Print and return completed form to: Scott Davenport University of Minnesota Medical School MMC Delaware Street SE Minneapolis, MN 55455

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Print and return completed form to: Scott Davenport University of Minnesota Medical School MMC 293 420 Delaware Street SE Minneapolis, MN 55455 Or save PDF and email to: daven016@umn.edu

University of Minnesota Medical School Flexible MD Program FINAL REPORT Name: Date: ID #: I am currently in the Class of: Address: Phone: Email: Category of your academic project/experience: Research Community-based service learning Global Health Advanced course, certificate program Dual degree program Location Additional degree Location Other: Brief project/experience description: 1

Describe how the project supported your progress towards the MD degree and/or your future career path in medicine: List competencies/academic requirements achieved. Check all that apply and provide method (see attached sheet for competency definitions): Competencies/academic requirements Method(s) Medical Knowledge Clinical Skills and Patient Care Scientific and Clinical Inquiry Professionalism Interpersonal and Communication Skills Systems of Health Care Continuous Improvement of Care Through Reflective Practice 2

Did this experience produce a scholarly outcome? Yes No If yes, check all that apply and provide details: Outcome type Details Research paper Journal article Poster presentation Presentation at a meeting Reflective writing Audio or video project Art project Other: Information for future students who may undertake a similar project or one related: 3

University of Minnesota Medical School Evaluation of Flexible MD Program Directions: Please rate your level of agreement for the following statements regarding your overall experience of the Flexible MD Program. Please provide specific examples in your comments, whenever possible. Strongly Agree Agree Disagree Strongly Disagree 1. The process for applying to the Flexible MD Program was clearly stated on the Flexible MD information website. 2. Navigating through the online application form was easy and simple to complete. 3. Materials and information on the website were clear and easy to locate. 4. Student Services provided me with the assistance I needed in preparation for my experience. 5. Student Services helped me maintain communication and connections with my matriculating class while completing my experience. 6. Student Services made the process of reentry into the clinical experiences appear seamless. 7. Overall, the Flexible MD Program provided me with a good opportunity to contribute to enhancement/s in the curriculum. 8. How do you hope to use the knowledge and skills gained from this experience as practicing physician? 9. How can we improve the program (ie., application process, available opportunities, support, communication, etc.)? Please be specific as possible. Yes No 10. Would you recommend this program to others? Please detach this evaluation from your final report and mail in separately to: Scott Davenport University of Minnesota Medical School Office of Student Affairs MMC 293 420 Delaware Street SE Minneapolis, MN 55455 or save and email to: daven016@umn.edu

Domains of Competence The University of Minnesota has organized its competencies into seven categories of knowledge, skills and attitudes which align with the ACGME core competencies. Medical Knowledge - Demonstrate the ability to apply knowledge of human structure, function, development, pathophysiology and psychosocial development to patient care. Clinical Skills and Patient Care - Demonstrate effective use of motor and cognitive skills in diagnosis, management and prevention of common health problems encountered in patient care. Scientific and Clinical Inquiry - Demonstrate understanding of scientific theory and methodology and the critical thinking skills needed to interpret and apply research to improve patient care. Professionalism - Demonstrate, through knowledge and behavior, a commitment to the highest standards of competence, ethics, integrity and accountability to the patient and the profession. Interpersonal and Communication Skills - Demonstrate effective listening, verbal and written communication skills with a wide range of individuals and groups in order to provide patient-centered care. Systems of Health Care - Recognize and work effectively within the larger context and system of health care to advocate for and provide quality patient care. Continuous Improvement of Care Through Reflective Practice - Demonstrate habits of self-directed learning, including awareness of gaps in understanding, recognition of personal limitations, and acquisition of new knowledge and skills, in order to stay current in all aspects of medical practice and provide optimal patient care. 5