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					                              CANADIAN ACADEMY OF SPORT MEDICINE
                              ACADÉMIE CANADIENNE DE MÉDECINE DU
                                            SPORT
                                “Committed to Excellence  L’excellence dans la pratique”


      Application for the Diploma Examination in Sport Medicine
            for the Canadian Academy of Sport Medicine

General Information
Applications are now being accepted individuals wishing to sit the Diploma Examination in Sport
Medicine, conducted by the Canadian Academy of Sport Medicine (CASM) in the Spring of 2008.
Applications are available upon request by writing to:

The CASM Executive Director,
Canadian Academy of Sport Medicine
5330 Canotek Road, Unit 4
Ottawa, ON, K1J 9C1

Completed application forms, together with the application fee, must reach the CASM National
Office no later than the specified date. The application form is not complete without the signature
of the applicant, the application fee and a passport-style photograph of the applicant. No payment

The application fee is $1200.00 Cdn. Examination candidates will be selected on a "first come first
served" basis. Every two year, accommodations will be made for candidates to write the exam in
French. Francophone candidates will be given priority for that year, if a minimum number of
Francophone candidates is reached. The exam will be offered in French at least every 4 years.
Priority is also given to fellows registered in Sport Medicine fellowship programs and those who
have failed the previous year (see below for specific information on priority applications). The
applicants accepted for examination will be notified by the CASM Executive Director, and will be
provided with information about the centre where he/she will take the examination.

In the event that an applicant qualifies to sit the examination but is unable, for whatever reason, to
sit the exam, the application fee of $1200 will be forfeited except for an administration fee of $500,
which can be applied to one of the next two subsequent examinations. (For complete details please
refer to Refund Policy). Future applications to sit the examination can be made upon payment of
the appropriate application fee.

The Examination
The examination is predominantly conducted using OSCE situations but other forms of
examination can be used as well, ie multiple choice or short answer questions. These are
designed to simulate, accurately as possible, situations that are likely to arise in the context of the
practice of clinical sport medicine. They are designed to evaluate and assess, not only
knowledge, but also clinical skills and behaviour. Applicants who have been involved in the
clinical practice of sport medicine, are familiar with the current literature, have participated in
ongoing CME activities in this area, and who are aware of contemporary issues in sport medicine
are ideal candidates for the examination. More information can be obtained by reading "The
Diploma Examination in Sport Medicine" a publication of the Canadian Academy of Sport
Medicine.

A candidate can sit the exam three times; a third failure will require an independent review by the
committee.

Priority
     -   Failed candidates receive priority to sit the next available exam, one time only.
     -   Fellows receive priority to sit the exam immediately following completion of their
         Fellowship.
     -   Francophones will receive priority on the list of the year the exam is held in French
         only, based on date of receipt of application.

Eligibility
Candidates for the CASM Diploma Examination in Sport Medicine must meet the following
criteria (Approved by the CASM Board of Directors in May of 2006):

 All candidates must be members in good standing of the CASM at the time they apply to sit the
   examination and must fulfill the following requirements:

          A minimum of 2 years of independent MEDICAL practice, which must include
            attendance at one provincial or national sport medicine conference and documented
            participation of 50 hours of team/sport/event coverage

OR

          The candidate must possess a CCFP and have completed a one-year Sport Medicine
            fellowship at a recognized University Medical Center. *

OR

          The candidate must be a Fellow of the Royal College of Physicians and Surgeons and
            have completed a one-year Sport Medicine fellowship at a recognized University
            Medical Center. *

         (* For candidates taking a one year Sport Medicine Fellowship and who take the exam
         before the full completion of that year, the Diploma will be sent upon successful
         completion of the fellowship year.)

Physicians practicing outside Canada must be licensed to practice in their country or residence
and fulfill the criteria noted above.

All who are interested in sitting the Exam should submit an application form with the appropriate
fee by the announced deadline. This is usually 7 months before the exam date.) Please note that
applications are accepted throughout the year, on a first-come, first-serve basis. The Credentials
Committee reviews applications periodically throughout the year, as required. Applications will
not be considered complete unless the candidate is a member (Active Category) in good
standing of the Academy.
Successful candidates may use Dip. Sport Med. as a nominal. The use of this designation is
contingent upon ongoing membership in the Canadian Academy of Sport Medicine.

