ANZBP Trainee Certification Exam Application Form

ANZBP Trainee Certification Exam Application

Application for Trainees to present for the ANZBP Exams

Before You Begin This application is for registered ANZBP clinical trainees seeking to sit the CCP (ANZ) Certification Examinations. To be eligible, trainees must have completed the requirements of the local ANZBP training pathway, including the required academic, clinical, portfolio, observation and other certification requirements. Submission of this form does not guarantee eligibility to sit the examination. The ANZBP will review your application and supporting evidence and confirm examination eligibility in writing. ANZCP Before applying, please review: – ANZBP Examination Policy – ANZCP Certification Policy – ANZBP Clinical Trainee Guidelines – ANZCP Competency Standards – Code of Ethical Standards and Professional Conduct – Mandatory Declarations – Continuous Professional Development Program.

Examination sitting you are applying for:(Required)

Order ID for Examination Payment

The Order ID must correspond to the Order number found on your receipt/invoice email. Note: Examination fees must be paid in full 2 weeks prior to exam. Non-payment will result in withdrawal from the examination.

Candidate Details

Name(Required)

First Last

Email(Required)

Phone(Required)

Hospital(Required)

Lead Supervisor(Required)

Lead Supervisor Email(Required)

Identify Documentation

The Examination Policy requires candidates to provide certified photographic identification in accordance with the Certification Policy.

Upload Certified Copy of Photographic Identification(Required)

Drop files here or

Max. file size: 32 MB.

Academic Requirements

The Examination Policy requires trainees to have successfully completed the academic requirements of the ANZBP-approved perfusion program before sitting the certification examination. These documents need to be certified.

I confirm that I have completed the approved perfusion qualification and have uploaded certified evidence of this.(Required)

Yes

Certified Copies of Required Documents(Required)

Drop files here or

Max. file size: 32 MB.

You are required to upload the following: 1. Certified Copy of Undergraduate Degree / Qualification, 2. Certified Copy of Undergraduate Academic Transcript, 3. Certified Copy of Postgraduate Perfusion Qualification / Degree, 4. Certified Copy of Final Postgraduate Perfusion Academic Transcript

Clinical Training Requirements

10 Case-Based Assessments / 20-Case Milesone Reviews

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Max. file size: 32 MB.

Upload all ten completed Case-Based Assessments. Each assessment must relate to the applicable 20-case milestone and contain the required trainee and supervisor assessment, feedback, reflection and sign-off

Final Clinical Logbook and Supervisor Attestation(Required)

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Max. file size: 32 MB.

Upload your completed final ANZBP clinical logbook demonstrating a minimum of 200 eligible CPB cases, together with the required observation records and any other clinical case information required by the ANZBP.

I confirm that the first 125 cases were completed under direct supervision in accordance with ANZBP requirements(Required)

Yes

I confirm that the these 200 cases included within my logbook I completed all aspects of the case (start to finish) as the primary perfusionist.(Required)

Yes

Clinical Observation Requirements: Observation Forms

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Max. file size: 32 MB.

The current requirements are 10 observations in the alternate patient population plus at least five observations at another perfusion unit

I confirm that I completed all of the required observations (10 from the alternate population + 5 observation undertaken at another perfusion unit/s.(Required)

Yes

Research Requirement / Declaration to Present(Required)

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Max. file size: 32 MB.

Evidence of ANZCP ASM Research Presentation. (Conference Program, Abstract, Presentation Certificate, ANZBP Confirmation)

Have you presented your required research project at the ANZCP Annual Scientific Meeting?(Required)

Yes – I have uploaded evidence that I have already presented this project.

No – Presentation is after the scheduled examination and I acknowledge that successful completion of the examination will not result in full CCP (ANZ) certification until the outstanding research presentation requirement has been completed.

Policy Acknowledgements

I confirm that I have read and understand the current ANZBP Examination Policy.(Required)

Yes

I confirm that I am familiar with the ANZCP Rules and Standards and Guidelines applicable to certification.(Required)

Yes

I confirm that I have read and understand the ANZCP Code of Ethical Standards and Professional Conduct.(Required)

Yes

I confirm that I have read and understand the ANZCP Mandatory Declarations requirements.(Required)

Yes

I confirm that I have read and understand the ANZCP Certification Policy.(Required)

Yes

I understand the requirements of the ANZCP Continuous Professional Development Program that apply following certification.(Required)

Yes

Examination Acknowledgements

These form inherent parts of the examination policy.

I understand that submission of this application does not guarantee eligibility to sit the examination and that examination eligibility must be confirmed by the ANZBP.(Required)

Yes

I understand that all required training and documentation requirements must be completed within the timeframe specified by the ANZBP.(Required)

Yes

I understand that the applicable examination fee must be paid by the required deadline before I sit the examination and if this is not confirmed, I will not be eligible for the examination round.(Required)

Yes

I understand that if I fail one or more examination components, I must resit all examination components at a future scheduled examination sitting.(Required)

Yes

I understand that there are no partial resits or supplementary examinations outside scheduled ANZBP examination sittings.(Required)

Yes

I understand that unauthorised reproduction, retention, disclosure or sharing of examination materials is prohibited and that any examination result obtained through cheating, unauthorised assistance, prohibited recording, use of artificial intelligence, concealed electronic devices, smart or AI-enabled glasses, or other examination misconduct may be declared invalid, including where the misconduct is identified after the examination has concluded.(Required)

Yes

Applicant Declaration

I declare that all information and supporting documentation provided in this application are true, complete and accurate to the best of my knowledge.(Required)

Yes

Sign your name:(Required)

ANZBP Trainee Certification Exam Application Form