<p> Elective Rotation Application</p><p>Please complete after reviewing the Elective Rotation – General Information for Residents information sheet and forward to Dr. Lowry with copy to bobbie fink and IMCHIEFS 3-6 months prior to your elective rotation. NAME: PGY: 1. What block will the elective be taken? 2. What is the elective you are requesting? Please briefly describe the elective. Board Study Reading Elective 3. What are the specific goals for the elective? (What will you have accomplished by the end of the month?) Study MKSAP for Boards Prepare a Curriculum/Calendar of Study for the Board Review Month and remainder of year Complete a Practice Test </p><p>4. Faculty Mentor (responsible for evaluation) Program Director Advisor who is: 5. Does the Mentor know that you will be assigning them this responsibility? No Yes (they must send a one-line email to Dr. Lowry accepting this task)</p><p>6. Reading List: list 8 specific journal articles as well as 2 book chapters suggested by your faculty mentor or that you have found to be relevant to your elective’s learning goals. (Please attach list to this application or type in below.) - Complete 1 MKSAP Book per Week - Text and Questions (ie: 4 weeks = 4 Books) - Submit a copy of MSKAP questions, or other notes used to study. Must be at least 300 questions per week submitted to your APD. - Meet with Alice Carrott, MA in the first week of my elective - Develop a study plan for the month and the rest of the year regarding board preparation - Schedule a Practice Test - Navigate the ABIM website with Alice Carrott. - Familiarize myself with the ABIM content - Familiarize myself with the routine of test day - Do the practice questions on the website -Take Practice Test - Through Alice Carrott, MA 7. - 100% attendance for noon conference and morning report is required while on board review elective (unless at a board review course). This must be emailed from bobbie weekly to your APD. This is your responsibility to ask bobbie for the document weekly. If this is not done you may be at jeopardy of being pulled from board review elective to cover an inpatient service. 7. Are you planning to do a research elective? No [If not please skip and move to question 8] Yes</p><p> a. Who will be directing the research? b. Have you discussed the project with the person directing the research? Yes No</p><p>Briefly describe the project.</p><p> c. Has the Human Subjects Committee approval been obtained? Yes No </p><p> d. Has HIPPA approval been obtained? Yes No </p><p>8. Are you planning on writing a paper (review, abstract, other) No [If not please skip and move to question 9] Yes If so, briefly describe the paper.</p><p> a. Which faculty member will be supervising the writing? </p><p> b. Do you expect to complete the paper by the end of the elective? Yes No</p><p>If not, describe what progress will be made? </p><p>9. Are you planning an international elective? Yes No</p><p> a. Have you filled out the GME application for an international elective? Yes No ; have you received approval? Yes No</p><p> b. Have you reviewed the International Elective General Information for Residents information sheet and complied with all necessary preparations? Yes No</p><p> c. Have you contacted the Travel Audit Office and the Office of International Programs? Yes No</p><p>10. Are you planning a reading elective? Yes No</p><p> a. Please attach a complete reading list as above. The MKSAP books that I will read are: XXX My Meeting with Alice Carrott, MA is scheduled for: XXX</p>