Application for Enrolment (FRACP)

Application for Enrolment

Stage 3 of Joint Training Program in Paediatric Emergency Medicine (PEM)
This form will allow you to submit an application to enrol into Stage 3 of the Joint Training Program in Paediatric Emergency Medicine with ACEM, for the purposes of dual Fellowship.

To enrol in the program you must be a Fellow of RACP.

Prior to enrolling, applicants are advised to read and understand the following:
- FACEM Training Program Regulation B
- ACEM Curriculum Framework
If you have any questions, please contact the Trainee Records team by email at training@acem.org.au, or by phone on +61 (0)3 9320 0444.

Application for Enrolment

Personal Details
Name*

TitleFirst NameLast Name
Date of Birth*

DayMonthYear
Date
Sex*
Email*
example@example.com
Phone Number*
Residential Address*

Street Address

Street Address Line 2

SuburbState

Post code
Postal address

My postal address is different to my residential address
Postal Address

Street Address

Street Address Line 2

SuburbState

Post code

Application for Enrolment

Eligibility
Have you previously been enrolled on any ACEM training program?*

YesNo
Medical Registration

All applicants are required to have General Registration with either the Australian Health Practitioner Regulation Agency (AHPRA) or the Medical Council of New Zealand (MCNZ).
Is your registration with AHPRA or MCNZ?*

AHPRAMCNZ
AHPRA Number:
MCNZ Number:
Confirmation of Fellowship

Please provide evidence of your FRACP qualification that also specifies completion of the requirements for Paediatric Emergency Medicine.
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Application for Enrolment

Education Details

Please provide details of your qualifications:*

	Qualification	University	City	Country	Year conferred
Medical degree
Other

Application for Enrolment

Indigenous Identity
Do you identify as Aboriginal, Torres Strait Islander, or Māori?

Application for Enrolment

Postgraduate Experience: Research
As a Fellow of RACP, the research requirement that you completed for your Fellowship may be recognised as equivalent to the research requirement of the FACEM Training Program.

You can find more information about the FACEM Training Program research requirement in the Trainee Research Requirement Policy.

So that the training team can contact you with further information, please identify the method by which you completed the research requirement of your RACP training.
Method of completion:*

Research in human subjects, populations and communities and laboratory research; epidemiology; field research; or medical education researchAuditSystematic reviewOther

Application for Enrolment

Postgraduate Experience: Current
Please advise where you are working/training at present, and what your training plans are for the remainder of the year.

Please note that minimum term duration is 3 months FTE. Training periods that do not meet this requirement will be recorded as interruptions to training.

If there is insufficient space to include all details on this form, please attach a separate sheet.

Please provide details of your current / future training plans:*

	Term start date	Term end date	Hospital	Sub-specialty	Hrs/wk	Position	Supervisor
Placement 1
Placement 2
Placement 3
Placement 4
Placement 5
Placement 6

Additional files (if required)

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Application for Enrolment

Postgraduate Experience: Previous
Please provide a list of all training rotations completed during your Fellowship training with RACP.

If there is insufficient space to include all details on this form, please attach a separate sheet.

Please provide details of your RACP Fellowship Training rotations:*

	Term start date	Term end date	Hospital	Sub-specialty	Hrs/wk	Position	Supervisor
Placement 1
Placement 2
Placement 3
Placement 4
Placement 5
Placement 6

Additional files (if required)

Browse Files

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Application for Enrolment

Trainee Agreement - Part 2: Obligations
I acknowledge that as a trainee, I have the following obligations:*

2.1 To abide by the professional standards of all registered medical practitioners as outlined in the professional codes of conduct of the Medical Board of Australia or the Medical Council of New Zealand as applicable and from time to time updated, as well as those of ACEM.2.2 Except where otherwise permitted by the College, to hold general registration with the Medical Board of Australia or registration in the general scope with the Medical Council of New Zealand as applicable at all times while undertaking the FACEM Training Program.2.3 To notify the College within the timeframe prescribed in the regulation if my medical registration with the Medical Board of Australia or Medical Council of New Zealand as applicable expires or if, for any reason, my medical registration is under investigation, withdrawn, suspended or conditions are imposed.2.4 To regularly visit the training portal and ensure the College has an accurate and current record of my contact and other details, and to maintain a working email account capable of receiving College correspondence and other communications from the College.2.5 To be aware of and observe all College regulations, policies, procedures and other processes relevant to me as a trainee enrolled in and undertaking the FACEM Training Program.2.6 To meet regularly with my DEMT and to participate fully in all College assessment and review processes, including in the development and implementation of a Learning Plan where beneficial or required.2.7 To undertake training in a range of settings and locations as required by the College in order to complete the requirements and achieve the outcomes of the FACEM Training Program.2.8 If I have concerns regarding my training, it is my responsibility to initiate the process through the College to have these concerns addressed.

Application for Enrolment

Trainee Agreement - ACEM Declaration
ACEM Declaration

ACEM agrees to provide support to its representatives, including DEMTs, Local WBA Coordinators, non-ED supervisors of training, WBA assessors and education officers, to provide trainees with appropriate resources and support in the following areas:

4.1 Achieving completion of all training periods, and assessment and other requirements of the FACEM Training Program.

4.2 Resources to assist trainees in achieving the learning outcomes of the FACEM Training Program.

4.3 The provision of supervision appropriate to the trainee’s level of training and having regard to the clinical setting, and regular review of performance during a placement for the purposes of support, feedback and assessment.

4.4 Fostering a training environment that is free from discrimination, bullying and harassment in the workplace.
ACEM Obligations

ACEM undertakes:

5.1 Through its accreditation processes, to strive to ensure training occurs in suitable and appropriately resourced and supported departments and placements.

5.2 To communicate training, assessment and other College decisions in a timely manner having regard to the entirety of the circumstances.

5.3 To give adequate notice of changes in the requirements of the FACEM Training Program, including the introduction of new requirements, to which existing trainees become subject.
Declarations*

I accept the rights and responsibilities of my position as detailed in this agreementI declare that this information provided in this application is accurate and complete the the best of my knowledge

Application for Enrolment

Submission
Upon clicking 'Submit', your details will be saved and your application to enrol into the FACEM Training Program will be submitted.

No changes can be made to your application after submission. Applications that are incomplete or missing items will not be considered.

Following submission, you will be contacted by the ACEM Training Team to confirm your enrolment. Your training start date will be aligned to the closest term date at the time of enrolment.

You will also receive an invoice for the entrance registration fee and the relevant annual training fee, which you must pay before the due date specified.
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