Exam in thoracic surgery_Application form

Exam in Thoracic surgery
Application form

Title

First name *

Family name *

Date of birth

Nationality

Address (including country) *

Phone number (with international code)

Email *

Subject *

Current position: Institution

Since

Is this a recognised training appointment?

Yes

Member of ESTS

Yes

Member of EACTS

Yes

Professional Education: Medical School

Surgical training

National certification and specialty recognition

Authority

Year

Copy of passport

Recent photograph

Copy of national medical diploma

Your diploma must be in English; otherwise, attach an official signed and stamped translation. If your diploma is obtained outside of the EU Member States (or Switzerland and Norway), the diploma must be ratified by the appropriate official body in the country where the specialist training takes place.

Copy of licence to practice medicine

Your licence to practice medicine must be in English; otherwise, attach an official signed and stamped translation.

Copy of national specialist diploma of CCST (certificate of completion of training)

Your National Specialist Diploma must be in English; otherwise, attach an official signed and stamped translation. If your Diploma is obtained outside of the EU Member States, you must provide a copy of European recognition of this diploma.

Short curriculum vitae

Detailed list of rotations

With precise dates during the whole training, signed by the Director/Coordinator of the training programme. Sample layout

Detailed list of positions held

Detailed list of positions held as junior staff member or full consultant, countersigned by the heads of concerned departments.

Logbook of operations

Precise and exhaustive logbook of operations performed during the training period, indicating separately which have been performed as an operating surgeon or an assistant, certified by the Director/Coordinator of the training programme.

List of operations performed after completion of training

Detailed list of operations performed after completion of training as junior staff or full consultant, certified by the Director/Coordinator of concerned departments.

List of courses and meetings attended

List of publications and presentations

PDF of publications

Printed programme of presentations

Certificate of Master’s degree in Science or PhD when existing, but optional

Recommendation letters of mentors

Optional

Proof of payment

Submit

Files will only be processed if proof of payment from your bank is included.

Bank Account of UEMS Section of Thoracic Surgery

Name of account: UEMS/S Thoracic Surgery

Number of account: 001-6929464-54

IBAN: BE42 0016 9294 6454

BIC/SWIFT: GEBABEBB

Name of bank: BNP Paribas Fortis

Address of bank: Montagne du Parc 3, BE-1000 Brussels

If you are applying from Switzerland, please provide copies of your yearly fmh evaluation (english version) plus a letter confirming your eligibilty from the Swiss Medical Association.

The UEMS Section of Thoracic Surgery account of payment is:

BE42 0016 9294 6454

AISBL UEMS/S.THORACIC SURGERY

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