Exchange Programme Host Centre Application

Contact Name*
Hospital Name*
Hospital Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Phone
Contact Email*
Who is in charge of the TEP training at this centre?*
- The Contact Person of the TEP centre (same as above)
- The Head of Department
- Other specialists, consultants (specify including name and position)
Name & Position*
Name Position
Department Profile: (a brief description max 100 words)*
Does the Host Centre offer*
Select all that apply
- hands-on training (will provide patient care/have direct patient contact)
- observership (will not provide patient care with direct patient contact)
Observership subject to the following legal requirements/prerequisites*
Hands-on practice subject to the following legal requirement/prerequisites:*
(suggestions: registrations with the relevant regulatory body, inclusion onto clinical indemnity register etc.)
Anaesthesia Subspecialty or Intensive Care Medicine training for foreign Trainees are offered (Hands-on training only):*
Select all that apply
- Cardiac
- Thoracic
- Transplantation
- General Paediatric
- Paediatric Cardiac
- Neonatal
- Head and neck/ENT
- General Surgery
- Vascular Surgery
- Obstetric
- Pain
- Neuroanaesthesia
- Trauma
- Orthopaedics
- Ultrasound Guided Regional Anaesthesia
- Intensive Care Medicine
- Neuro ICU
- Cardiac ICU
- Paediatric ICU
- COVID ICU
- Other
Anaesthesia Subspecialty or Intensive Care Medicine training for foreign Trainees are offered (Observership only):*
Select all that apply
- Cardiac
- Thoracic
- Transplantation
- General Paediatric
- Paediatric Cardiac
- Neonatal
- Head and neck/ENT
- General Surgery
- Vascular Surgery
- Obstetric
- Pain
- Neuroanaesthesia
- Trauma
- Orthopaedics
- Ultrasound Guided Regional Anaesthesia
- Intensive Care Medicine
- Neuro ICU
- Cardiac ICU
- Paediatric ICU
- COVID ICU
- Other
Educational activities offered*
- Exam Preparation Tutorials
- Journal club
- Departmental lectures
- Skill training sessions (TTE, TOE, USGRA, etc)
- Interdisciplinary consultations (MDM multidisciplinary meetings)
- One-to-one teaching
- Simulation
Research activity offered*
- Experimental research
- Clinical research
- Data mining
- Collaboration: collaborative learning, international cooperation, development of new courses, meta-analysis
- Possibilities for the future: further collaboration, grant applications etc.
Sample publications (1-3)*
Preferred exchange programme (Duration)*
- 1 month
- 2 months
- 3 months
Specific months:*
- January
- February
- March
- April
- May
- June
- July
- August
- September
- October
- November
- December
Language requirements of an attending trainee:*
(according to the CEFR define or link or specific exam)
Languages spoken in the department*
Is accommodation available for an attending trainee (hospital facilities, useful links)?*
- Yes
- No
Additional details*
Remarks and comments:
Please upload:
- A cover letter
- Any additional relevant documents
Drop files here or

Max. file size: 128 MB, Max. files: 5.
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