SECTION 2A:  Continuing Educational Professional Development

Please complete in respect of each Provider / Instructor course on which you are the Course/Medical Director, Educator or *Course Coordinator.

*Please note the role of course coordinator does not contribute towards the instructor recertification process
Name		
					
Course Centre		
Course Dates		
Type of Course
(circle one)	ARC ALS2/ALS	ARC  ALS1/ILS	ARC ALS2 Instructor	RC(UK)
ALS	RC(UK) ILS	
	EMST	APLS	ATLS	ERC ALS	GIC	
	Other:	

Role(s) on Course	
Course/Medical Director?
☐
	Course Co-ordinator?
☐	Course Co-ordinator? ☐	Course Co-ordinator? ☐	
Course Director/Medical Director/Course Co-ordinator 

Number of courses previously directed:
	Number of courses previously in role of medical lead:	Number of Instructor courses previously in role of Educator:	Number of courses previously in role of Course Coordinator:	
				
Reflect on what went well:

What would you do differently next course?