2018 Awards: Criteria and Nomination Forms NOTE: All nominations must be submitted with the following items: 1. Nomination Application 2. Curriculum Vitae (with photo) 3. Recommendations Letter (if applicable) Please see award criteria for additional information Student & Resident Awards: Deadline April 13 th Family Medicine Resident of the Year Keith Ellis Resident Scholarship T.A. Sappington Award Physician Awards: Deadline May 4 th Family Medicine Community and Volunteer Services Award Georgia Family Physician of the Year Family Medicine Educator of the Year
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2018 Awards: Criteria and Nomination Forms - GAFP · 2018-03-28 · 2018 Awards: Criteria and Nomination Forms NOTE: All nominations must be submitted with the following items: 1.
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2018 Awards: Criteria and Nomination Forms
NOTE: All nominations must be submitted with the following items: 1. Nomination Application
2. Curriculum Vitae (with photo) 3. Recommendations Letter (if applicable)
Please see award criteria for additional information
Student & Resident Awards: Deadline April 13th Family Medicine Resident of the Year
Keith Ellis Resident Scholarship T.A. Sappington Award
Physician Awards: Deadline May 4th
Family Medicine Community and Volunteer Services Award Georgia Family Physician of the Year
Family Medicine Educator of the Year
FAMILY MEDICINE RESIDENT OF THE YEAR
CRITERIA NAME OF AWARD: TYPE OF AWARD: Family Medicine Resident of the Year Award Engraved Plaque
SELECTION CRITERIA AND NOMINATION REQUIREMENTS: A candidate for the Award will be a deserving GAFP resident member who has been a leader in academic, community and professional affairs, along with making an outstanding contribution to the profession or the community. Candidates will be evaluated on the following: 1. Member of the GAFP in good standing, holding membership at least one year prior to the
year of selection; 2. Completed general nomination form; 3. Current Curriculum Vitae submitted by the nominator; 4. Qualifications to be considered are: Academic, Clinical Expertise, Community Involvement,
Involvement in the Discipline of Family Medicine and Involvement in Academy Activities.
MECHANISMS OF SELECTION: Nominations may come from any member, resident, faculty member or residency program
director. Nominations must be made by April 13. Nomination references to the Family Medicine Resident Award are to be published in August, September, November and January issues of Briefly Stated. Nominations will be reviewed by the Membership Committee in late April, and a winner will be announced in early May. PRESENTATION: This Award is to be presented at the GAFP Annual Scientific Assembly (Annual Meeting) when similar awards are presented.
FAMILY MEDICINE RESIDENT OF THE YEAR NOMINATION FORM
NOMINEE: ADDRESS: CITY: STATE: ZIP: PHONE: EMAIL:
RESIDENCY PROGRAM: YEAR OF RESIDENCY:
OUTLINE THE CANDIDATE'S QUALIFICATIONS IN THE FOLLOWING AREAS: ACADEMIC:
CLINICAL EXPERTISE:
COMMUNITY INVOLVEMENT:
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FAMILY MEDICINE RESIDENT OF THE YEAR NOMINATION FORM (PAGE 2)
INVOLVEMENT IN THE DISCIPLINE OF FAMILY MEDICINE: INVOLVEMENT IN ACADEMY ACTIVITIES: Nominator: (please print)
The Family Medicine Resident of the Year Award is to honor a deserving GAFP resident who has been a leader in community and professional affairs, along with making an outstanding
contribution to the profession.
