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BPEI Clinical Observership Application

The Bascom Palmer Eye Institute offers a clinical observership program for international ophthalmologists to observe specialty practices for periods of 2-4 weeks. The program is non-clinical and designed for physicians to observe only. Applicants must submit documents including a CV, license, and fees at least 3 months prior to the requested dates. Accepted observers are required to carry health insurance meeting minimum standards and obtain a B1/B2 visa. Upon arrival, observers meet with directors to discuss interests and rotate among faculty of their selected specialty.

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Dayana Salas
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282 views4 pages

BPEI Clinical Observership Application

The Bascom Palmer Eye Institute offers a clinical observership program for international ophthalmologists to observe specialty practices for periods of 2-4 weeks. The program is non-clinical and designed for physicians to observe only. Applicants must submit documents including a CV, license, and fees at least 3 months prior to the requested dates. Accepted observers are required to carry health insurance meeting minimum standards and obtain a B1/B2 visa. Upon arrival, observers meet with directors to discuss interests and rotate among faculty of their selected specialty.

Uploaded by

Dayana Salas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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The Bascom Palmer Eye Institute, Department of Ophthalmology of the University Of Miami

Miller School Of Medicine, in keeping with its commitment to global exchange, is pleased to
provide a clinical observership program for ophthalmologists from around the world.

The Clinical Observership program for physician is open to international physicians including
residents and fellows in institutions abroad. U.S. physicians may also participate if not currently
enrolled in a U.S. residency program. Please note that this program is not an elective rotation
or a fellowship. This program is an observational tutorial which does not permit any
direct patient care. To be accepted into the program you must have a good command of
the English language.

Clinical Observership for Physicians

• Duration of clinical observership can be from 2 days and up to 4 weeks


• Application requires three months for processing
• See attached application for required supporting documents
• Clinical Observers will need to obtain a B-1 or B-2 Visa (Tourist Visa)
• Non-refundable $250 application fee
• At this time, there are no tuition fees for a clinical observership
• Maximum visit: 4 weeks (no extensions)

Observers visiting for longer than two weeks are required to carry $250,000USD accident and
sickness medical benefits maximum with a deductible $250USD to $500USD (Insurance
company will pay 80% of the first $5,000USD of eligible expenses, and the 100% of the
remaining Eligible expenses), Emergency medical evacuation of
$25,000USD, Return of Mortal Remains - $10,000USD, and Emergency Dental for accidents
$500USD. If you already have insurance with these coverage specifications, please submit
copies of your policy along with your application form. If you do not have the above
coverage, you will be required to purchase insurance prior to your arrival at the
Bascom Palmer Eye Institute.

The application process begins once the potential observer submits his/her complete
application (including all supporting documents) and an available date range has been identified
with the CME Manager. The application and supporting documents are then forwarded to the
service director of the sub-specialty that the potential observer identified he/she was interested
in for approval. Once accepted, a signed letter of acceptance is sent to the observer.
Upon arrival, the observer meets with the service director to discuss his/her current
interests. Typically, observers rotate with most of the faculty of the indicated sub-
specialty in order to see many different physicians in practice. This process, however, varies
by sub-specialty.

Thank you very much for your interest in the Bascom Palmer Eye Institute. We look
forward to your visit.

Sincerely,

Karen Davila
Manager, Continuing Medical Education Bascom
Palmer Eye Institute
CLINICAL OBSERVERSHIP APPLICATION (PHYSICIANS ONLY)

PLEASE RETURN TO:


Karen Davila
Department of Continuing Medical Education Tel (305) 326-6110
th
1400 NW 10 Avenue, Suite 508 Fax (305) 326-6518
Miami, FL 33136 [email protected]

PERSONAL INFORMATION

Last Name: First Name: Middle Initial:

Degree: Male Female Birth date: - -


Month Day Year
Address:

City: State: Zip Code: Country:

Language(s) spoken: E-mail Address:

Telephone: Fax:
(please include country code, city code)

EDUCATION/PROFESSIONAL INFORMATION

Medical School: Graduation Year:

License #: Date Issued:


Specialty: Check if Board Certified: □
Hospital Affiliations:

OBSERVERSHIP PREFERENCES
Area of Interest: □ Cornea □ Glaucoma □ Neuro-Ophthalmology □ Oculoplastics
□ Pathology □ Pediatrics □ Retina
Please provide preferred date ranges for your visit:

1. to 2. to

3. to 4. to

Required Attachments:
□ Curriculum vitae
□ Current photograph
□ Non-refundable $250 application fee
□ Medical license renewal for current year – certified translation into English
□ Letter of Intent indicating goals while in Observership Program (1 page max)

*Bascom Palmer Eye Institute and University of Miami require 3 months to process Clinical Observer Applications*
OBSERVERSHIP APPLICATION FEE
BASCOM PALMER EYE INSTITUTE
UNIVERSITY OF MIAMI/DEPT. OF OPHTHALMOLOGY

Last Name: First Name: Middle Initial:

Billing Address:

City: State: Zip Code: Country:

Telephone: Fax:
(please include country code, city code)

OBSERVERSHIP APPLICATION FEE: $250

□ Cashier’s check in US dollars payable to University of Miami.


Please do not send personal checks or cash.

□ Bill my credit card: □ American Express □ Visa □ MasterCard

NAME ON CARD

SIGNATURE

Cut and shred below the line after the credit card has been charged

[_ |_ _| | | | | | | | | | | | | | ]

SECURITY CODE EXPIRATION DATE

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