Please respond to all sections of the application .
Applicants should provide a CV in support of the application. A list of publications/presentations is expected but copies of presentations, project proposals, publications, book chapters, or evidence of awards is not appropriate. Electronic submission is required.
Each application is reviewed/evaluated by members of the Fellows (FCSHP) Recognition Committee against the five specific criteria clearly identified in this application form. To be successful, the applicant must take the time to thoroughly and thoughtfully complete this application. The experience of the Committee that worthy candidates have been unsuccessful due to an incomplete application, often without attention to detail and/or missed deadlines. Descriptions should be specific and detailed; do not simply state “refer to CV”.
Please note, in its evaluation of your application for Fellow status, the Fellows (FCSHP) Recognition Committee will consider only the documentation submitted. It is your responsibility to ensure that your application and documentation is complete and presented in a manner that proves your fulfillment of each of the identified criteria. Every applicant is encouraged to perform a self-assessment as well as consulting a recently successful colleague before deciding to submit this application.
Completed application, Signature pages, CV and documentation of achievement related to criterion 3 to accompany the application should be emailed to email@example.com
Ensure your completed application and all required documentation is submitted no later than August 2, 2022 11:59 Pacific time to:
Chair, Fellows (FCSHP) Recognition Committee
c/o Pamela Saunders
Canadian Society of Hospital Pharmacists
30 Concourse Gate, Unit 3, Ottawa, ON, K2E 7V7
Tel: 613-736-9733 Ext: 224
Form adapted with permission from the American Society of Health-System Pharmacists Practitioner Recognition Program and the American College of Clinical Pharmacy
Section 1: Personal/Contact Information
Membership number, years of membership, address(es), phone and email address required for this section
Section 2: Fellow Criterion
Describe how you fulfill each of the following criteria, being specific and providing examples. A general reference to your curriculum vitae is not adequate; however, your curriculum vitae should be submitted along with your signature form .
All Criteria are Mandatory
Criterion 1: Work Experience
Candidate must have practiced pharmacy for at least ten years, of which a minimum of five must have been in an organized health care setting.
Describe or list in reverse chronological order, including dates, positions that document your pharmacy practice. Please include a description of your responsibilities and accomplishments in each of these positions. The minimum ten years of pharmacy practice must all be fulfilled following a first professional degree. The minimum five-year period in an organized health care setting and the minimum of 10 years of pharmacy practice cannot include time spent as a full-time student in a residency, fellowship or graduate degree program (e.g. Masters, Pharm D or PhD degree).
Criterion 2: Society Activities & Leadership
The candidate must be a current Member of CSHP. Candidate must demonstrate support and leadership for the profession through current membership and voluntary participation in CSHP for a minimum of five consecutive years. Candidate must show consistent involvement, including leadership, in professional pharmacy association activities. (Participation in APES is accepted as equivalent to participation in CSHP activities.)
(A candidate must score more than 10 points and had significant involvement in at least 2 areas.) “Please address your experience based on these specific scoring criteria”
- Describe or list in reverse chronological order (including dates) leadership positions and offices held under the following areas:
- Describe your involvement/contributions in CSHP or APES. Please specify the years for your consistent involvement, which would include ongoing participation such as:
- Being a member of the national Board, or a national committee or task force. ( President & Delegates score 5 points while other executive positions score 0.5 points, per year you acted on the committee)
- Being a member of a provincial, Branch or Chapter committee or task force ( Chair scores 1 point per year, for each committee while members score 0.25 points per year, for each committee)
- Being a member of an affiliated board such as the Canadian Pharmacy Residency Board or the CSHP Research & Education Foundation. 1 point (per 3 year term)
- Being a representative of CSHP or APES to an affiliated organization such as CCCEP, PEBC, or a provincial organization. 1 point (per 3 year term)
- Journal editor 5 points, Associate editor 3 points (per 3 year term), Reviewer (1 point for 10 articles, min)
Criterion 3: Practice Excellence/External CSHP Leadership Activities
a) candidate must have demonstrated sustained practice focus/excellence and have implemented progressive pharmacy program(s):
Sustained is interpreted as a consistent and committed effort to maintain practice focus/excellence on behalf of the profession over a period of 5 years (specified). The purpose of this is to ensure ongoing contributions to the profession versus sporadic, infrequent contributions.
Please state the specific area(s) of sustained practice focus/excellence which are over and above the expected professional responsibilities consistent with your position. (Choose one example of a project from all the work you have done that you would like to submit to us)
Please document any further education that applies to the specialty, the number of years in this area and what measures demonstrate how practice excellence has been achieved. This shall involve a description of the implementation of a progressive pharmacy program that has resulted in an improved level of pharmacy practice.
Appropriate documentation of the achievement must be submitted with your CV and Signature form .