2017 Chetan Patel, MD Columbus Family Medicine Residency Program
2016 Edward Agabin, MD Augusta University, Medical College of Georgia
2015 A. Phil Carter, MD Floyd
2014 P. J. Lynn, MD Floyd
2013 Wilhelmina Prinssen, MD Emory
2012 Ann Marie Lam, MD Emory
2011 Jennifer Malcolm, DO Medical College of Georgia
2009 Jennifer Herbert, MD Medical College of Georgia
2008 Tanya Pandya, DO, MBA Emory
2007 Justin F. Harrell, MD Medical College of Georgia
2006 Jairai Goberdhan, MD Medical Center of Central GA
2006 Sonal Patil, MD Emory
2005 Ryan R. Rees, MD Medical College of Georgia
2004 Michelle Y. Evans, MD Medical College of Georgia
2003 Jameelah Gator, MD Emory
2002 Anne Lang Dunlop, MD, MPH Emory
2002 Eddie Richardson, Jr., MD Columbus
2001 Cheryl Hawley Jordan, MD Emory
2000 Judith Nance, MD Savannah
1999 Hilary L. Canipes, MD Savannah
1998 Tod Bethea, MD Medical Center of Central GA
1997 Shaun Franklin, MD Savannah
1996 Rebecca Hammond, MD Savannah
1995 James Everett, MD Morehouse School of Medicine
1994 Rosa King, MD Savannah
1993 Mark Overbay, MD Savannah
1992 Gary Hunt, MD Floyd
1991 Raquel Watson, MD Medical Center of Central GA - Macon
1990 Adam Goldstein, MD Augusta
1989 Gregory Foster, MD Columbus
1988 Claire Hicks, MD Medical Center of Central GA – Macon
1987 Alfred Johnson, MD Rome
1987 David Morris, MD Savannah
1986 Bruce Johnson, MD Savannah
1985 John Aicher, MD Columbus
1985 William Hutchings, II, MD Medical Center of Central GA - Macon
1984 Patrick Barmore, MD Augusta
1983 Russell Hostletler, MD Medical Center of Central GA - Macon
1982 Ben Thomas, MD Savannah
KEITH ELLIS RESIDENT SCHOLARSHIP
CRITERIA NAME OF AWARD: TYPE OF AWARD: Keith Ellis Resident Scholarship Award Free Registration to the GAFP Annual Meeting
Transportation/Lodging for the GAFP Annual Meeting (up to $500)
SELECTION CRITERIA AND NOMINATION REQUIREMENTS: The Award Nominee will be a deserving chief/co-chief resident who has been a leader in academic and community affairs. He/she should also be making outstanding contributions to the profession or community. Candidates will be evaluated on the following: 1. Member of the GAFP in good standing, holding membership at least one year prior to the
year of selection, and active involvement with AAFP/GAFP; 2. Chief / Co-Chief Resident; 2. Completed nomination form; 3. Current CV submitted by the nominator; 4. Nomination letter from Program Director; and, 5. Qualifications to be considered are: Academic, Clinical Expertise, Community Involvement,
Involvement in the Discipline of Family Medicine. MECHANISMS OF SELECTION: Nominations must be submitted by Program Directors by April 13. PRESENTATION: This award is to be presented at the GAFP Annual Scientific Assembly (Annual Meeting) when similar awards are presented.
KEITH ELLIS RESIDENT SCHOLARSHIP
NOMINATION FORM
NOMINEE: ADDRESS: CITY: STATE: ZIP: PHONE: RESIDENCY PROGRAM: YEAR OF RESIDENCY:
OUTLINE THE CANDIDATE'S QUALIFICATIONS IN THE FOLLOWING AREAS: ACADEMIC:
CLINICAL EXPERTISE:
COMMUNITY INVOLVEMENT:
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KEITH ELLIS RESIDENT SCHOLARSHIP
NOMINATION FORM (PAGE 2)
INVOLVEMENT IN THE DISCIPLINE OF FAMILY MEDICINE: INVOLVEMENT IN ACADEMY ACTIVITIES:
The Keith Ellis Resident Scholarship is awarded to a deserving chief/co-chief resident, who has been a leader in academic/community affairs and one who is also making outstanding
contributions to the profession or community.
2017 Mary Keith, MD Savannah Family Medicine Residency Program
2016 Naheed Lakhani, MD Emory
2015 Jason Varghese, MD Georgia Regents University
2014 Jennifer Anne Burkmar, MD Emory
2013 Isioma Okwumabua, MD Morehouse
2012 Jose Ventura, MD Morehouse
2011 Viktoria Nurpeisov, MD Atlanta Medical Center
2010 Jonathan Tsung M. Hsu, MD Medical College of Georgia
2009 Marzena Slater, MD Emory
2008 Leena Mane, MD Emory
2007 Keren Holmes, MD Medical College of Georgia
2006 James Oliviere, Jr., MD Macon
2005 Nichole LeBoyd, MD Morehouse
2004 Samantha Brown-Parks, MD Emory
2003 Benjamin Harrell, MD Floyd
2002 Iyotsna Prasad, MD Emory
T.A. SAPPINGTON AWARDS TO GRADUATING FAMILY MEDICINE
MEDICAL STUDENTS
CRITERIA NAME OF AWARD: TYPE OF AWARD: Outstanding Student in Family Medicine Monetary award and an Engraved Plaque
SELECTION CRITERIA AND NOMINATION REQUIREMENTS: Candidates for the Award will be those graduates of medical schools in Georgia who have been selected for Georgia Family Residency Programs. Candidates will be evaluated on the following: 1. Member of the GAFP in good standing, holding membership at least one year prior to the
year of selection: 2. Demonstrated abilities (i.e., Leadership); 3. Participation in school and community activities; 4. Academic standing; 5. Participation in the Georgia Academy of Family Physicians and Family Medicine activities on
local, state and national levels; and 6. Enrolled in a Georgia Family Medicine Residency Program
SCHOOLS WHERE AWARDS ARE TO BE GIVEN: 1. Emory School of Medicine 2. Augusta University 3. Mercer University School of Medicine 4. Morehouse School of Medicine 5. Philadelphia College of Osteopathic Medicine MECHANISMS OF SELECTION: The Chairman of each Department of Family Medicine, with the involvement of his/her faculty, nominates up to three (3) candidates in order of preference, who meet the criteria as
stated herewith. Nominations must be made by April 13. The three (3) nominees from each school are presented to the GAFP Membership and Member Services Committee and Board of Directors, at which time a selection for each school will be made. Only ONE award will be presented at each school. If no student is eligible in a respective school, no award will be given. PRESENTATION: This Award is to be presented at each medical school's graduation ceremony. The Program Chair is requested to present this award.
T.A. SAPPINGTON AWARDS TO GRADUATING FAMILY MEDICINE
MEDICAL STUDENTS
NOMINATION FORM
Medical School:
Program Director:
Address:
City, State, Zip
Phone, Fax, Email
Honors/Graduation Program Date
STUDENT'S NAME:
ADDRESS:
CITY:
STATE:
PHONE:
NAME OF FAMILY MEDICINE RESIDENCY PROGRAM ENROLLED IN: LIST OR GIVE EXAMPLES OF: DEMONSTRATED LEADERSHIP ABILITIES:
OUTSTANDING PERSONALITY:
PARTICIPATION IN SCHOOL AND COMMUNITY ACTIVITIES:
PARTICIPATION IN GAFP AND FAMILY MEDICINE ON A LOCAL, STATE OR NATIONAL LEVEL:
T.A. SAPPINGTON AWARDS TO GRADUATING FAMILY MEDICINE
MEDICAL STUDENTS
PAST WINNERS
This award, in memory of Thomas Asbury Sappington, MD, a dedicated family physician from Thomaston, originally was presented to high-school seniors for completing projects that best promoted the understanding of family medicine. In 1999 the criteria was changed, the award is given to one graduating medical student from each of the medical schools. The recipient must attend a Georgia Residency Program.
2017 Kristen McDermott Philadelphia College of Osteopathic Medicine
2017 Leila Myrick Emory University School of Medicine
2017 Rodneysha Brown Morehouse School of Medicine
2017 Kristen Kettelhut Mercer University School of Medicine
2016 Kayla Dziuba Philadelphia College of Osteopathic Medicine
2016 Monique Merritt Morehouse School of Medicine
2016 Natalie Britt Mercer University School of Medicine, Savannah
2016 Afua Akhi-Gbade Medical College of Georgia at Augusta University
2015 Rebecca Doris Jones Philadelphia College of Osteopathic Medicine
2015 John McCaskey Georgia Regents University - Augusta
2015 Shad Stormant Mercer-Macon
2015 Davon Thomas Morehouse School of Medicine
2015 Amethyst Wilder Mercer-Savannah
2014 Daniel Gordon/Mary Keith Mercer-Savannah
2014 John Macon Morehouse School of Medicine
2014 Sunaina Nanchahal Mercer-Macon
2013 Naheed Lakhani Mercer-Macon
2013 Joe Livingston Georgia Regents University - Augusta
2012 Jennifer Francois Morehouse School of Medicine
2012 Raj Singh Philadelphia College of Osteopathic Medicine
2011 Zachary Cohen Mercer University School of Medicine
2011 Michelle Cooke Morehouse School of Medicine
2011 Amanda Fischer Philadelphia College of Osteopathic Medicine
2011 Erin Meeks Medical College of Georgia
2010 Arwyn Raina Mercer University School of Medicine
2010 Lindsay Fowler Hales Philadelphia College of Osteopathic Medicine
2009 Angela N. Evans Philadelphia College of Osteopathic Medicine
2008 Nakato Kibuyaga Morehouse School of Medicine
2007 Malcolm G. Floyd Medical College of Georgia
2007 Brian Neil Lewis Medical College of Georgia
2007 David W. Zimmerman Medical College of Georgia
2007 Tara Joyce Davis Mercer University School of Medicine
2006 Jacqueline DuBose Medical College of Georgia
2006 Allison Kimball Mercer University School of Medicine
2005 Elizabeth Korcz Morehouse School of Medicine
2005 Charity G. Wilson Medical College of Georgia
FAMILY PHYSICIAN COMMUNITY AND VOLUNTEER SERVICES AWARD CRITERIA
NAME OF AWARD: TYPE OF AWARD Family Physician Community and Volunteer Services Award Engraved Plaque SELECTION CRITERIA AND NOMINATION REQUIREMENTS: Candidates for the Award will be those members who have gone above and beyond the call of duty to support their communities; physicians who have made outstanding contributions in welfare, education, health, government or the arts. Candidates will be evaluated on the following: 1. Member of the GAFP in good standing, holding membership at least one year prior to the
year of selection; 2. Completed general information form: 3. Current Curriculum Vitae; 4. Newspaper clippings, copies of certificates and other relevant supporting material; 5. Nominating letter from a member of the GAFP including the following:
- Community service activities in which the nominee has been involved
- What impact his/her community service activities have had on the community 6. One (1) additional letter of recommendation from a member of the GAFP; and, 7. One (1) recommendation letter from a community leader who is knowledgeable of
community service activities. MECHANISMS OF SELECTION: Nominations may come from any member, any medical or community organization or self.
Nominations must be made by May 4. This is not an annual award and is given on merit. Nomination reference to Community Service Award is to be published in Briefly Stated, the bimonthly enewsletter of the Georgia Academy of Family Physicians. Nominations will be reviewed by the Membership Committee and will make a recommendation to the Board of Directors. If no member is nominated or selected as a winner, no award will be given. PRESENTATION: This award is to be presented during the GAFP Annual Scientific Assembly when similar awards are presented. The President is requested to present this award.
FAMILY PHYSICIAN COMMUNITY AND VOLUNTEER SERVICES AWARD NOMINATION FORM
NOMINEE: EMAIL: HOME ADDRESS: CITY: STATE: ZIP: PHONE: OFFICE ADDRESS: CITY: STATE: ZIP: PHONE TOTAL YEARS IN PRACTICE SOLO GROUP ADMIN OTHER RESIDENCY PROGRAM:
OUTLINE THE CANDIDATE'S QUALIFICATIONS IN THE FOLLOWING AREAS: PROFESSIONAL /COMMUNITY INVOLVEMENT:
2007 Freddy Gaton, MD Roberta 2006 Kathy Klein Keebaugh, MD Kathleen
FAMILY PHYSICIAN OF THE YEAR CRITERIA
NAME OF AWARD: TYPE OF AWARD: Georgia Family Physician of the Year Engraved Plaque
SELECTION CRITERIA AND NOMINATION REQUIREMENTS: Candidates for the Award will be those members who have been leaders in professional affairs, along with making outstanding contributions to the profession or the community. Candidates will be evaluated on the following: 1. Member of the GAFP in good standing, holding membership at least ten years prior to the
year of selection; 2. Completed nomination form; 3. Current Curriculum Vitae; 4. Must be in good standing in his/her medical community: 5. Provides his/her community with compassionate, comprehensive and caring medical
service on a continuing basis; 6. Is directly and effectively involved in community affairs and activities that enhance the
quality of life of his/her home area; and, 7. Provides a credible role model as a healer and human being to his/her community, and as a
professional in the science and art of medicine to colleagues, other health professionals and especially, to young physicians in training and to medical students.
