The Leadership Fundamentals is a 12-week cohort program designed to build and sustain effective leadership habits and confidence levels of new medical leaders.

Type: Blended (in-person and Zoom class sessions)
Duration: 22 hours over 12 weeks (10.5 hours in class)

*1.Who would you like to nominate to this program?(Required.)

First Name

Last Name

Email address

*2.What is your nominee's leadership role?(Required.)

Vice PresidentMSA PresidentAMAC ChairSenior Medical DirectorRegional Medical DirectorRegional Program Medical DirectorChief Medical Health OfficerMedical Health OfficerChief Medical Information OfficerAssociate Chief Medical Information OfficerMedical DirectorAssociate Medical DirectorRegional Department HeadDepartment HeadAssociate Department HeadDivision HeadAssociate Division HeadProgram HeadNP ExecutiveNP LeadSite LeadPhysician/Medical LeadCommittee ChairCommittee MemberNo current leadership role at VCHOther (please specify)

*3.What is your nominee's department?(Required.)

AnesthesiaCommunity MedicineEmergency MedicineMedicineMidwiferyNurse PractitionerObstetrics and GynecologyOphthalmologyOrthopedicsPediatricsPsychiatryRadiologySurgeryOther (please specify)

*4.What is your nominee's practice type?(Required.)

DentistMidwifeNurse PractitionerPhysicianNon Medical Staff

*5.Which community of care does your nominee primarily work in?(Required.)

Coastal ruralCoastal urbanProvidenceRichmondVancouver AcuteVancouver CommunityNon Medical Staff

*6.Why do you wish to nominate this individual?(Required.)

*7.Please provide the following information about yourself as a nominator:(Required.)

First Name

Last Name

Email address