Clinical Rotation LoR Checklist
Fill out the individual form for each clinical rotation.
Name
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First Name
Last Name
Phone/WhatsApp
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-
Country Code (+)
Phone Number
Email
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example@example.com
AAMC ID
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City, State/Province
State / Province
Zip Code
Medical School & Address
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Street Address, City, State, Country
City, State/Province
State / Province
Zip Code
Hospital Name & Address
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Street Address, City, State, Country
City, State/Province
State / Province
Zip Code
Preceptor/Physician's Name
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Rotation Date: MM-DD-YYYY to MM-DD-YYYY
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Rotation Type: (1) Core-Externship, (2) Elective-Externship, (3) Observership, (4) Hands-on experience as IMG, (5) Tele-rotation/Tele-education
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What specialty will you be applying to?
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Month of Application
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September 2024 for Match-2025
How many patients did you assist per day?
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Describe the patient population.
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Clinical Diseases, Procedures, Protocol, Management
Describe in detail your duties and responsibilities during your clinical rotation.
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Ex.: Took history, performed exams, presented cases, ordered tests, wrote prescriptions, used EMR, etc.
Describe at least two interesting cases in which you were involved in patient care/teamwork that demonstrated your excellence in the ACGME core competencies.
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Describe any milestone that you achieve after your observership.
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Ex.: Skills, knowledge, and behaviors in the six ACGME Core Competency domains: patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice.
What type of feedback and/or grades did you receive?
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Describe in detail the name, type, form, and status of the publications with the preceptor.
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Ex: Type: Case report or Literature review; Form: Presentation of abstracts in conference or Publication of manuscript in journals; Status: submitted, presented, or published
Upload a picture with your preceptor or team for record and memory for the preceptor.
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Upload a video of your detailed experience during the rotation with your name and hospital site name for our letter-writing team physician.
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Have you left a Google Review?
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Yes
Understanding of Timeline (August 1-31: Drafting LoRs by IFMGE Team -> September 1-7: Students will send the ERAS Letter of Recommendation Portal (LoRP) request to their Attending Physician -> September 7-30: Uploading LoRs by Faculties)
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Yes
Signature
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Submit
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