MECHANISMS OF SELECTION: Nominations may come from any member, any medical society, community organization or
self. Nominations must be made by May 4. Nominations will be reviewed by the Membership Committee, at which time a recommendation will be put forward to the Board. If no one is nominated, no award will be given. PRESENTATION: This award is to be presented during the GAFP Annual Scientific Assembly when similar awards are presented.
FAMILY PHYSICIAN OF THE YEAR NOMINATION FORM
NOMINEE: EMAIL: HOME ADDRESS: CITY: STATE: ZIP: PHONE: OFFICE ADDRESS: CITY: STATE: ZIP: PHONE: MEDICAL SCHOOL: TOTAL YEARS IN PRACTICE RESIDENCY PROGRAM:
OUTLINE THE CANDIDATE'S QUALIFICATIONS IN THE FOLLOWING AREAS: PROFESSIONAL /COMMUNITY INVOLVEMENT:
The Georgia Family Physician of the Year is presented to a family physician that has been a leader in the community and professional affairs and has made an outstanding contribution to the community.
2017 Samuel “Le” Church, MD Hiawassee
2016 Paul Forney, MD Augusta
2015 Folashade Omole, MD East Point
2014 William F. Bina, MD Macon
2013 Harry S. Strothers, III, MD East Point
2012 Howard McMahan, MD Ocilla
2011 James Leon Ray, MD Swainsboro 2010 Michael S. Busman, MD Americus
NAME OF AWARD: TYPE OF AWARD: Family Medicine Educator of the Year Award Engraved Plaque
SELECTION CRITERIA AND NOMINATION REQUIREMENTS: Candidates for this Award will be deserving members who have been leaders in academic, community and professional affairs, along with making outstanding contributions to the profession or the community. Candidates will be evaluated on the following: 1. Member of the GAFP in good standing, holding membership at least one year prior to the
year of selection; 2. Completed nomination form; 3. Current Curriculum Vitae submitted by the nominator; 4. Supporting documentation from his/her students and other relevant supporting material: One letter of support from a medical student or a resident; 5. Nominee should have a minimum of seventy-five (75) hours spent teaching family
medicine; and 6. Areas of expertise to be considered are: Clinical, Teaching Skills-Lecture, One-on-One and
Small Groups, Academic Credentials and Community Involvement. MECHANISMS OF SELECTION: Nominations may come from any member, student, and faculty member or residency program.
Nominations must be made by May 4. Nomination references to the Family Medicine Educator Award will be published in Briefly Stated, the bimonthly enewsletter of the Georgia Academy of Family Physicians. Nominations will be reviewed by the Membership Committee and will make a recommendation to the Board of Directors. If no one is nominated, no award will be given. PRESENTATION: This award is to be presented at the GAFP Annual Scientific Assembly when similar awards are
presented. The President is requested to present this award.
FAMILY MEDICINE EDUCATOR OF THE YEAR NOMINATION FORM
GUIDELINES: 1. The application should be completed and a current curriculum vitae should be submitted by the
nominator; 2. Each entry must have supporting documentation from his/her students and others; 3. Each nominee should have a minimum of seventy-five (75) hours spent teaching family medicine
annually; and, 4. All nominations should be submitted to the GAFP headquarters no later than May 4, 2018. NOMINEE: EMAIL: ADDRESS: CITY: State: Zip : Phone
PLEASE COMMENT ON YOUR NOMINEE'S QUALIFICATIONS IN THE FOLLOWING CATEGORIES: 1. CLINICAL EXPERTISE
2. TEACHING SKILLS: a. LECTURE FORMAT:
ONE-ON-ONE (BEDSIDE) TEACHING:
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FAMILY MEDICINE EDUCATOR OF THE YEAR NOMINATION FORM (PAGE 2)
EDUCATOR: 2. TEACHING SKILLS (CONT'D): c. SMALL GROUPS:
The Family Medicine Educator of the Year is to honor a deserving member who has been a leader in academic, community and professional affairs, along with making an outstanding contribution to the profession.