Course Director Referee Form

Please provide details of the instructor you wish to nominate below.

To be eligible as a Director Candidate, the nominee would need to have instructed on a minimum of 10 APLS courses as a full instructor (Please note, this would mean 12 courses in total when including courses as an IC).

Upon receiving your nomination, we will contact the nominated instructor and request that they submit a form with a copy of their CV and a personal statement on why they wish to become an APLS Director. The nomination will then be presented to the IDC for consideration.

Please feel free to contact ashlee.farrell@apls.org.au or faculty@apls.org.au if you have any questions.

Your full name (Director submitting the nomination)*

Your email address (Director submitting nomination)

Full name of instructor being nominated

Email address of nominated instructor*

Please ensure this is not your email address, but the email address of the person you are nominating

Date of Nomination*

Day/Month/Year

Please indicate the extent to which (in your experience) the nominee possesses these attributes, in their current role as an APLS Instructor using a scale of 1 to 10.

Communication
1 = Nervous presenter. Lacks confidence, clarity and/or cohesion. Comments reflect limited insight into understanding of others.
10 = Confident and coherent speaker with excellent presentation skills. Seeks and is receptive to information from others.*

Comments*

Openness to Learning
1 = Shows little curiosity, rarely asks questions. Poor at listening, seldom checks understanding. Avoids opportunities for mentoring/coaching type conversations. Demonstrates rejection of feedback when it is provided.
10 = Demonstrates active listening by paraphrasing to confirm shared understanding. Admits to not knowing or being able to do certain things. Engages with new skills and thinking by persisting with new tasks or concepts. Acknowledges and acts on feedback.*

Comments:*

APLS Teaching/Coaching Skills
1 = Unable to explain basic issues. Lacks flexibility. Unable to adapt and respond to the learning needs of others.
10 = Flexible teaching skills – ability to adapt to the diversity of learner needs: gives appropriate explanations and checks understanding. Approachable, patient and respectful.*

Comments:*

Collaborative Team Member
1 = Insensitive to others. Functions without consideration of group. Interrupts and provides negative feedback.
10 = Shows sensitivity to group members, supports and encourages others - an excellent team player.*

Comments*

Management
1 = No insight into course objectives, disregards time and logistic constraints. Unable to facilitate learning within time constraints.
10 = Diligence with time keeping and insight into logistical course considerations. Excellent leadership skills.*

Comments*

APLS Content
1 = Inadequate clinical paediatric expertise. Frequently unable to answer content questions.
10 = Excellent knowledge, able to elaborate on difficult areas and has clinical experience of content.*

Comments*

Professionalism
1 = Professional background lacks direct involvement in education or practice of acute paediatric care.
10 = Brings perspective from craft group and able to promote interdisciplinary approach. Has credibility as a teacher in acute care paediatrics.*

Comments*

Advocate for APLS
1 = Undermines APLS teaching and promotes alternative or individual opinions.
10 = Promotes APLS approach and able to see the strengths and weaknesses of the course.*

Comments*

I confirm the following:
1. I have been a Director on a course where the nominee was an instructor
2. The nominated instructor has shown leadership as demonstrated by:
a) assessing capabilities and confirming roles and responsibilities of team
b) exchanging information and taking into consideration views of others
c) assertive communication that states case and justification for decision
d) the ability to have respectful conversations regarding the impact of behaviours that are affecting others and/or the APLS program
3. The nominated instructor has shown the ability to adapt to support the development of others including:
a) situational awareness shown by seeking and responding to information from other members of faculty regarding candidates
b) anticipating potential problems and
c) taking accountability for contingency plans

Do you have any comments to make about the strength of these attributes or any other comments about their nomination?