Resident Training Program – Application for Banner Group (Franchisor) Central Site Accreditation and Program Approval Form questions for reference (pdf) "*" indicates required fields Step 1 of 8 – Part 1: General details 12% Details of person completing the formBy completing this application, you acknowledge that you have the authority of the Franchisor to submit this application. The person of authority at the Franchisor may be contacted to confirm this authority. Name* Dr.MissMr.Mrs.Ms.Mx.Prof.Assoc. Prof. Preferred title First name Last name Position* Banner Group Name* Phone*Email* Are you an AdPha member?* Yes No AdPha member number* Person of authority at the FranchisorAre these details the same as the person above? Yes Name* Dr.MissMr.Mrs.Ms.Mx.Prof.Assoc. Prof. Preferred title First name Last name Position* Franchisor email* Consent*By completing this application, you consent to your Banner Group being listed and named by AdPha as an applicant or approved site in AdPha communications, which may appear in both online and offline media. Do you consent to AdPha using your application to consider your accreditation as an AdPha Resident Training Program Central Site and Program Approval? Yes, I consent Central Site (Franchisor) Accreditation Application DetailsNote: If any of the following standards are managed by the individual community pharmacy (Franchisee) rather than the Franchisor, please indicate that accordingly in each of the responses.Describe the process the Franchisor uses to ensure currency of Pharmacy Board registration of pharmacist staff. (Standard 1.1)*Describe the support offered by the Franchisor to support Franchisees (community pharmacies) in the Banner Group to implement and deliver professional services to improve health outcomes for their community. (Standard 1.2)*Describe the structure of your Resident Training Program Support Group (Standard 2.1)*Provide an outline of the in-house educational programs (CPD) provided by your Franchisor over the last 6-12 months (Standard 2.2)*Option to upload a copy of the of the in-house educational programs (CPD) for the last 6-12 months below Optional – upload a copy of the of the in-house educational programs (CPD) for the last 6-12 months. (Standard 2.2) Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. Provide an outline of the in-house educational programs (CPD) planned for your Franchisor over the next 6-12 months (Standard 2.2)*Option to upload a copy of the of the in-house educational programs (CPD) planned for the next 6-12 months below Optional – upload a copy of the of the in-house educational programs (CPD) for the next 6-12 months. (Standard 2.2) Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. Name of individual who manages/coordinates educational programs at the Franchisor* Email* Provide an outline of your Franchisor’s overall strategy and broad commitment to the betterment of the pharmacy profession and public health overall through active involvement in external advisory groups, professional committees, community health promotions, and/or staff membership of professional bodies. (Standard 2.3)* Describe any peer-learning training opportunities for pharmacy staff provided by the Franchisor. How does the Franchisor support the professional development of pharmacists and pharmacy staff in the community pharmacies within the Banner Group? (Standard 3.1)*Describe your existing commitment to pharmacy student education and training. (Standard 3.1)*Describe your existing commitment to the education and training of pharmacist interns. (Standard 3.1)*Describe any additional links with universities (in addition to student placements). (Standard 3.1)*Describe leadership and management training opportunities for pharmacists within the community pharmacies in the Banner Group, and how a Resident Candidate can be involved in developing skills outside of clinical expertise. (Standard 3.2)*Describe the opportunities that pharmacists working in community pharmacies within the Banner Group have for training other pharmacists and members of the pharmacy team. (Standard 3.3)*Describe how pharmacists working in community pharmacies within the Banner Group can access support from others within the Banner Group. What resources are available for staff seeking support as a practitioner? (Standard 3.4)* Describe how the Franchisor plans to identify and recruit pharmacists suitable for the Program: (Standard 4.1)*Describe your existing orientation process for new pharmacist staff to the community pharmacies within the Banner Group: (Standard 4.2)*What clinical resources will be available to Resident Candidates in addition to what is provided at the community pharmacy level? (Standard 4.3)*e.g. Online/hard copy texts and referencesWhat existing programs/arrangements do you have to support staff within the community pharmacies of the Banner Group? (Standard 4.4)*e.g. Employee assistance program, psychological support, educator for learning and development needs, buddy program for new staff etc Outline the types of performance evaluation tools and assessments you currently utilise in the community pharmacies within your Banner Group: (Standard 5.1)*Describe how these tools are used, including by who and when, as part of an overall professional development plan for staff in the community pharmacies: (Standard 5.1)*How often do staff performance appraisals occur? (Standard 5.2)*Provide evidence/examples of performance evaluation documentation (de-identified). Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB, Max. files: 5. Describe how the Franchisor facilitates or plans to facilitate opportunities for Resident Candidates to partake in peer-learning activities. (Standard 5.2)*Describe how the Franchisor plans to support Preceptors in the Resident Training Program. (Standard 5.3)* Resident Training Program Approval DetailsHow many Resident Candidates do you expect to commence in your Resident Training Program* When do you expect them to commence (month, year)?* Upload your Banner Group organisational structure as it relates to the Resident Training Program including proposed reporting lines for Resident Candidates, Preceptors and the Program Lead. (Standard 1.1)*This does not need to include all aspects of the organisational chart of the Franchisor and all the Franchisees, but only the aspects related to the delivery of the Resident Training Program within the Banner Group Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. Describe how the Franchisor will identify community pharmacies within the Banner Group that are a suitable site for a Candidate to undergo a Residency Training Program. (Standard 1.2)*Describe how the Franchisor will identify community pharmacies within the Banner Group that are suitable as a Rotational site in the case where a primary site doesn't meet all the site accreditation requirements. (Standard 1.3)*Describe how you will preserve the overall Program experience in times of staff shortages?*Upload the Resident Candidate position description (Standard 1.4)* Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. What is the name of your proposed Resident Training Program Lead? (Standard 2.1 & 2.3)* Program Lead email* Program Lead mobile* Upload the Program Lead CV* Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. Provide details of the proposed Resident Training Program Support Group including who will form the group, their roles within the Banner Group and the proposed meeting schedule for the group. (Standard 2.2)*Provide details of how the Franchisor will assist the community pharmacies to identify suitable Preceptors for the Program. (Standard 2.5)*Provide details of how the Franchisor will support Preceptors to ensure they are appropriately trained to take on the role and how they will support their ongoing professional development as a Preceptor. (Standard 2.6)*Upload your Resident Training Program Manual including learning objectives, curriculum and workplan (Standard 4.1 & 4.2)* Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. Is the Franchisor able to facilitate an internal annual CPD-accredited seminar/conference equivalent to approximately 10 hours of learning or 20 Group 2 CPD credits that Resident Candidates can participate in? (Note this event does not need to be exclusive to Resident Candidates.) If you facilitate seminars/conferences that don’t equate to 10 hours of learning or 20 Group 2 CPD credits (or is not CPD-accredited), please provide the relevant details. (Standard 4.3) This Standard only applies to seminars/conferences run internally by the Banner Group.* Yes No If Yes, please provide details of your annual seminars/conferences*Upload seminar/conference program details* Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. If No, please provide details of what your internal annual seminars/conferences you facilitate. If you support pharmacists to attend external conferences, please provide details of how this is done and what conferences they attend.*Would you like AdPha to assist you with getting your annual Banner Group seminar/conference to meet the requirement of 20 CPD-accredited Group 2 credits? Yes No Upload relevant seminar/conference program details Drop files here or Select files Accepted file types: png, jpg, pdf, doc, docx, Max. file size: 5 MB. Is your Resident Training Program able to provide candidates with the opportunity to engage with other candidates across the community pharmacies within the Banner Group in learning experiences? (eg. facilitate Case Presentations to colleagues, delivery of education to other pharmacists in the Banner Group, either face-to-face or virtually) (Standard 5.1)* Yes No If Yes, please provide details* Declaration and Application SubmissionResident Training Program*By checking this box, you agree that the Franchisor will deliver a Resident Training Program in accordance with AdPha’s requirements as outlined in the AdPha Community Pharmacy Resident Training Program Framework and the AdPha Accreditation Standards for Community Pharmacy Resident Training Programs. I agreePrivacy Policy*You agree to the AdPha privacy policy available at https://www.adpha.au/privacy-policy I agreeDeclaration*By checking this box, you declare that the information you have provided is true and correct and in no way misleading. I agreeEmailThis field is for validation purposes and should be left unchanged.
