S U R V E Y. Family Medicine Survey for Undergraduate & Postgraduate Elective Opportunities. Dear Faculty Members and Services Groups,

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1 Family Medicine Survey for Undergraduate & Postgraduate Elective Opportunities Dear Faculty Members and Services Groups, The Northern Ontario School of Medicine is undertaking a survey to create an online Electives catalogue to serve all of the NOSM and visiting learners. The survey will provide a broader knowledge and experience of the elective opportunities supported by NOSM. Together, we can provide learners with an informative online catalogue which will enable all medical school students and residents to make informed choices in the selection of their elective experiences. The information gathered via this survey will assist with the implementation and maintenance of such a catalogue. Sample Learning Objectives for Family Medicine Electives assessment. Enhancing your clinical reasoning skills and using the best evidence available. Identify the rights and legal responsibilities of physicians to patients and the community. Describe the determinants of health and apply them appropriately to enhance individual and community well being. Adapt treatment plans to the individual with consideration for the patient s age, general health, special needs, expectations, cultural background, progress, or changes in condition. Conduct patient-centered interviews that explore the patient s feelings, ideas, impact on function, and expectations Assist patients in accessing the health care system for physical, psychological, social, and economic rehabilitation or long-term care. Demonstrate an approach to the assesment and management of patients with multiple medical problems. Thank you in advance for your time and cooperation in our survey. If you have additional comments or concerns do not hesitate to contact. Charles Lemieux Consultant-Electives Catalogue Project Coordinator Northern Ontario School of Medicine charles.lemieux@normed.ca Tel: ext 276 Cell: Fax:

2 SURVEY Family Medicine Undergraduate & P o s t g r a d u at e E l e c t i v e Opportunities Full Name: Title: City, Postal Code: Office Phone: Fax:

3 SURVEY 1. Please check all that apply to your current situation. I am in full-time Part-time medical practice I am semi-retired I am a locum tenens Other, please specify : 2. Please estimate your average on-call work schedule None 1 night in: 1 weekend in: 3. Please estimate the number of patients office visits you have in a TYPICAL WEEK, EXCLUDING patients visits while on-call (on-call is defined as time outside of regularly scheduled activity during which you are available to patients): Number of patient visits per week: 4. Which learners training level are you comfortable with for electives. Please check ALL that apply: Postgraduate Specialty Resident/Postgraduate Family Medicine Undergraduate Clerkship (UGY3/UGY4) Undergraduate Pre-Clerk (UGY1/UGY2) Undergraduate Shadowing Only

4 5. To assist learners at various training levels (as delineated above), please specify which experiences they may expect within their training level during their clinical placement in your practice: Postgraduate Specialty Resident Postgraduate Family Medicine Undergraduate Clerkship (UGY3/UGY4)

5 Undergraduate Pre-Clerk (UGY1/UGY2) Undergraduate Shadowing Only

6 6. Specialize within an area of Family Medicine: Rural Medicine Northern Medicine Emergency Internal Medicine Obstetrics Gynecology Pediatrics Surgery Dermatology Psychiatry Other 7. The following is a list of work settings. Check the category(ies) which best describe(s) the setting(s) where you work. Please check ALL that apply: Community clinic/community health centre Free-standing walk-in clinic Community hospital Emergency department (local hospital) Academic health science centre Nursing home and research unit Free-standing laboratory/diagnostic clinic Other:

7 8. a) Please write one statement to describe the environment of your practice and community elective description.(optional) 8. b) Please review the sample objectives describes on the cover letter and propose any supplemental objectives specific related to your practice environment (optional)

8 SURVEY 9. If you are looking to inquire about NOSM Faculty Appointment check yes to have additional information sent to you. Yes No