us how you would benefit from the Program. The essay will be
considered using the following criteria:
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
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Demonstrated commitment to medical education and training
Demonstrated commitment to developing as a medical leader
Demonstrate strategic perspective
Demonstrated commitment to leading change and improving patient centred care
Statement of support from Supervisor
To be completed by the Applicant’s Supervisor
Full Name: ________________
Contact Number: ____________________
Position________________________
Email Address: ______________________
Department and hospital: ____________
In 300 words or less, please outline why you believe the applicant would benefit from the LEAD
and LEAP course.
Please submit completed form and essay to: alexandra.hernandez@health.nsw.gov.au
Forms must reach HETI by Sunday, 10 January 2016
Applicants will be notified of the application outcome by early February 2016
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