Fellows Application Form

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Completing an application for the CSHP Fellows Program

Step 1: Complete the online application form
Step 2: Complete the signature form and send to CSHP along with a copy of your curriculum vitae and documentation of achievement related to criterion 3 no later than July 2, 2018 at 5:00pm EST. (psaunders@cshp.ca or fax: 613-736-5660)
Step 3: Have each recommender complete the recommender form and send to the CSHP office no later than July 2, 2018 at 5:00 pm EST. (psaunders@cshp.ca or fax: 613-736-5660)

Please respond to all sections of this application.

Applicants should provide a CV in support of 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 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 is that worthy candidates have been unsuccessful due to an incomplete application, often without attention to detail and/or not completed in a timely fashion.  Descriptions should be specific and detailed and not simply “refer to CV” in response to specific criteria. 

Please note, in its evaluation of your application for Fellow status, the Fellows 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. 

Signature pages to accompany the application may be faxed, or scanned and sent by email (preferred).

Ensure your completed application and all required documentation is submitted no later than July 2, 2018 5pm EST

Please list the year you first became a member followed by / the year your membership expires
(example: 2006/2018)

Please list the year you first became a honorary member followed by / the year your membership expires
(example: 2006/2018)

Hospital/Organization Address
List Country if Outside of Canada
Home Address
List Country if Outside of Canada
Section 2: Fellows Criteria


Describe how you fulfill each of the following criteria, being specific and providing examples. General reference to your curriculum vitae is not adequate; however, your curriculum vitae should be submitted along with your signature form which you should download from the main page of Fellows.

All criteria are mandatory

Criterion 1: Work Experience


Candidate must have practiced pharmacy for at least 10 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: Professional Pharmacy Association Activities


The candidate must be a current member of CSHP. Candidate must demonstrate support and leadership for the profession through active, 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.)

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.
  • Being a member of a provincial Branch or Chapter committee or task force.
  • Being a member of an affiliated board such as the Canadian Pharmacy Residency Board or the CSHP Research & Education Foundation.
Being a representative of CSHP or APES to an affiliated organization such as CCCEP, PEBC, or a provincial organization
Criterion 3: Practice Excellence


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)
Describe progressive pharmacy program (use headings from criteria description)
Criterion 3 Practice Excellence (b)


(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 and 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 must be met:

(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.

Criterion 4: Publications, Presentations and Research (b)

 
(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 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)
(use headings from criteria)
Criterion 4: Publications, Presentations and Research (c)


(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.

Criterion 4: Publications, Presentations and Research OR


OR

(a)   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.

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Criterion 5: Educational Activities


Candidates must have demonstrated 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:

(i.e., course coordination or responsibility for at least a 4-5 lecture module at college or university level) for at least 3 years.

(i.e., program or service preceptor for >3 weeks) for at least 3 years.

(i.e., >3 per year) for at least 3 years.

(i.e., program specific -- diabetic, respiratory, cardiovascular, etc.) for at least 3 years.

for at least 3 years.

(i.e., use of technology)

Criterion 6: Recommendations


Provide the names of at least two (2) recommenders who you have requested to submit confidential recommendations attesting to your contributions as a practitioner and ratings on the attributes list, and who support this application for Fellow status.

Recommenders must use the “Fellow Program Recommendation Form”. (You must download this form from the main Fellows page). Scanned copies of the form are acceptable. 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 Recognition Committee members cannot act as recommenders for Fellow applicants.
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