PLDP application 2024-25

The completion of this application form indicates your interest and commitment to the Physician Leadership Development program for 2024-25 (Cohort #6).

This program requires a considerable time commitment from participants. In addition to the six learning modules, participants are required to participate in the following:

Half-day virtual kick-off prior to Module 1
A comprehensive 360-degree leadership assessment prior to Module 1
six, one-hour individual coaching sessions over the course of the program
Four group coaching sessions over the course of the program
Pre-course reading or reflection prior to each module
A physician 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).

Have you previously taken any CMA Physician Leadership Institute (PLI) Courses?

KEY QUESTIONS

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

See sample application for additional guidance.

1. Tell us why you want to participate in this program and what are you hoping for as a result? (min 250-max 500 words) Consider including a description of your strengths and areas for development.

2. Tell us about yourself as a leader. (min 250-max 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? (min 250-max 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. Health inequities are preventable disparities in the health outcomes and access to resources between populations. They are the result of systemic racism, colonialization, discrimination and oppression and result in inequity in social and economic conditions. Doctors Nova Scotia recognizes the role of health inequities in the health of Nova Scotians and prioritizes applicants who self-identify as 2SLGBTQI+ or as a Person of African descent, Indigenous (First Nations, Inuit, Metis), racialized or women. Do you self-identify as belonging to a historically underrepresented and/or marginalized group, such as Indigenous peoples, African Nova Scotians, newcomers to Canada, 2SLGBTQSI+ people, racialized people, or people with disabilities? If you are comfortable sharing the aspects of your identity that are relevant to physician leadership, we invite you to do so:

OPTIONAL

Link to LinkedIn Profile

Attach resume

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

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