LEADERSHIP ACADEMY. Florida College of Emergency Physicians 3717 S. Conway Road, Orlando, FL emlrc.org

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1 LEADERSHIP ACADEMY Established in 2012, FCEP s Leadership Academy provides the necessary orientation and skills development for those who aspire to become future leaders in emergency medicine. Florida College of Emergency Physicians 3717 S. Conway Road, Orlando, FL emlrc.org

2 Welcome Message from Your Chair As FCEP s current Leadership Academy Chair, I want to thank you for your interest in FCEP s Leadership Academy. The Academy is a year-long program that focuses on providing all of the ingredients necessary to grow leaders in our field while harnessing your specific area(s) of interest. The Academy combines elements of mentoring, organization and guided experiences to selected participants who want to grow in their interest area of emergency medicine. My personal goal for the Academy is to facilitate professional growth and energize the program into a highly-coveted springboard of leadership. We want to submerge participants into a pool of networking and leadership experiences, which span across our specialty, the state of Florida and beyond. I know all too well the current demands and time constraints we have in our personal and professional lives. As Chair, I make it my personal goal to ensure the Academy does not interfere, but rather complements the commitments you may already have on your plate. This way, you get the most out of this unique opportunity and truly enjoy your experience and all those you will meet. FCEP is committed to fostering your professional growth within the organization and sees the potential you may hold as a valued member in our ever-changing healthcare landscape. On behalf of FCEP, I welcome all who have made that commitment to our patients and the practice of emergency medicine today, and those who desire to be our leaders of tomorrow. I sincerely hope you consider FCEP s Leadership Academy as that springboard for your career and future leadership endevaors. I look forward to answering any questions you may have, and wish you continued success in all your endeavors. Sincerely, Pat Agdamag, MD, FACEP FCEP Leadership Academy Chairman FCEP Board of Directors Member pagdamag@gmail.com

3 Program Details PROGRAM OBJECTIVE The purpose of the Leadership Academy is to provide the necessary orientation and skills development for future leaders of FCEP and emergency medicine. Each Academy participant selects an area to focus on and works on projects that are aligned with FCEP goals and objectives. The bottom line is future growth and leadership opportunity for all Academy participants. PROGRAM GOALS 1. Recognize individuals with the potential to become leaders in emergency medicine. 2. Encourage support for participation by working with local FCEP leaders and group sponsors. 3. Provide orientation and receive one-on-one mentorship from active FCEP Board members and leaders. Provide opportunities to visit and network with ED medical directors, healthcare administrators and residency programs around the state. 4. Develop the leadership skills necessary to actively promote the specialty of emergency medicine on the local, state and national level. 5. Upon completion of the program, participants can successfully matriculate into a leadership position. COMMITMENT EXPECTATIONS The program is one-year long and participants are accepted on a rolling basis. Participants are expected to attend the following: November 28-29, 2018 EMLRC in Orlando, FL FCEP Committee Meetings February 7, 2019 EMLRC in Orlando, FL Emergency Medicine Days & FCEP Board Meeting March 11-13, 2019 Hotel Duval in Tallahassee, FL ACEP Leadership & Advocacy Program May 5-8, 2019 Washington, D.C. May 22-23, 2019 Orlando, FL Symposium by the Sea August 1-4, 2019 Boca Raton, FL Estimated cost: $400 ACEP Scientific Assembly October 27-30, 2019 Denver, CO Estimated Cost: $1,000 May serve as FCEP Alternate Councillor Find FCEP s full calendar of events at emlrc.org/fcep-calendar

4 LEADERSHIP ACADEMY APPLICATION This application will be reviewed by the Florida College of Emergency Physician s Selection Committee. Please complete the following form and to FCEP Executive Director Beth Brunner at bbrunner@emlrc.org or mail to the Florida College of Emergency Physicians at 3717 S. Conway Road, Orlando, FL APPLICANT PROFILE Name & Credentials of Applicant: Mailing Address: Phone: Hospital / Management Affiliation: DESCRIPTION OF PRACTICE Number of years as a member of ACEP, EMRA and/or FCEP: Please list the state or national activities in which you have participated (leadership positions, committee or task force involvement, etc.): Please list any leadership positions in organized medicine: Please list your membership in other medical associations:

5 Please describe your interest in the Leadership Academy, including why you should be selected by the Selection Committee to participate: Please describe how your participation in the Leadership Academy might benefit your state and/or hospital: Name of Sponsoring Group: If selected, I agree to participate in all designated elements of the Leadership Academy. Signature of Applicant Date Please include any supplementary material you would like the Selection Committee to review concerning this nomination.

6 FCEP LEADERSHIP ACADEMY: SPONSOR PLEDGE As a Florida Emergency Medicine Group Leader, please submit one or two nominations from within your group to participate in FCEP s Leadership Academy. individuals must be FCEP members in good standing. The following is a list of events Academy participants are expected to attend along with estimated costs: November 28-29, 2018 Orlando, FL Est. cost for non-local members: $200 FCEP Committee Meetings February 7, 2019 Orlando, FL Est. cost for non-local members: $200 Emergency Medicine Days & FCEP Board Meeting March 11-13, 2019 Hotel Duval in Tallahassee, FL ACEP Leadership & Advocacy Program May 5-8, 2019 Washington, D.C. May 22-23, 2019 Orlando, FL Est. cost for non-local members: $200 Symposium by the Sea August 1-4, 2019 Boca Raton, FL Estimated cost: $400 ACEP Scientific Assembly October 27-30, 2019 Denver, CO Estimated Cost: $1,000 Find FCEP s full calendar of events at emlrc.org/fcep-calendar Estimated total cost for non-local members: $4,000 Sponsoring Company: Company Address: Contact Name: Contact Contact Phone: Company Website: Nominee(s): Pledge Amount: Partial Pledge Amount: Invoice Me Process Credit Card Credit Card Number: Exp. Date: Security Code: Billing Zip Code: Authorized Signature: