FAMUS

FAMUS New Supervisor Application Form

Personal Details

Relevant ultrasound qualification(s)

FAMUS / FUSIC accreditation (with dates)

Other relevant qualifications

Current Ultrasound Usage

Frequency of ultrasound scanning: DailyWeeklyMonthly

Supervisor area(s) applied for: ThoracicAbdominal / renalDVTLumbar Puncture

Would you be prepared to attend a 'Train the Trainers' event, if recommended (no cost) YesNo

SAM-Butterfly National Cloud

The Society for Acute Medicine and FAMUS team have worked with Butterfly Network to develop a national training platform to help people undertaking FAMUS training achieve their competencies. This is the first collaboration of its kind in the world and it is hoped will remove some barriers to achieving FAMUS competence for all interested clinicians. This cloud will be free to access for FAMUS registrants and SAM members and will allow those in possession of a Butterfly device to register, upload training scans with reports, and link with local Supervisors to have those scans reviewed. The user can generate training logs, QA reports and receive feedback on training scans if a local mentor or Supervisor is not available.

Please check this box if you would like to be added for access to the SAM-Butterfly National Cloud

Confirmation of correct data

I confirm that the above is an accurate reflection of my ultrasound experience/qualification(s) and that having reviewed the curriculum pack I am competent in overseeing the FAMUS module(s) applied for.

yes

Data Protection

Your registration details will be stored on a database by Eventage Ltd on behalf of the Society for Acute Medicine (SAM) in compliance with the General Data Protection Regulation (GDPR), accessed only by administrative staff working on behalf of SAM for the purposes of administering your registration. SAM may, from time to time, send you communications relating to your registration. As a supervisor, your name, position, trust/hospital, date of registration and email address will be made available in the FAMUS directory of supervisors on the SAM website, if you consent. I consent to having my email address displayed in the FAMUS Supervisor directory on the SAM website

yes

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