Faculty of Sport and Exercise Medicine (UK) Patron: HRH The Princess Royal APPLICATION FORM: 1. FELLOWSHIP 2. FELLOWSHIP BY ELECTION 3. MEMBERSHIP 4. MEMBERSHIP BY ELECTION 5. CORRESPONDING FELLOW (delete as applicable) Surname Forenames Title Qualifications Date of Birth GMC No. University Graduated from and date Home Address Telephone Fax E-mail Fax E-mail Current Appointment Work Address Telephone Specialist Register Trainee Other Other (please state) Enclosures: Please enclose with this application a copy of your full up-to-date C.V., letter describing your involvement in Sport and Exercise Medicine, letters of support from either 2 Upstanding Fellows of this Faculty if applying for Fellowship / Corresponding Fellow or 1 Upstanding Fellow of this Faculty if applying for Membership who are willing to nominate you. Subscriptions Fees: Please see Faculty website under “Members and Fellows/Members and Fellows fees - all categories”. NB: Fees are not paid unless the applicant has been awarded relevant category as detailed above. I hereby request the Council of the Faculty of Sport and Exercise Medicine to recommend my name for election as a Fellow / Corresponding Fellow / Member (delete as appropriate) at the next Council Meeting. If elected, I promise to abide by the Rules and Regulations of the Faculty as set out by the Faculty, or such amendments which from time to time may be approved in accordance with the Council of the Faculty. I also agree to maintain my registration on the relevant specialist list and to inform Council of any change in circumstances, which may affect my elected status. Signature Date We the undersigned Fellow(s) of the Faculty of Sport and Exercise Medicine (UK) do hereby certify that: (Name) of is, in our estimation, a fit person to be elected as a Fellow/Corresponding Fellow/Member of the Faculty and satisfies the criteria for Fellowship/Corresponding Fellowship/Membership (delete as applicable). Name: …………………………………………… Signature: …………………………………….. Date: ……………………. Name: …………………………………………… Signature: …………………………………….. Date: ……………………. 1 FACULTY OF SPORT AND EXERCISE MEDICINE (UK), 6 HILL SQUARE, EDINBURGH EH8 9DR Faculty of Sport and Exercise Medicine (UK) Patron: HRH The Princess Royal Membership and Fellowship Guidelines Quick Overview of Categories Fellowship: Completed trainees and medical practitioners who have completed specialist training, including via the CESR route Fellowship by Election: UK SEM specialists (and rare exceptions from other specialties who have made an outstanding contribution to UK SEM) Corresponding Fellowship: Overseas SEM specialists Membership: Trainees Membership by Election: UK doctors from other specialties with an interest in SEM FELLOWSHIP Medical practitioners who have satisfactorily completed a recognised training programme in Sport and Exercise Medicine, who have obtained a CCT in Sport and Exercise Medicine (SEM) and who are on the UK Specialist Register in SEM will be granted Fellowship on application at the discretion of Council, through the Members and Fellows Committee. Medical practitioners who have completed their training abroad, have obtained a CESR in SEM and are on the UK Specialist Register in SEM may apply for Fellowship. FELLOWSHIP BY ELECTION Medically qualified practitioners who are adjudged by Council through the Members and Fellows Committee to have made a significant contribution to Sport and Exercise Medicine in the UK may be elected as a Fellow by Election. Normally, the applicant should be able to demonstrate a minimum of the equivalent of five years’ full time experience in SEM. Normally, the applicant should have completed either a Diploma or MSc in SEM. The applicant should be able to demonstrate ongoing regular attendance at SEM – related CPD and ideally membership of BASEM or similar Sport and Exercise Medicine associations. The applicant must be able to demonstrate that during the period of time in the speciality they have made a significant contribution to service delivery, education or the development of infrastructure within the speciality of SEM, and in the case of service delivery should have significant experience of direct involvement with more than one sport. In the case of service delivery this would involve a minimum of 0.4 WTE of their typical working week being spent in Sport and Exercise Medicine as an ongoing commitment. Time spent seeing SEM cases within the typical caseload of another specialty such as General Practise, Orthopaedic surgery or Emergency Medicine, would not count towards this total. Medical practitioners who have made outstanding contributions to the work of the Faculty, such as devoting a significant amount of time to the development of the examination, education programmes, and the work of the Faculty etc. may also be considered. 