First Name (required)
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---Clinical Teaching AssistantClinical InstructorAssistant Clinical ProfessorAssociate Clinical ProfessorClinical Professor
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I agree to spend 60 hours in each calendar year in formal teaching activities. (Please select YES or NO)
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This time will be spent in the following teaching activities (select all that apply):
Lectures, Workshops and ColloquiaMentoringClinical Skills ExaminerClinical Skills PreceptorPBL TutorResearch AdvisorTeaching Attending at Affiliated Hospitals (Rounding with Team)Ambulatory Medicine Preceptor during Third-year Clerkship in Internal MedicineOffering A Student ElectiveOffering A Resident ElectiveContinuity Clinic for Residents
Over the last THREE years, I have participated in the following teaching activities in the Department of Medicine (check all that apply):
Please provide the number of hours (or any additional information) for the activities you indicated above.
Please follow this format:
Number from List Above. Title (if applicable), Number of Hours, and Additional Information.
4. Clinical Skills Preceptor, 30 Hours, Student Names: Elizabeth Farr, Laura Hsu, Ryder Onopa, Keane Young
5. PBL Tutor, 40 Hours
7. Medical Team Care Attending at Queen's Medical Center, 65 Hours, etc.
Hours and details for the activities listed above:
I have participated in the following community service:
Please list your recent abstracts, reports, manuscripts and publications:
I have read the guidelines for appointment and wish to remain a member of the Clinical Faculty:
Questions? (You can also call Julieta Rajlevsky at 808-586-7478 or email her at firstname.lastname@example.org)
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