EWH BMET Guest Instructor Application
Basic Contact Info
Name: *
Your answer
Email: *
Your answer
Phone: *
Your answer
Address: *
Your answer
Teaching Experience
Please briefly describe your past teaching experience (classroom instruction, on-the-job training, etc.). Are you comfortable preparing a delivering a lecture to a classroom of 20 people? *
Your answer
Travel and Developing World Experience
Please briefly describe your international travel experience, including any experience living abroad and/or any experience in developing countries or resource-poor settings. *
Your answer
Foreign Language Experience
Please list any languages you speak, and for each indicate your skill level (e.g. native, fluent, conversant, limited knowledge). *
Your answer
Current Employment and Availability
Which of the following best describes your current work situation? *
You may elaborate with any relevant information (optional).
Your answer
Would your employer support you to go on a two-week trip with EWH by offering PTO, vacation time, credit for professional development, or other incentives, awards, or compensation (if applicable)? Please describe. *
Your answer
If EWH were to need a guest instructor to fill in an unexpected gap on short notice, could we call to ask about your availability? *
Subject Matter Expertise
Please rate your knowledge or expertise in the following types of equipment on a scale from 1 to 4. *
1 = no knowledge / I don’t know what this is
2 = some knowledge, limited experience
3 = I have worked on these devices many times
4 = I am a subject-matter expert on this type of equipment
X-ray
ESU
ECG
Sterilizers / autoclaves
Dental equipment
MRI
Ultrasound
Ventilator
Anesthesia machine
Infusion pump
Fetal Doppler
Infant incubator / warmer
Suction machine
Blood pressure device
Defibrillator
Nebulizer
Centrifuge
Chemical analyzer (clinical lab)
Capnograph
Oxygen concentrator
Spectrophotometer / colorimiter
Phototherapy
Surgical lamp
Laryngoscope
Dialysis
Heart-lung machine
Microscope
Respiration monitor
Ophthalmology equipment
Otoscopes
Pulse oximeter
Water purifier
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