2 FACULTY OF SPORT AND EXERCISE MEDICINE (UK), 6 HILL SQUARE, EDINBURGH EH8 9DR Faculty of Sport and Exercise Medicine (UK) Patron: HRH The Princess Royal Medical practitioners who are on the UK Specialist Register as a specialist in other medical disciplines, e.g. Orthopaedic Surgery, Radiology, Accident & Emergency, and General Practice would not usually be considered for Membership by Election unless they are adjudged to have made an outstanding contribution to the Faculty or to the development of SEM in the UK. Designation FFSEM(UK) Full Voting Rights SENIOR FELLOW For retired FELLOWS of the Faculty; if the applicant is no longer receiving an income derived from Medicine, the current fee payable is £26. Designation FFSEM(UK) Full Voting Rights HONORARY FELLOW The Council may elect, without examination, persons of eminence who have rendered exceptional services to the science, practice or development of Sport and Exercise Medicine. Honorary Fellows need not be medically qualified. Designation Hon.FFSEM(UK) No Voting Rights CORRESPONDING FELLOW The applicant will have been involved with the delivery of SEM services, education or infrastructure over a period of more than 5 years full time or the equivalent part time. The applicant will demonstrate CPD pertinent to the area of SEM in which they are involved. Doctors who are working abroad, who are on the Specialist Register in their Country as a specialist in SEM or equivalent will be considered. Designation NONE No Voting Rights MEMBER Medical practitioners on the UK Specialty Training Programme, who have successfully completed ST3 and ST4 years of training and have passed the Diploma of Sport and Exercise Medicine (UK & Ireland) examination, may apply for Membership. MEMBERSHIP BY ELECTION Medical Practitioners who have obtained the Diploma of Sport and Exercise Medicine (UK & Ireland) or equivalent and are in good standing with the GMC may apply. Equivalence will be determined by the Faculty on a case by case basis. 3 FACULTY OF SPORT AND EXERCISE MEDICINE (UK), 6 HILL SQUARE, EDINBURGH EH8 9DR Faculty of Sport and Exercise Medicine (UK) Patron: HRH The Princess Royal The applicant must be able to demonstrate over a two/three year period that at least 0.4 WTE of their job plan reflects Sport and Exercise Medicine practice. These should lead to approximate equivalence of ST3/4 competencies as per the UK Sport and Exercise Medicine training programme. Time spent seeing SEM cases within the typical caseload of another specialty such as General Practice, Orthopaedic surgery or Emergency Medicine, would not count towards this total. The applicant should be able to demonstrate an ongoing commitment to CPD in SEM (as a minimum of three years duration). Applicants are expected to have done a minimum of one year post diploma demonstrating an ongoing commitment to Sport and Exercise Medicine. Applicants are expected to be members of BASEM or similar Sport and Exercise Medicine associations. The applicant should be able to demonstrate that they have access to mentorship or the support of colleagues within the speciality so that their practice is not isolated. Medical Practitioners who are on the UK Specialist Register as a specialist in another medical discipline and who practice SEM in a part-time capacity may also apply. Designation MFSEM(UK) Full Voting Rights SENIOR MEMBER For retired MEMBERS of the Faculty; if the applicant is no longer receiving an income derived from Medicine, the current fee payable is £26. Designation MFSEM(UK) Full Voting Rights ASSOCIATE MEMBER Associate Membership is open to medical trainees in UK and Ireland. There would be an administration fee. SEM trainees, once they have passed the Diploma Exam become eligible for full membership and pay the full membership fee. Designation NONE No Voting Rights AFFILIATE MEMBER Undergraduate medical students who are interested in SEM may apply for Affiliate Membership. There is no fee for Affiliate Membership. All information will be sent by email. Designation NONE No Voting Rights FOUNDATION FELLOWSHIP AND MEMBERSHIP IS NOW CLOSED. 4 FACULTY OF SPORT AND EXERCISE MEDICINE (UK), 6 HILL SQUARE, EDINBURGH EH8 9DR