Divide the text of the documentation of the progressive pharmacy program into the following sections, using the headings as described below:
- Project or Program Title, and
- Objectives, and
- Brief supporting background, and
- Brief description of methods used to implement the program and (where appropriate) to collect data, and
- Brief summary of the outcome or results, and
- A description of how the knowledge gained has been translated into practice, and
- All publications or presentations related to the program
Some examples of new pharmacy programs may include but are not limited to:
- New or expanded role for the pharmacist (ex: Antibiotic Stewardship)
- New Seamless Care, Med Rec, Community Care or Home health care service
- Modernization of drug distribution system (ex: Oncology Compounding Facility
- Medication Safety Pharmacist (Institutional, Regional or Provincial)
- Innovative management system for pharmacy (ex: Senior Technician Role)
(The candidate must achieve a minimum of 40 points on the chart below)
- Area of Sustained Practice
- Number of Years in this area of practice
Min 5 years
- Additional formal post-graduate (eg. Residency (CSHP), Masters, post BSc PharmD) education
Score 5 points
- Additional training completed to support this speciality practice (eg. Board certification, CDE, other)
Score 3 points
- Selected example of a progressive, innovative pharmacy program in this area of practice (candidate to submit one)
- Candidate prepared submission in compliance with outline on application form. (if No, STOP review process)
- Project design used appropriate data collection method for the project or program evaluation
- 1 = limited information on methodology used
- 3 = methodology appears to be adequate
- 5 = methodology is well described and is consistent with that expected for the type of project submitted
Score: 1 to 5
- Results supported value of project to future practice
- 1 = strongly disagree
- 5 = strongly agree
Score: 1-5 points
- Candidate provided evidence other than a publication or a presentation (practice implications, acceptance by other health professionals or other centres) of knowledge translation of project results
* candidate to submit a letter or other evidence to support this
- 1 = strongly disagree
- 5 = strongly agree
Score: 1-5 points
- Results have been published (journal, report to government, other) Published in CJHP +1 Point
Score 10 points
- Results have been presented at a provincial, national or international professional meeting or to a meeting of primary stakeholders.
- (if evidence of both ix and xi) = 10 points
- (if evidence of ix, x and xi) = 20 points
Score 10 or 20 points
b) Describe your involvement in any additional leadership activities with other professional organizations that have a broad impact on pharmacy practice in hospitals, other collaborative healthcare settings or on pharmacy education.
Criterion 4: Publications, Presentations, Research
Candidate must have contributed to pharmacy knowledge through publication, presentation, and research.
Please present a complete list of publications, presentations, and research reports, etc. that indicate your contributions to the profession in this area.
A minimum of two of the following categories under Option 1 must be met OR complete Option 2
a) Author or co-author of at least five papers/articles (please include a list of all publications) on pharmacy practice in national or international peer-reviewed or refereed* journals (papers must be refereed, i.e., editorials, letters to the editor, abstracts are not applicable). If the article is in-press, please provide confirmation of acceptance. For listings of multiple papers/articles, please highlight or list separately those in peer-reviewed or refereed journals. Do NOT send copies of publications.
(Note: *A peer-reviewed or refereed journal is one which asks a selection of experts to pass judgment on a paper prior to publication [i.e., a journal which uses only editorial staff or the same one or two reviewers for all papers is not considered refereed]).
Alternately, you could fulfill this category as an author or co-author of a textbook or chapter in a textbook on an aspect of pharmacy (this does not include manuals, formularies, or guidelines used primarily within your hospital; however, it can include those which are widely used throughout the province or the country.) Please provide the complete details for this type of publication, including when it was published and the name of the publisher. Do NOT send copies of books/chapters.
b) Delivery of at least five invited oral presentations on different topics. Please provide a list of all invited oral presentations that you have delivered. For each presentation, clearly indicate the title of the presentation, as well as the date, location of the meeting, and the name of specific audience or group to whom the presentation was made (i.e. CSHP Professional Practice Conference).
- Oral presentations must be at provincial, national, or international professional meetings; local or hospital presentations are not acceptable and should not be included on the list.
- In the list of your oral presentations, clearly specify whether it was delivered to a provincial, national, or international professional meeting. (Poster presentations are not acceptable and should not be included)
c) Principal investigator* in a research project -- please include a brief description of each research project.
* The principal investigator (PI) is the person who directs a research project or program. The PI usually writes and submits the grant application, oversees the scientific and technical aspects of the grant, and has responsibility for the management of the research.
Delivery of at least 10 invited presentations on different topics at provincial, national, or international meetings (poster presentations are not acceptable). Do NOT send copies of presentations.
Criterion 5: Educational Activities
Candidates must have demonstrated the ongoing commitment to educating health care practitioners, patients, and the public.
Please describe activities which demonstrate ongoing commitment over a period of years to educating health care practitioners and the public. A minimum of three (3) of the following or related areas must be met:
a) Teaching in a health care program (i.e., course coordination or responsibility for at least a 4-5 lecture module at college or university level) for at least 3 years.
b) Being a preceptor in a health care program (i.e., program or service preceptor for >3 weeks) for at least 3 years.
c) Routinely creating pharmacy bulletins or newsletters (i.e., >3 per year) for at least 3 years.
d) Sustained provision of in-service education (i.e., program specific -- diabetic, respiratory, cardiovascular, etc.) for at least 3 years.
e) Development and delivery of patient-education program(s) for at least 3 years.
f) Other Educational activities (i.e., use of technology)
Criterion 6: Recommendations
Recommenders shall be representative of at least two of the following areas: CSHP Fellows, practitioners, academicians, or administrators. It is encouraged that one of your recommenders includes a current CSHP Fellow and that you do not have a direct reporting staff member as one of your recommenders.
Current Fellows (FCSHP) Recognition Committee members cannot act as recommenders for Fellow applicants.