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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 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

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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Page 1: 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

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

Page 2: 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

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.

Page 3: 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

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:

(OVER)

Page 4: 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

FAMILY MEDICINE RESIDENT OF THE YEAR NOMINATION FORM (PAGE 2)

INVOLVEMENT IN THE DISCIPLINE OF FAMILY MEDICINE: INVOLVEMENT IN ACADEMY ACTIVITIES: Nominator: (please print)

Program Director:

Address:

City, State, Zip:

Phone, Fax:

Email:

Honors/Graduation Program Date:

RETURN TO: ANGELA FLANIGAN

[email protected] GEORGIA ACADEMY OF FAMILY PHYSICIANS

3760 LAVISTA ROAD, SUITE 100 TUCKER, GEORGIA 30084

404-321-7445/FAX 404-321-7450 ---DEADLINE IS APRIL 13, 2018---

Page 5: 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

FAMILY MEDICINE RESIDENT OF THE YEAR

PAST WINNERS

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

Page 6: 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

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

Page 7: 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

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.

Page 8: 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

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:

(OVER)

Page 9: 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

KEITH ELLIS RESIDENT SCHOLARSHIP

NOMINATION FORM (PAGE 2)

INVOLVEMENT IN THE DISCIPLINE OF FAMILY MEDICINE: INVOLVEMENT IN ACADEMY ACTIVITIES:

Program Director:

Address:

City, State, Zip

Phone, Fax

Email

Honors/Graduation Program Date

RETURN TO: ANGELA FLANIGAN

[email protected] GEORGIA ACADEMY OF FAMILY PHYSICIANS

3760 LAVISTA ROAD, SUITE 100 TUCKER, GEORGIA 30084

404-321-7445/FAX 404-321-7450 ---DEADLINE IS APRIL 13, 2018---

Page 10: 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

KEITH ELLIS RESIDENT SCHOLARSHIP

PAST WINNERS

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

Page 11: 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

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.

Page 12: 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

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:

RETURN TO: ANGELA FLANIGAN

[email protected] GEORGIA ACADEMY OF FAMILY PHYSICIANS

3760 LAVISTA ROAD, SUITE 100 TUCKER, GEORGIA 30084

404-321-7445/FAX 404-321-7450 ---DEADLINE IS APRIL 13, 2018---

Page 13: 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

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

Page 14: 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

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.

Page 15: 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

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:

OUTSTANDING CONTRIBUTION TO COMMUNITY:

NOMINATOR:

(PLEASE PRINT)

RETURN TO: ANGELA FLANIGAN

[email protected] GEORGIA ACADEMY OF FAMILY PHYSICIANS

3760 LAVISTA ROAD, SUITE 100 TUCKER, GEORGIA 30084

404-321-7445/FAX 404-321-7450 ---DEADLINE IS MAY 4, 2018---

Page 16: 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

FAMILY PHYSICIAN COMMUNITY AND VOLUNTEER SERVICES AWARD PAST RECIPIENTS

2015 Jonathan Mitch Cook, DO Athens

2014 David N. Westfall, MD Gainesville 2013 James Hagler, MD Buena Vista

2012 Linda Inez Walden, MD Cairo

2011 Bidemi Olaniyi-Leyimu, MD Newnan 2008 Lynn Taylor Denny, MD Macon

2007 Freddy Gaton, MD Roberta 2006 Kathy Klein Keebaugh, MD Kathleen

Page 17: 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

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.

Page 18: 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

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:

ACADEMIC AND CLINICAL EXPERTISE:

NOMINATOR:

(PLEASE PRINT)

