Your details First Name * Last Name * Mobile Phone Number * Email * Professional Status * - Select -GPRespiratory Specialist DoctorIntegrated Care PhysicianOther Qualified DoctorPractice NurseNurse Practitioner (General Practice)Respiratory Nurse SpecialistOther Qualified NursePharmacistRespiratory Specialist PhysiotherapistOther supervised clinical role (eg healthcare assistant, emergency care practitioner, physician assistant)Other qualified health professionalNon-clinician (eg researcher, commissioner, manager)Pharmaceutical or device company or agency thereofRetired GP, nurse, other qualified health professional Setting in which you work GP practice Community team Hospital based team CCG / Health board University academic department Other not for profit organisation Commercial company None of the above Activity Have you participated in the PCRS Respiratory Leaders Programme? Yes No Have you been involved in PCRS research network? Yes No Have you attended PCRS annual conference in last three years? Yes No Have you ever attended a major international respiratory conference? (e.g. ERS, ATS, BTS) Yes No Please provide details of your role and how you are working towards leadership to improve respiratory health * How will your participation in this programme fit in with your personal development plan? * What are your short term ambitions as a respiratory practitioner/researcher? * What are your long term ambitions as a respiratory practitioner/researcher? * What do you think you will learn from participating in this programme? * What does being a respiratory leader mean to you and where do you see yourself on this journey? Please advise which meetings you would be able to attend if you are successful in this application ERS Congress, 9-13 September 2023, Milan, Italy PCRS Annual Conference, 21-23 September 2023, Telford, UK BTS Winter Meeting, 22-24 November 2023 - London I do not want to attend respiratory events but would like mentorship in another area based on my goals Please upload a summary professional CV Files can be MS Word or PDF in format and must not exceed 5MB One file only.2 MB limit.Allowed types: pdf, doc, docx. Terms and Conditions of Mentorship Applications will be subject to scrutiny by a review panel comprising of a PCRS composed board of up to five reviewers Successful applicants will be required to share details of cell phone numbers with PCRS and mentors to facilitate communication Delegates will be required to book their own place at the ERS conference based on their role and age; where possible booking early to facilitate early bird registration PCRS will be responsible for registering delegates for the BTS Winter Meeting and the PCRS Respiratory Conference Delegates will be provided with a single bursary to support registration, travel and accommodation requirements (depending on the location of the event) Delegates are advised to take out appropriate comprehensive travel insurance cover. PCRS cannot be held responsible for any health, loss or travel claims for any reason including cancellation due to COVID-19 Successful applicants must be available to take time out of work to attend the conference Successful applicants will be required to prepare personal learning objectives for the conference and share these with the mentors before attendance Successful applicants will be required to prepare a plan on how the learning will be disseminated in own healthcare environment Successful applicants will be required to prepare a short editorial on their experience for publication in the PCRS publication Primary Care Respiratory Update Successful applicants will be required to present feedback on their learning at a PCRS event or digital learning media (e.g. podcast/webinar) In the event that the programme is cancelled or cannot take place for any reason outside the control of PCRS the total liability of PCRS shall be limited to the registration fee and bursary amount only and it shall not be liable for any other loss, cost or expense howsoever arising Successful applicants who fail to attend will be required to reimburse any payments made to them by PCRS and be expected to cover any out of pocket expenses independently Status I confirm that: 1) I am a PCRS member, 2) A healthcare professional or researcher, 3) I work in a primary, community or integrated care setting, AND 4) I have little or no previous experience of attending international respiratory congresses Yes No PCRS is grateful to GlaxoSmithKline for the provision of an educational grant to support the scientific mentorship programme. The programme has been solely organised by PCRS. Leave this field blank
PCRS is grateful to GlaxoSmithKline for the provision of an educational grant to support the scientific mentorship programme. The programme has been solely organised by PCRS.