Please contact the National Office to receive an application form. Interest in the CASM Diploma
Exam in Sport Medicine continues to increase, as does the number of applicants. Please submit
your application promptly.

Candidates unsuccessful in passing the examination in previous years are encouraged to repeat the
examination in a subsequent year. Such candidates need not submit an application form but must
submit a letter of intent to sit the examination no later than the specified application deadline date
for that year. The application fee should accompany this letter.
  Application for "The Diploma Examination in Sport Medicine"
Application
Date:_______________________________

Name in full
                      (Surname)                                        (Given name)

Address                                                             Tel. No.__________________
                                                                                (office)
                                                                   Tel. No.___________________
(City)                  (Province)                 (Postal Code)                 (home)

Fax No.___________________                      Email_____________________________________

Sex              Citizenship                        Date of Birth ____________________________

Language Preference            English                 French
 (To take the exam)

Medical Education Medical School_________________________________

                               Degree(s)__________________________________

                               Date of Graduation___________________________

Other Medical Qualifications and/or Degrees___________________________

Internships :      University                                   Type             Date____________
                                                                Type             Date____________
Residencies :      University                                   Type             Date____________
                                                                Type             Date____________

Fellowships :   Location                                        Type             Date____________
University Teaching Appointments (Please list)


a) How many years in Active Practice? (location with dates):
      i)                                                                    ______
          ii)                                                               ______
          iii)                                                              ______
          iv)                                                               ______
b) What proportion of your practice time is given to sport medicine (Approx. % of time):__________
c) Are you engaged in the following areas of practice and to what degree?
        FAMILY PRACTICE                             SPECIALTY        _________________
                                         % Sport Medicine_____________
                                         % Research_________________
                                 % Teaching_________________
d) Are you now an active member of Canadian Academy of Sport Medicine? _____ Yes _____ No
        (If no, please enclose a completed application for membership and include the membership
        fee with payment of the examination fee.)
Declaration
In submitting this application to sit the examination for the Diploma in Sport Medicine of the
Canadian Academy of Sport Medicine, I declare the following:

1)     I am in possession of a license to practice medicine.
2)     I have met all eligibility criteria as stated above and have submitted my documented hours
       of sport coverage.
3)     I am a member of the Canadian Academy of Sport Medicine or will enclose an application
       for membership.



Signature                              Date__________________________




                               Example of Acceptable Photograph
                               Showing a full front view of the head and shoulders without head
                               covering taken against a plain white background.
                               Photographs should normally measure 2 x 2 3/4 inches including
                               ½ blank signature space at the bottom, which forms part of the
                               photographic print.

                               Please Note
                               This application cannot be processed unless it is accompanied by
                               the following:
                               1) one signed "acceptable" photograph; please paperclip to
                               application
                               2) application fee of $1200.00 Canadian.




                           CANADIAN ACADEMY OF SPORT MEDICINE
                           ACADÉMIE CANADIENNE DE MÉDECINE DU
                                         SPORT
                             “Committed to Excellence  L’excellence dans la pratique”




       REFUND POLICY
        2008 CASM DIPLOMA EXAM
           IN SPORT MEDICINE
All interested candidates are required to submit their completed
application form and exam fee of $1200.00 to confirm their
position to sit the 2008 CASM Diploma Exam.

Date of the Exam: to be determined
Location: Ontario

Withdrawal or Cancellation Policy

WRITTEN NOTICE OF WITHDRAWAL from the exam process MUST BE
RECEIVED BY HEAD OFFICE.

IF NOTICE OF WITHDRAWAL IS RECEIVED AFTER YOUR
APPLICATION HAS BEEN APPROVED (ONCE THE DATE AND
LOCATION HAVE BEEN CONFIRMED AND YOU HAVE AGREED TO
SIT) $700 WILL BE FORFEITED. THE ADMINISTRATION FEE OF $500
CAN BE APPLIED TO ONE OF THE NEXT TWO SUBSEQUENT
EXAMS. NO REFUNDS WILL BE ISSUED.

Failure to provide written notice of withdrawal will result in
forfeiture of the entire exam fee.

				
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Description: general information