for _____ Respond to all required (*) fields to ensure successful submission
for _____ Respond to all required (*) fields to ensure successful submission
Your last name
*
Your first name
*
Your email address
*
I am a PURCH student
I prefer to complete my FCEs at Baystate Health
_____ Do you plan to complete an FCE during FCE week 1August 31 - September 4 2020
_____ Do you plan to complete an FCE during FCE week 1August 31 - September 4 2020
response required
*
-- Select an option --
Yes | please see my department preferences below
No | I will not be completing an FCE during this week
No | I will defer this week until my AS year
If yes, please indicate your top two clinical department preferences for this FCE
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 1
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 2
I will submit a self-design FCE proposal for FCE week 1
_____ Do you plan to complete an FCE during FCE week 2December 14-18 2020
_____ Do you plan to complete an FCE during FCE week 2December 14-18 2020
response required
*
-- Select an option --
Yes | Please see my department preferences below
No | I will not be completing an FCE during this week
No | I will defer this week until my AS year
If yes, please indicate your top two clinical department preferences for this FCE
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 1
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 2
I will submit a self-design FCE proposal for FCE week 2
_____ Do you plan to complete an FCE during FCE week 3January 4-8 2021
_____ Do you plan to complete an FCE during FCE week 3January 4-8 2021
response required
*
-- Select an option --
Yes | Please see my department preferences below
No | I will not be completing an FCE during this week
No | I will defer this week until my AS year
If yes, please indicate your top two clinical department preferences for this FCE
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 1
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 2
I will submit a self-design FCE proposal for Week 3
_____ Do you plan to complete an FCE during FCE week 4January 11-15 2020
_____ Do you plan to complete an FCE during FCE week 4January 11-15 2020
response required
*
-- Select an option --
Yes | Please see my department preferences below
No | I will not be completing an FCE during this week
No | I will defer this week until my AS year
If yes, please indicate your top two clinical department preferences for this FCE
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 1
-- Select an option --
Anesthesiology & Perioperative Medicine
Dermatology
Emergency Medicine
Family Medicine & Community Health
Medicine
Neurobiology
Neurology
Neurosurgery
Obstetrics & Gynecology
Ophthalmology & Visual Sciences
Orthopedics & Physical Rehabilitation
Otolaryngology
Pathology
Pediatrics
Psychiatry
Radiology
Radiation Oncology
Surgery
Urology
Preference 2
I will submit a self-design FCE proposal for Week 4
_____ Additional Preference Information We can't promise we will have the capacity to satisfy the additional preferences you add below, although we will make every effort to do so.
_____ Additional Preference Information We can't promise we will have the capacity to satisfy the additional preferences you add below, although we will make every effort to do so.
list previously offered FCEs (faculty or student designed) that you would like to be offered in AY20-21
list faculty you would like to supervise your FCE
What else should we know to create the best FCE schedule for you?
Submit to FCE course leadership