CQU

Step 3: Apply to become part of CQU

Download the PDF version here or complete this form online below (Note: due to some compatibility issues with Internet Explorer, the online form works best in Google Chrome).

Applications are due by February 15, 2018. 

The program will kick off with a webinar on February 15, 2018. First session will be March 2-3, 2018. Questions? Contact Erin Grover, egrover@ncmedsoc.org, 919.833.3836 ext. 134.

Apply Online Now

Team Profile
The CQU program will allow a team of up to three members (a physician and up to two additional team members) to participate in the program. Physician and physician assistant participants in this program must be a current member of the North Carolina Medical Society (NCMS) to participate. To join the NCMS, visit www.ncmedsoc.org/join or contact member services at 1-800-722-1350.
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Please list other professional associations in which team members hold current memberships.
Please list any quality improvement, patient safety or other similar training and/or experience team members have.
Describe your team's practice setting and the role each team member plays in this setting.
Team Assessment
NOTE: For best results, copy your pre-written text (preferably from Notepad or other simple text editor) and paste into the text areas below.
1) Describe your team's quality improvement project.(Please limit to 1000 characters or less.)
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2) Why should your team be chosen for participation in CQU? (1000 character limit)
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3) Provide a brief description of the top three quality improvement challenges physicians/PAs face in the work/practice setting and the opportunities your team has to impact these challenges with additional training. (1000 character limit)
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4) Please describe how your participation in CQU will benefit a) your patients; b) your practice setting; and c) the NCMS and broader "family of medicine." (limit 1000 characters)
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5) Is the team willing to share its clinical quality successes and lessons learned with other organizations such as the NCMS, specialty medical societies, the NC Hospital Association, or other professional associations?
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Team Agreement
If selected, our team agrees to complete a clinical quality project of our choice and to fully participate in all required educational sessions, conference calls and project work of CQU of the Kanof Institute for Physician Leadership as specified.
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The North Carolina Medical Society

Physical Address:
222 N. Person Street
Raleigh, NC 27601
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Phone:
919.833.3836
800.722.1350 (NC only)
919.833.2023 FAX
Mailing Address:
PO Box 27167
Raleigh, NC 27611
 
 

 

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