Apply to Participate in the 2021-22 Physician Leadership Development Program

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PLDP application 2021-22

The completion of this application form indicates your interest and commitment to the Physician Leadership Development program for 2021/2022.
This program requires a considerable time commitment from participants. In addition to the six face-to-face sessions, participants are required to participate in the following:

One-hour virtual kick-off prior to Module 1
A 360-degree feedback assessment prior to Module 1
Five, one-hour individual coaching sessions over the course of the program
An action learning project that requires a minimum of 2-5 hours between modules

Please visit the Doctors Nova Scotia website for more program details including program goals, timelines, and application process.

CONTACT INFORMATION

Name

First

Middle

Last

Address

City/Town

Province

Postal Code

Phone number

Organization, if applicable

Title, if applicable

What best describes your primary work setting(s)?

Please specify

Specialty

Number of years in practice

Do you currently hold formal leadership role(s)?

If yes, please provide title(s) of your formal leadership role(s) and length of time in role(s).

KEY QUESTIONS

Where applicable, please be as specific as possible as to role, impact, and outcome

1. Tell us why you want to participate in this program and what are you hoping for as a result? (max 250-500 words)

2. Tell us about yourself as a leader. (max 25-400 words) Consider including examples of significant change initiatives you may have led or key leadership accomplishments you are proud of and any previous leadership development training experience.

3. What is the impact you want to have in the health-care system and how will this program prepare you for that? (max 250-400 words)

OTHER

Max 100 words per question

4. Have you been encouraged or sponsored to apply for this program? If so, why?

5. Is there any other information you would like the selection committee to consider?

6. Are there any barriers to your full participation, attendance, and commitment to the program?

7. Have you previously applied to this program? If yes, what made you re-apply?

8. Inequity is a public health care issue. The leadership in our healthcare systems lack diversity and inclusion of populations that are historically marginalized and underrepresented, particularly indigenous peoples and African Nova Scotians, resulting in policies and practices which do not support physicians or patients. Joule and Doctors Nova Scotia are committed to creating an inclusive, just, and diverse learning culture to address these inequities and improve the health system in Nova Scotia.

Do you self-identify as belonging to a historically underrepresented and/or marginalized group, particularly indigenous peoples and African Nova Scotians, or based on ethnicity or immigration status, Indigeneity, gender identity, sexuality, ability.

Yes, indigenous and/or African Nova Scotian

Yes, other group

Prefer not to say

OPTIONAL

Link to LinkedIn Profile

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Apply to Participate in the 2021-22 Physician Leadership Development Program

Apply to Participate in the 2021-22 Physician Leadership Development Program

PLDP application 2021-22

CONTACT INFORMATION

KEY QUESTIONS

OTHER

OPTIONAL

All applications will remain confidential and be reviewed by a selection committee.

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