EHM Structural Heart Diversity Fellowship
APPLICATION

Purpose: The EHM Structural Heart Diversity Fellowship offers support for cardiothoracic surgeons and trainees who are seeking to enhance their skills in either transcatheter valve techniques or open valve surgery. The fellowship will provide the grantee with direct experience utilizing novel and less invasive solutions for complex structural heart patients, for a designated fellowship period.

The fellowship applicant will have secured an arrangement with the host institution and sponsor capable of providing an in depth structural heart experience in either open or transcatheter heart valve procedures.

The participating institution should have a strong program with a supportive sponsor experienced in minimally invasive surgery techniques and therapies. Suggestions for suitable host institutions can be provided at the applicant’s request.

Eligibility: The applicant must be a cardiothoracic surgeon who is a member of an underrepresented demographic group in medicine as defined by the AAMC, and meet one of the following criteria:

Cardiothoracic surgeons who are within the first seven years of completion of an ACGME-accredited cardiothoracic surgery residency (or its equivalent outside the U.S.) and who are certified or eligible for certification by the American Board of Thoracic Surgery (ABTS) or its equivalent outside of the U.S. by the grant start date.

Cardiothoracic surgery residents in their last year of training at an ACGME-accredited program at the time of application.

Required Application Attachments:

Applicant CV
Sponsor/Mentor CV
Two (2) Letters of Recommendation
Budget (approximate breakdown of funding costs)

Question Title

* 1. Applicant Information:

First Name

Middle Initial

Last Name

Designation

Institution

Title at Institution

Mailing Address

Suite #

City

State/Province

Country

Zip Code

E-mail Address

Phone Number

Question Title

* 2. Mentor Information:

First Name

Last Name

Designation

Institution

Title at Institution

City

State/Province

Country

E-mail Address

Phone Number

Question Title

* 3. Gender Identity:

Male

Female

Non-binary

Decline to Answer

Question Title

* 4. Race/Ethnicity: (Please check all that apply)

White/Caucasian

Black/African/African American

Latino/Hispanic

Native American/Alaskan Native/Canadian Indigenous

Asian/East Asian/South Asian

Middle Eastern

Hawaiian/Pacific Islander

Other racial/ethnic group

Decline to answer

Question Title

* 5. Please check the appropriate boxes below to affirm that you meet the eligibility criteria for this award. (Note: Only surgeons from underrepresented demographic groups are eligible for this award.)

I am a cardiothoracic surgeon who is a member of an underrepresented demographic group in medicine as defined by the AAMC. Underrepresented in medicine minority group as defined by the Association of American Medical Colleges: “Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population."

I am a cardiothoracic surgeons who is within the first seven years of completion of an ACGME-accredited cardiothoracic surgery residency (or its equivalent outside the U.S.) and who are certified or eligible for certification by the American Board of Thoracic Surgery (ABTS) or its equivalent outside of the U.S. by the grant start date.

I am a cardiothoracic surgery residents in their last year of training at an ACGME-accredited program at the time of application.

Question Title

* 6. Please indicate the number of years you have been practicing cardiothoracic surgery after completion of a cardiothoracic surgery residency or other training.

Question Title

* 7. Title of Project

Question Title

* 8. Budget Justification (Include a budget justification below, or upload a detailed budget with your submitted application).

Question Title

* 9. Duration of Fellowship

12 month fellowship (up to $50,000)

6 month fellowship (up to $25,000)

3 month fellowship (up to $20,000)

2-4 week fellowship (up to $10,000)

Other (please specify)

Question Title

* 10. Personal Goal: State exactly what skill you wish to learn in the proposed time frame. Describe how this intended skill and how this experience will benefit you and your institution or practice.

Question Title

* 11. Background: Please provide information about your background as it relates to your personal goal.

Question Title

* 12. Education Environment at Host Institution: Identify available resources and training environment.

Question Title

* 13. Upload CV or NIH Biosketch

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 14. Upload Mentor's CV or NIH Biosketch

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 15. Upload Letter of support (from current institution)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 16. Upload Letter of support (from mentor's institution)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File