FCE Student Designed Course Proposal AY 2014-2015

The self-designed FCE is your opportunity to develop an experience that isn’t offered anywhere else in the medical school curriculum. These experiences can be done within the medical school or at an outside institution.

You can also use this form to develop a unique experience that will specifically inform your Capstone project. You may ask your Capstone project advisor to be your FCE supervisor or you may want to work with another professional who has expertise in your topic. The Capstone FCE must not serve simply as “more time” to work on your project (e.g., extra digging in the library); it must be a distinct, independent piece that informs your project. You may design up to two distinct Capstone FCEs. While approving a Capstone FCE, your proposal will be evaluated as if it were a stand-alone FCE; all rules and requirements for self designed FCEs will apply.

See the FCE Program FAQ webpage for specific requirements.

Your Name *
Your email *
FCE Course Title
If a Capstone self-design, start FCE title with appropriate prefix. EG: FCE 3005 Capstone Research: [your title]
Has this FCE been offered previously?
Course Faculty Sponsor
Hosting Department
FCE Location (include contact information if available)

Please provide contact information for supervisors who will evaluate student performance.
Faculty Evaluating Supervisor Faculty Evaluating Supervisor Administrative Support
Inter disciplinary
(multiple clinical departments)
Inter professional
(multiple professionals)
List other professional(s) and or additional discipline(s) here
FCE Discipline
FCE Discipline
FCE Discipline
FCE Discipline

AY 2013-2014 Course Date(s) * - Select both FEs if this is a 2 week FCE

[note: use the FE-Special option if you are back dating an AY1415 FCE Proposal Submission]
FE-Special Dates (eg, Spring Break)

Part II Course Description

Brief Course Description (attach further information via email to UMMSFCEprogram@umassmed.edu )
Course Objectives e.g., By the end of this session students should be able to name, explain, perform, demonstrate, describe... (list 3-5 objectives)

UMMS Core Competencies (check all that apply) Evaluation Type & Criteria (select at least one from each list)
Describe /explain evaluation(s) here
Explain any prerequisites for this Flexible Clinical Experience
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