The Applications for the GHHM 2022-23 cohort will open in March 2022. Application Form Thank you for your interest in applying for the 2021/22 Global Health and Humanitarian Medicine course. Please ensure that you have read all the relevant information about the course. Please note that this is the full application form, and we will not require you to send any document at this stage. We could ask you to provide a copy of a recommendation letter from your current or previous direct line manager/supervisor after completing the first round of selection. Once you are selected, you will be requested to submit a copy of your Primary medical qualification certificate (MBBS Degree or equivalent) and your valid Passport. For more information about the program, contact us at ghhm.southasia@new-delhi.msf.org. Applications will close at 23:59 IST on 26 April 2021. Page 1 of 6 Before submitting form please accept few Acknowledgement points : I have read the GHHM course FAQs and understand I meet the eligibility requirements to apply for this course The minimum requirement for the course completion (i.e., 70% attendance in the weekly webinars; Contribution to 70% of the online group activities; Participation in the 16 hours of parasitology laboratory training; Participation in the Mock Exam) The GHHM site I am applying to best suits my current time zone If shortlisted, I could be required to submit a letter of recommendation Next Application Form Please note that this is the full application form, and we will not require you to send any document other than the letter of recommendation at this stage. Once you are selected, you will be requested to submit a copy of your Primary medical qualification certificate (MBBS Degree or equivalent) and your valid Passport. Page 2 of 6 Email address * First Name * Surname * Gender * FemaleMalePrefer not to sayOther Date of Birth * Nationality * Current Country of Residence * Permanent Address * Contact details All postal communications will be sent to this address Current Address * City / Town * State / Union Territory * Country * Email address (Please enter your personal e-mail id only) * Skype Email ID (Please ensure it is functional) * Phone Number * Alternate Number Are you currently enrolled in a Graduate or Diploma Program (Including an online course)? * YesNo Have you applied to any other Graduate or Diploma Program (Including an online course) and awaiting results for selection to start the program while you are enrolled in the GHHM course? * YesNo The GHHM course is an English Language course. A good standard of English comprehension is required. Please rate your English Communication skill: * Native/Fluent Intermediate Beginner Speaking Native Intermediate Beginner Reading Native Intermediate Beginner Writing Native Intermediate Beginner Listing Native Intermediate Beginner Have you applied for the GHHM course before? * YesNo If yes, in which year and GHHM site did you submit your application? BackNext Curriculum Vitae This section helps us in understanding your education background and your current job profile. Candidates will be requested to provide evidence for the same at a later stage of the admission process. Page 3 of 6 Current level of Study * MBBS or equivalentPost Graduate Medical DiplomaMPHMD/MS/DNBDM/MChOther Medical Degree (Year of Graduation, YYYY) * Medical Degree - Name of the Medical College (along with City and Country) * Are you currently registered with your respective medical council ? If yes, which ? * Medical Council Registration Number * Post-graduate Medical education * YesNo If yes, your Medical field of specialization (e.g. pediatrics, emergency medicine etc.) Years of medical practice (excluding the mandatory internship). * less than 2 years2- 4 years4-6 years6 years and above Current country of medical practice * Are you currently enrolled in a Graduate or Diploma Program (Including an online course)? * YesNo Are you currently employed? * YesNo Do you work with any of the following? * MSFOther international non-governmental organization (INGO)National non-governmental organization (NGO)Ministry of Health (MoH)Other What is your current job profile? * Enrolled in a Post graduate degree / diploma programAcademicianClinicianAdministrativeAcademic and Clinical Current Employment (Name/address of your affiliation, organization, institution) * Your Position/Designation * Do you have any publications in peer reviewed journals? If yes, please mention the link / reference below: * Are you currently working or have you previously worked for MSF? (Please note your answer won't impact your application) * YesNo As a MSF staff, were you recruited as a medical doctor: * to work with MSF in your country of residence (national / locally hired staff)to work with MSF outside your country of residence (international staff)? Please indicate the duration and country of project, your role, and the Operational Centers of your last five projects with the MSF. * How long have you worked with MSF (in terms of total number of months)? BackNext Course Administration Teaching will commence in June 2020 and will run through for about 45 weeks. The course utilizes blended learning approach and lectures will be organized from our collaborating sites in India. For completion of the course, it is mandatory to attend 70% of the weekly webinars and also contribute to the online group activities. The participation/ contribution to the both should not be less than 70%. Students must also attend 16 hours laboratory training held at our collaborating academic site or virtually (contingent on the Covid-19 pandemic). Page 4 of 6 Where will you be based for the duration of the course? (Please indicate Country/City e.g. India/New Delhi) * Are you able to commit to attend at least 70% of lectures and participate in at least 70% of group activities and online work? Failure to meet these criteria will mean that we cannot declare you as eligible to sit the DTM&H exam. * Yes, I will definitely attend the live webinarsNo, it might be difficult to attend the live webinars due to other professional commitmentsMaybe, I'm not sure Are you able to commit to 6-8 hours of self-directed learning per week? * Yes, definitelyNo, it might be difficult to find that much time due to other professional commitmentsMaybe, I'm not sure Are you preparing for other exams in the next 12 months or do you have other competing commitments? * YesNo If yes please give an explanation of other commitments and how you might be able to manage 70% attendance, 70% group work participation, and 6-8 hours per week of self-directed learning: * The GHHM course prepares you to sit the DTM&H exam, which is run by the Royal College of Physicians. Do you intend to appear for the 2022 DTM&H examination? * YesNoMay be How did you hear about the GHHM South Asia course? * Word of mouthGHHM WebpageLearning and Development CatalogueFacebookLine Manager/ Head of MissionGHHM AlumniOther Are you planning to travel or spend time working oversees while completing the GHHM course? * YesNo If yes, please give an indication of your plans. BackNext Personal Statement Your personal statement is the main component of your application. Your answers to the next seven questions will be used to shortlist your application. Please help us understand your decision to apply for the GHHM - South Asia Course. Page 5 of 6 Please state your motivation to apply for this Course (answer between 300-450 words). * What was the most decisive factor for you to choose the GHHM course? (Answer between 200-450 words) * Do you have any qualifications in the field of tropical/humanitarian medicine? (For example any training, teaching experience, publications you have been involved in, bursaries, prizes, quality improvement) (Answer between 250-300 words) * Please tell us your particular interest in the field of both Tropical and Humanitarian Medicine and what you have done to demonstrate this interest through your career to date? (E.g., previous work experience, current employment, conference attendance). If any of the above-mentioned work experiences were based in low and middle-income countries (LMICs), please elaborate? (Answer between 250-500 words) * What do you understand by peer learning and how will you contribute to the course? (Answer between 150-200 words) * The GHHM course is founded on the principle of Blended learning. What do you understand by it, and how will you strike a balance between the requirement of 6-8 hours of weekly self-directed learning for the course and your professional and personal commitment? (Answer between 250- 400 words) * Please tell us your future career plans after completing this course - do you have any concrete plans to use your qualification in the field of tropical/humanitarian medicine? (Answer between 250-400 words) * BackNext Acknowledgement Page 6 of 6 I acknowledge that the information provided above is true and correct to the best of my knowledge. I understand and agree that if selected, I will be required to pay the required amount of course fee before the deadline and be required to attend at least 70% of the educational activities to complete the program. Yes, I understand and agree that I will meet all the necessary admission and course requirements * Back