RETURN TO: ANGELA FLANIGAN

[email protected] GEORGIA ACADEMY OF FAMILY PHYSICIANS

3760 LAVISTA ROAD, SUITE 100 TUCKER, GEORGIA 30084

404-321-7445/FAX 404-321-7450 ---DEADLINE IS MAY 4, 2018---

Page 19: 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

FAMILY PHYSICIAN OF THE YEAR PAST WINNERS

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

2009 Bruce M. LeClair, MD Evans

2008 Jack Roof, Jr., MD Blue Ridge

2007 Ferrol Sams, MD Fayetteville 2006 Roslyn D. Taylor, MD Savannah

2005 Sidney J. Morgan, MD Sylvania

2004 J. Larry Boss, MD Villa Rica

2003 Don Waters, MD Blackshear

2002 Asbury Clark Robinson, MD Douglas

2001 Tanya Jones, MD Atlanta

2000 Winnie Claire Hicks, MD Jesup

1999 Laurence Crimmins, MD Albany

1998 Cyler Garner, MD Gordon

1997 George Shannon, MD Columbus

1996 John Antalis, MD Dalton

1995 Catherine Andrews, MD Kennesaw

1994 S. Catherine Huggins, MD Stone Mountain

1993 Keith Ellis, MD Savannah

1992 Richard Wherry, MD Dahlonega

1991 Robin Fine, MD Atlanta

1990 Dwana Bush, MD Atlanta

1989 Charles Lanford, MD Macon

1988 Lanny Copeland, MD Albany

1987 John Heard, MD Decatur

1986 Henry Smith, MD Swainsboro

1985 A.A. McNeil, Jr., MD Camillla

1984 G.H. Perrow, MD Jasper

1983 Frank Houser, MD Macon

1982 H. Gordon Davis, MD Sylvester

1981 Abraham Germain, MD Jonesboro

1980 Charles Hillis, MD Lafayette

1979 Emory Bohler, MD Brooklet

1978 Wells Riley, MD Jonesboro

1977 James Dismuke, MD Adel

1976 John Bell, MD Dublin

1975 William Mendenhall, MD Dekalb

1974 Ollie McGahee, MD Jesup

1973 Robert Walter, MD Calhoun

Page 20: 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

FAMILY MEDICINE EDUCATOR OF THE YEAR CRITERIA

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.

Page 21: 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

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:

-- over --

Page 22: 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

FAMILY MEDICINE EDUCATOR OF THE YEAR NOMINATION FORM (PAGE 2)

EDUCATOR: 2. TEACHING SKILLS (CONT'D): c. SMALL GROUPS:

3. TEACHING ACTIVITIES:

4. ACADEMIC CREDENTIALS:

5. COMMUNITY INVOLVEMENT:

6.

TEACHING ENVIRONMENT (PLEASE INDICATE PRINCIPLE AREA):

_____UNDERGRADUATE _____RESIDENCY _____PRECEPTORSHIP NOMINATOR: (PLEASE PRINT)

ADDRESS: CITY: STATE: ZIP: PHONE: EMAIL:

RETURN TO: ANGELA FLANIGAN

[email protected] GEORGIA ACADEMY OF FAMILY PHYSICIANS

3760 LAVISTA ROAD, SUITE 100 TUCKER, GEORGIA 30084

404-321-7445/FAX 404-321-7450 ---DEADLINE IS MAY 4, 2018--

Page 23: 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

FAMILY MEDICINE EDUCATOR OF THE YEAR PAST WINNERS

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.

2017 John Bucholtz, DO Columbus

2016 Philip Rogers, MD Atlanta

2015 Fred S. Girton, MD St. Simons

2014 Emily Herndon, MD Atlanta

2013 Bruce LeClair, MD Evans

2012 Susan Schayes, MD, MPH Atlanta

2011 Gregory Strayhorn, MD Atlanta

2009 Daryl C. Wiley, MD Thomson

2008 Jonathan E. Reimer, MD Augusta

2007 Eddie Needham, MD Atlanta

2006 Folashade Omole, MD Marietta

2005 Charles Gary Lodge, MD Moultrie

2004 Frank L. Carter, MD Waynesboro

2003 Phil Rogers, MD Dunwoody

2002 David Matthew Jester, MD Augusta

2001 Michelle Nichols, MD Atlanta

2000 Harry S. Strothers, III, MD Atlanta

1999 Lonnie Fuller, Sr., MD Atlanta

1999 Walter Treadwell, MD Macon

1998 Kitty Carter-Wicker, MD Atlanta

1997 Richard Ackermann, MD Macon

1997 Lawrence Lutz, MD Atlanta

1996 Patrick Barmore, MD Thomson

1995 Linda Walker, MD Columbus

1994 George Rust, MD Atlanta

1991 Joseph Hobbs, MD Augusta

1991 Al J. Mooney, Jr., MD Statesboro

1989 1987

Mason P. Thompson, MD Walter Treadwell, Jr., MD

Augusta Atlanta

1985 Larry Boss, MD Villa Rica

1985 Lanny Copeland, MD Albany

1985 Ollie McGahee, MD Jesup

1985 Robert Smith, MD Rome

1984 Joseph Hobbs, MD Augusta

1983 Keith Parmer, MD Rome

1982 Dee Russell, MD Rome