Academy of Clerkship Directors

The role of Surgical Clerkship Director is challenging, important, and deserving of special recognition. The ASE Academy of Clerkship Directors (ACD) was established in 2015 to recognize Surgery Clerkship Directors for their commitment to excellence in undergraduate surgical education. This is demonstrated by membership and involvement in the ASE, participation in faculty development around undergraduate education, years involved in surgical education and scholarly activity. In addition, receiving “Fellow” Certification may allow Clerkship Directors to obtain more resources and other support for educational endeavors, improving the overall quality of surgical education. Certification and Membership attests to leadership, experience and expertise while Academy Mentor designation recognizes those educators who demonstrate additional commitment to serve as role-models and mentors to other clerkship directors and surgical educators.

Verification of credentials for Academy membership will be determined by an Oversight Committee (OC) under the direction of the ASE Board of Directors (BOD). The OC will be composed of the current Clerkship Directors Committee Chair and Vice-Chair, and a BOD Representative, currently the ASE Secretary. Once verification by the OC that all criteria are met, “Fellow” status is conveyed to the member. Certificates documenting Fellowship in the Academy of Clerkship Directors will be awarded at the ASE Annual Meeting.

After 5 years, for those who are still Clerkship Directors, or still directly related to teaching students, and want to continue in the Academy, they will need to submit a 0.5-1 page summary of their current role, to be reviewed by the CD Chair and Vice Chair to change their designation to “Master.” For those who have moved on to other roles, but are still interested in mentoring others, they should submit a 0.5 page summary of their current role(s) and change their designation to “Emeritus.” For those who are no longer interested in the Academy, please let the ASE office know so that they may be removed from the contact list. The information may be submitted to the ASE office at [email protected].

Academy members are encouraged to participate as speakers for the Updates on the Surgery Clerkship (formerly Trouble Shooting Your Clerkship) Course and engage in other activities (workshops at ASE Annual Meeting, collaboration with the ACS, selected projects) of the Clerkship Directors Committee and the ASE.

SUBMISSION DEADLINE: February 7, 2025 

Application for certification entails the following requirements:

• Applicants must be active ASE members
• Total of 12 or more credits required for certification
  • Credit system criteria:
    • 2 credits per year of being Clerkship Director
    • 1 credit each for:
      • Podium educationally oriented presentation at ASE, ACS, or equivalent
      • Published educational research articles in a peer review journal
      • Chair/Vice Chair of an ASE committee
      • Attended ACS “Surgeons as Educators” course
      • Attended the ASE Updates on the Surgery Clerskhip (formerly Trouble Shooting Your Clerkship) Course
      • ASE SERF Program Participant
      • ASE SELF Program Participant
    • 3 credits for completion of a mentored project in clerkship development as either Mentor or Mentee
    • 0.5 – 2 credits per year for associate/assistant CD position depending on role (must have letter of recommendation from CD describing role)
    • Credit for additional activities (to be determined at the discretion of the OC)
      • National Teaching Award (1 credit)
      • Institutional Teaching Award (0.5 credit)
      • Other Service awards or educational activities (0.5-1 credit)

Additionally, applicants are required to upload the following supporting documents:

• Two letters of recommendation from your education institution
• Curriculum Vitae
• Educators Portfolio (Please note: the portfolio should include any podium educationally oriented presentations at ASE, ACS, or equivalent and published educational research articles in a peer review journal)
• A photo of yourself
• Additional documents to support educational activities

Fee of $200 submitted with application. Secure, online payments can be made via the online form.

SUBMISSION DEADLINE: February 7, 2025

For any questions, please contact [email protected]

Academy of Clerkship Directors Application Form

Verification Process Details:

To obtain certification, an applicant must be an active ASE member (all dues paid) and have participated in additional activities to accumulate 12 credits.

Application Fee is $200.

Documentation must be submitted electronically. Application fee must be paid at time of submission with credit card. The application fee is not refundable.

If there are any questions please contact [email protected].

Once the above documentation has been reviewed by the Oversight Committee (OC), the applicant will be notified of their application status. Final acceptance and level of Certification are at the discretion of the OC.

"*" indicates required fields

Name*

First Last Degree(s)

Title*

Phone*

Email*

Clerkship Coordinator

First Last

Clerkship Coordinator Email

Medical School*

Institution Address*

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Campus Role*

Clerkship Director

Associate/Assistant Clerkship Director

Other

Number of years as Clerkship Director*

2 credits/year with maximum of 8 credits

Number of years as Associate/Assistant Clerkship Director*

0.5-2 credits/year, with max. of 4 credits at discretion of the OC

Other Campus Role(s)*

Describe the roles and number of years in each role.

Check all that apply below and supply additional information requested:

1 credit each for the following.

Podium educationally oriented presentation at ASE, ACS, or equivalent

Published educational research articles in a peer review journal

Chair/Vice Chair ASE committee

Attended ACS “Surgeons as Educators” course

Attended the ASE Updates on the Surgery Clerkship (formerly Troubleshooting Your Clerkship) Course

SERF Program Participant

SELF Program Participant

Check all that apply below and supply additional information requested:

3 credits for the following.

Completion of a mentored project in clerkship development as either Mentor or Mentee

Check all that apply below and supply additional information requested:

Credit for additional activities (to be determined at the discretion of the OC)

National Teaching Award (1 credit)

Institutional Teaching Award (0.5 credit)

Other Service awards or educational activities (0.5-1 credit)

Which years did you serve on an ASE Committee as a Chair or Vice-Chair?*

List the Committee(s).

Which year(s) did you attend the ACS Surgeons as Educators Course?*

Which year(s) did you attend the Updates on the Surgery Clerkship (formerly Troubleshooting your Clerkship) Course?*

Title of education project and year in which you served as mentor:*

Title of SERF Project Related to UME or GME*

Title of SELF Project Related to UME or GME*

Please list education or service awards earned for educational activities.*

Supporting Documents*

PROOF OF EARNED CREDITS

As ONE PDF, please upload your supporting documents

Without supporting documents, your application will be disqualified.

The information that you will need to upload is as follows:

1. Two letters of recommendation from your education institution
2. Curriculum Vitae
3. Educators Portfolio
4. A photo of yourself
5. Additional documents to support educational activities

Accepted file types: pdf, Max. file size: 512 MB.

Application Fee*

Price:

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Total

Credit Card*

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Supported Credit Cards: American Express, Discover, MasterCard, Visa

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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

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