OFEC Group Mentoring Program: Mentee Application

Fill in this form to be mentored in creating a continuing professional development project. Please fill in the fields with asterisks. If you have any questions or concerns filling in this form please contact Ashley Elliott. aelliott@ophthalmologyfoundation.org

For the Person Filling Out This Form
Organization Information
Do you have any formal role specific to Medical Education in your organization? *
Do you have any formal role specific to CPD in your organization? *
0/500 characters
Does your organization have a structured Continuing Professional Development (CPD) system? *
Have you conducted a needs assessment in your organization to justify specific development needs (educational programs and/or a structured educational system) in CPD? *
Regarding CPD programs:
Please rate your interest in developing the following topics: *
 1-Must develop2-Should develop3-Nice to develop
Identifying an eye care problem and identifying the knowledge gap
Conducting a needs assessment
Formulating goals and objectives outcomes
Selecting adequate educational methods, models and tools
Implementing and facilitating learning programs
Evaluating the impact of educational programs
Please rate your interest in developing the following types of educational formats : *
 1-Must develop2-Should develop3-Nice to develop
Plenary presentations / keynote lectures
Small group training sessions (<50 attendees)
Small group(< 15) case-based presentations
Interactive learning strategies (audience response systems, think-pair-share, jigsaw discussions, one minute paper, etc)
Blended learning, (some technology and some live elements)
Brief, focused didactic presentations (microlearning)
Simulation based training
Faculty Development
Longitudinal learning experiences
Time spent with colleagues outside of sessions
Formation of a community of practice
Flipped classroom
Online education (web based courses, video-conferences)
Personal study methods and tools (self-assessment, practice audit, personal learning projects)
Regarding Structured CPD Systems:
Please rate your interest in developing the following topics: *
 1-Must develop2-Should develop3-Nice to develop
Coordinating the perspectives of the multiple CPD stakeholders
Involving eyecare professionals into the CPD system processes
Communicating and advocating for CPD
Implementing CPD good practices: events accreditation, implementation of personal learning plans, clinical practice audits
Forming a community of practice focused on a particular area of eye health
Designing, implementing and/or improving the quality of a structured CPD system
Setting up a project on quality improvement
Creating a mentoring program
Building a unit of continuing education
Involving the patients and public into education and eye care delivery
When you think about starting and managing a CPD program/system what are some of the strengths and challenges of your organization? Please mark with (C) the resources you consider challenges for your organization, and with an (S) those you consider as strengths. *
 C - ChallengeS - Strength
Administrative Staff
Communication / Marketing
Educational Resources
Financial support
Organizational recognition
Eyecare professionals engagement
Eyecare authorities’ support
Faculty engaged
Faculty knowledgeable in education strategies
Information / Technology people/equipment
Simulation-based training equipment/facilities
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