APM Osteopathic Department of Internal Medicine Chair Application

_____________________________________________________________________________________

Please use proper capitalization when completing the form. Fields marked with an asterisk must be completed.

AAIM staff will submit all completed applications to the APM Council for review. After APM Council has completed their review, AAIM staff will notify applicants of their membership application status.

Membership Criteria

Chairs of departments of (internal) medicine at Commission on Osteopathic College Accreditation (COCA) accredited medical schools may apply for membership if they meet the following criteria.

Supervise one or more ACGME approved internal medicine residency training programs (including programs with initial accreditation)
Training programs have both inpatient and outpatient experiences
The department of internal medicine is a discreet department and not an amalgam of other primary care departments or a primary care department per se
The department has an internal medicine clerkship
The chair supervises at a minimum all educational and research programs in the department of internal medicine and ideally also supervises clinical programs within the institution
The department comprises at least five full-time internal medicine faculty in addition to the chair, all of whom are employed/appointed by the school
The department is involved in research which includes quality improvement for patient care and/or education
Shall not be a faculty member at an LCME- or CACMS-accredited medical school (see Institutional Affiliate)

Attestation

By submitting this application I attest that I do in fact meet all of the criteria noted in the section Membership Criteria.

I have read the Membership Criteria, and I *

Do meet all of the stated requirements.

Information

First Name *

Middle Initial

Last Name *

Suffix 1 *

Suffix 2

Title *

Department

Division

Institution *

Subspecialty

Address 1 *

Address 2

City *

State/Province *

ZIP Code *

Country

Phone *

Fax

Email Address *

Curriculum Vitae

Please attach a copy of your curriculum vitae.

Curriculum Vitae *

To attach a file, select Browse, then navigate to the file you would like to attach. Select the file and click Open. The path to your selected file will appear next to the Browse button.

Additional comments regarding your membership application.