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Canadian Field Epidemiology Program

CFEP Placement Application 2011-2013

^* Required

Department / Organization

please provide contact information for the department / organization with which the Field Epidemiologist would be placed

*1.1 Mailing Address:

Identification of Supervisors

Primary Supervisor

* 2.1 Name:

*2.2 Title / Current position:

*2.3 Telephone:
(xxx-xxx-xxxx)

*2.4 Fax:
(xxx-xxx-xxxx)

*2.5 Email:

*2.6 CFEP Alumni Y/N (year):

*2.7 Degrees / Education:

*2.8 University Affiliation:

Alternate Supervisor #1

2.9 Name:

2.10 Title / Current position:

2.11 Telephone:
(xxx-xxx-xxxx)

2.12 Fax:
(xxx-xxx-xxxx)

2.13 Email:

2.14 CFEP Alumni Y/N (year):

2.15 Degrees / Education:

2.16 University Affiliation:

Alternate Supervisor #2

2.17 Name:

2.18 Title / Current position:

2.19 Telephone:
(xxx-xxx-xxxx)

2.20 Fax:
(xxx-xxx-xxxx)

2.21 Email:

2.22 CFEP Alumni Y/N (year):

2.23 Degrees / Education:

2.24 University Affiliation:

Understanding of the Program

3.1 How did you learn about the Canadian Field Epidemiology Program?

3.2 Has the proposed primary supervisor supervised a Field Epidemiologist in the past?

3.3 If yes, who and when?

3.4 Is the proposed primary supervisor a CFEP Alumni?

3.5 If yes, from which cohort/year?

3.6 Are there former Field Epidemiologists in your immediate team, division or program?

3.7 If yes, name and cohort/year?

3.8 Has the proposed primary supervisor had prior experience supervising or working with a field epidemiologist on an EPI-Aid investigation?

3.9 If yes, when?

3.10 Why does the proposed primary supervisor want to supervise a Field Epidemiologist for two years? What advantage would a Field Epidemiologist give to your organization? To the proposed primary supervisor personally? To the staff the Field Epidemiologist will work with?

3.11 What advantage would a Field Epidemiologist gain by working with you and your organization?

Support

4.1 All potential placement sites are different. Please describe, in no more than 500 words, the structure of your organization in terms of program and technical functions.
(You may also provide additional documentation if you wish, but it cannot be a substitute for a written, 500-word response)

4.2 Summarize the mandate of your department / organization

4.3 Summarize the roles and responsibilities of your department / organization

Each placement site provides unique learning opportunities. Please describe some of the unique project/work opportunities of your jurisdiction with respect to the following attributes:

4.4 Specific/ higher-need populations served

4.5 Other features

Placement sites have different capabilities in terms of logistical and technical support. Please describe what logistical support would be available to the Field Epidemiologist? (Please provide some detail in your response rather than a simple “yes” or “no”):

4.6 Office / cubicle

4.7 Funding for placement-related travel

4.8 Computer

4.9 Standard software applications (word processing, spreadsheet, statistical)

4.10 Telecommunication capacity (phone / internet)

4.11 Other

Describe what technical resources would be available to the Field Epidemiologist?

4.12 Administrative support

4.13 Statistical/biostatistical support

4.14 Epidemiological support

4.15 Content area expertise

4.16 Other specific expertise

Supervision and Training

5.1 Placement supervision is an important component of the Canadian Field Epidemiology Program. On average, how much work-related travel does the proposed primary supervisor do annually?

5.2 If the proposed primary supervisor was unavailable for an extended period of time (> 2 weeks) because of vacation, duty travel, leave of absence, etc., what specific provisions would you make to ensure that a Field Epidemiologist placed with you is adequately supervised?

5.3 Can the proposed primary supervisor commit to at least 1/2 day per week for supervision of a Field Epidemiologist?

5.4 As effective placement supervision is such an important part of the success of Field Epidemiologist’s placement, please describe the proposed primary supervisor’s approach to supervising a Field Epidemiologist.

5.5 There are many characteristics of worthwhile feedback. Please describe how the proposed primary supervisor would provide feedback to a Field Epidemiologist?

5.6 Would the proposed primary supervisor be able to commit to participation at a one day Supervisor’s Retreat (date to be determined)?

5.7 If not: What is the main obstacle to his/her
participation?

Orientation to Placement

6.1 Orientation to the placement site is important in order for the Field Epidemiologist to get familiar with this new working environment. Please describe how the proposed primary supervisor would orient a Field Epidemiologist to your organization and jurisdiction.

6.2 What specifically would the proposed primary supervisor and other staff do to prepare for a Field Epidemiologist’s first week on the job?

Opportunities

7.1 Each placement site provides unique opportunities. Does your organization have affiliation with other organizations (e.g. university or research unit)?

7.2 Describe the range of activities with which a Field Epidemiologist may become involved in your placement
(In your response please address details such as, topic, population, type of work, analysis, etc.)

7.3 Indicate how these activities relate to the CFEP Professional Experience Guidelines (PEGs)

7.4 Indicate the level of responsibility the Field Epidemiologist might have with various activities

7.5 Describe opportunities for field investigations at this placement.

Describe activities of your organization over the previous year:

7.6 Surveillance

7.7 Outbreak investigation

7.8 Field / operational research

7.9 Scientific / professional communication

7.10 Teaching / training

Each placement site has specific opportunities that may not have been already covered. Please describe other opportunities and resources available at your placement site:

7.11 Links with students (e.g. medical students/residents, graduate students or programs)

7.12 Links with other health professionals (e.g. infection control practitioners, environmental health officers, nurses)

7.13 Other

Projects

Each placement site is expected to support Field Epidemiologists to complete the eight required Professional Experience Guidelines (PEGs).

8.1 Data analysis project (PEG #2): Identify specific data analysis projects that the Field Epidemiologist could take responsibility for in order to meet PEG #2.

8.2 Surveillance project (PEG #3): Identify specific health events under surveillance that would be suitable to the Field Epidemiologist’s requirement to design and implement, OR revise and implement, OR evaluate a public health surveillance system.

8.3 Communication skills (PEGs #4-8): What opportunities will be made available to the Field Epidemiologist to improve their competencies in communication and meet the requirement for the communications related PEGs.

Other

9.1 What are the main strengths and key attractions of this placement?

9.2 What are some potential limitations of this placement?