AAPSM Fellow Application

Purpose of Fellowship:

• To encourage high standards of professional  proficiency, and service to the Academy.
• To promote and encourage a continuing program of professional development.
• To recognize professional achievement and competence in podiatric sports medicine. 
• To recognize the candidate who exhibits a deep and ongoing interest and dedication to the goals and long-range activities of AAPSM. 
• Fellow-applicants should demonstrate each of the following:  
1. A high level of competence and ethical conduct with knowledge of the principles and practices of podiatric sports medicine. 
2. Active participation in the Academy by attendance at the AAPSM meetings; presentations of papers; peer and public education.
3. A desire to become more active in the internal affairs of AAPSM, including serving in a leadership capacity.

Checklist for Applicants

The following requirements must be met:

• "Shall have earned a diploma from an accredited college of podiatric medicine (DPM)"
• "Shall be a member in good standing of the American Podiatric Medical Association (APMA) or equivalent organization"
  (if a podiatrist)
• "Shall have been a member of the American Academy of Podiatric Sports Medicine (AAPSM) for three consecutive years at the time of application for advancement, OR, shall have completed an AAPSM-approved Podiatric Sports Medicine Fellowship"
• "Shall have demonstrated high standards of professional development and commitment to the goals and long-range activities of the Academy:   
  *Must attain a minimum total score of 30 on the Application or a total score of 15 points if candidate has completed an AAPSM-approved Podiatric Sports Medicine Fellowship"
• "Shall have received a letter of recommendation by an AAPSM Fellow or affiliated sports team professional (team physician, etc.)" OR, shall have completed an AAPSM-approved Podiatric Sports Medicine Fellowship"
• "Shall have submitted a curriculum vitae, including evidence that he or she has fulfilled the requirements of the Academy"

**Upon acceptance of the above requirements, shall achieve:

1. A minimum passing score of 75% on a Written Examination (this take-home exam will be sent to you after acceptance of your completed Fellow Application) 
2. Face to face interview with an AAPSM Board member
3. Attend Stand Alone meeting for Fellowship Plaque awarding if have not previously attended

The following must be mailed to the AAPSM Headquarters:

• Completed application and all supporting material and attachments (Fellowship certificate if applicable)
• Curriculum vitae
• Recommendation for Advancement to Fellowship.
• The processing fee of $250.  Applications can not be processed without this fee.

Questions? Call: 301-370-2397 or e-mail: ritayates2@aol.com

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* All Fields are Required

Date:
Name:
Main Office Address (Address will display on website):
Email Address:
Highest Degree Earned:
Date Received:
Year Joined AAPSM:
Consecutive years as an AAPSM member:
Have you completed an AAPSM-approved Fellowship-in-training program?	Yes No
If yes, name of program:
Date:
Are you Board Qualified?	Yes No
If yes, Which Board?
Date:
Are you Board Certified?	Yes No
If yes, Which Board?
Date:
List the AAPSM Annual Meetings that you have attended (Year and Location)
List the AAPSM-Fellow who will be writing a recommendation on your behalf:

Education (List most recent degree first):

Institution #1
Degree
Date
Institution #2
Degree
Date
Institution #3
Degree
Date

Post-Graduate Internships, Residences, Fellowships, Special Certifications, etc.

Experience #1
Date
Experience #2
Date
Experience #3
Date

 

Please be as specific as possible when responding to the following questions in order for the Credentials Committee to thoroughly review your application. (The statement "refer to c.v." is not sufficient.)

Professional Experience and Employment (Positions held - list most recent first):

Service to the American Academy of Podiatric Sports Medicine and to the sports medicine community:

The MINIMAL requirement for service can be met by any combination of items listed below. Total points must add up to a score of at least 30 points. Applications are encouraged to document as many points as possible. Contact Rita Yates for additional "points" assignments

Professional Presentations

	Present a lecture or workshop at an AAPSM-sponsored meeting (4 points; 8 if presented at more than one sponsored meeting)
	Present a lecture or workshop at an AAPSM-sponsored podiatry school meeting (3 points; 6 points if presented at more than one school meeting)
	Present a case presentation/study at any AAPSM-sponsored meeting (2 points per case; 4 points maximum)
	Presented a sports medicine lecture at a national or international meeting such as ACSM, ACFAS, APMA, NATA, PFOLA, Podiatry Institute, GFFC (Munich), etc. (2 points; 4 points if presented at more than one meeting)
	Conducted a sports medicine tutorial/grand rounds/lectures/labs/workshops in a clinical or educational setting (2 points per talk; 6 points maximum)

Professional Presentations

	Written a published book on a sports medicine topic (15 points)
	Contributor to a published sports medicine book (3 points; maximum 6)
	Published a sports medicine article in a peer-reviewed journal such as JAPMA, JFAS, Clin Pod. Med., Foot Ankle Int., etc. (6 points each)
	Submitted a case review for publication in the AAPSM Newsletter (3 points; maximum of 6 points)
	Submitted a Journal Review article in the AAPSM Newsletter (3 points each; maximum of 6 points)
	Responded to a Pearl in the AAPSM Newsletter (2 point each, maximum of 6 points)
	Published a sports medicine article in a magazine such as Podiatry Management, Podiatry Today, Biomechanics, etc. (3 points)
	Published a sports medicine article in a lay publication such as a running club newsletter, newspaper, or magazine (2 points)
	Served as a reviewer for a peer-reviewed journal focused on a sports medicine (2 points; maximum of 6 points)

Clinical and Lay Service

	Served as State Level Clinical/Medical Director for a Sporting Event (6 points)
	Completed a full term of service - at least 1 year - on an AAPSM Committee (5 points)
	Served as a team physician/consultant for any community, high school, collegiate or professional athletic team for at least 2 years (5 points)
	Volunteered as a member of the medical team for a sporting event or running event (4 points)
	Volunteered at a pre-season physical screening, health fair, or other free screening (2 points)
	Established an education service to the community in the area of sports medicine (e.g. TV program, newsletter, etc) (2 points)
	Published a sports medicine article in local newspaper (1 point per article; 3 points maximum)
	Presented a sports medicine lecture to the lay public; group, organization, school, etc (1 point per talk; 3 points maximum)
	Completed an AAPSM approved Fellowship (15 points)

 

Total Points (Must be at least 30 points)

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Describe your clinical and/or professional practice involving sports medicine:

Describe in 100 words or less why you:
a) would like to be an AAPSM Fellow and
b) should be approved for the advancement to Fellow Status.

If advanced to Fellow status, how do you intend to exhibit your dedication to the goals and activities of the Academy?
For example, on which committees would you like to serve or chair? Be as specific as possible.

Any ethics violations, failure to complete a training program or loss of clinical/surgical privileges? Please Explain.

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**IMPORTANT** Once Fellow Status has been achieved, it must also be maintained - every 5-year period - by either of the following:

Requirements for AAPSM Fellow Retention are as follows:

• An AAPSM Fellow will be required to attend at least one AAPSM-Stand Alone Meeting in a 5-year period – or
• * An AAPSM Fellow may attend 2 AAPSM sponsored meetings in a 5-year period (these meetings must be submitted in writing and approved by the board) - or
• An AAPSM Fellow may serve as a clinical director and/or volunteer at an approved Special Olympic event (2 events in a 5-year period)

Any questions or concerns, please contact Rita Yates at ritayates2@aol.com.

* In regard to the AAPSM Fellow Retention Requirement and the PRESENT E-Learning Platform – the AAPSM will Consider a total of Eight (8) Sports Medicine PRESENT lectures equal to one AAPSM sponsored event. A Maximum of 8 Sports Medicine Present Lectures can be used.