Whitetulip Health Foundation 2025 Intern Preparation Course Enrollment Form
Name
*
First Name
Last Name
Country of Origin
Email
*
example@example.com
My speciality is
*
Internal Medicine
Pediatrics
Neurology
Surgical
Pathology
Other
I matched to residency program at
*
I am interested in joining to "Whats App" group
Yes
No
Maybe
How familiar are you with health care system in US?
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Not familiar at all
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9
very familiar
10
1 is Not familiar at all, 10 is very familiar
How familiar are you with the role of multi-disciplinary team members in US health care (social workers, case managers, respiratory therapists, dieticians, etc)?
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Not familiar at all
1
2
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4
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8
9
very familiar
10
1 is Not familiar at all, 10 is very familiar
Have you ever used any electronic medical record system prior to residency?
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Yes
No
Other
How confident are you using electronic medical system in US and navigating it (writing patients notes, admission and discharges)
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Not confident at all
1
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8
9
very confident
10
1 is Not confident at all, 10 is very confident
Please rate your confidence in presenting a patient during rounds?
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Not confident at all
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9
very confident
10
1 is Not confident at all, 10 is very confident
Please rate your confidence in creating a full "assessment and plan"
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Not confident at all
1
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5
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7
8
9
very confident
10
1 is Not confident at all, 10 is very confident
Rate your confidence level practicing as an intern at your residency program on July 1st
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Not confident at all
1
2
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4
5
6
7
8
9
very confident
10
1 is Not confident at all, 10 is very confident
Submit
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