Electives - Introductory Information

For Faculty: How to Propose a New Elective

• Attach the course description on a separate page
• Follow this format for your proposed elective - you can answer questions directly on this form.
• Obtain a supporting letter by the Chair of your Department.
• Mail to Electives Coordinator, PO Box 800739.

1. Title of Elective: ________________________________________________

2. Type of Elective: Lottery, Arranged, or Away

(Lottery electives are scheduled at the beginning of the year and any changes afterwards are made by supervisor's signature. Arranged electives are always scheduled by supervisor's or designated signor's signature on add/drop form. Away electives are supervised by physicians who are not UVA faculty members.)


3. Supervisor: ______________________________________________________

Office location: ___________________________________________________

Office phone and fax: ______________________________________________

E-mail address: ___________________________________________________

Supervisor's signature: _____________________________________________


4. Supervisor's secretary: _____________________________________________

Office location: ___________________________________________________

Office phone and fax: ______________________________________________

E-mail address: ___________________________________________________


5. Designated signor for add/drop forms (if different from supervisor):

Name: __________________________________________________________

Office location: ___________________________________________________

Office phone and fax: ______________________________________________

E-mail address: ___________________________________________________

6. Number of students per rotation _________ or

Minimum (if any - elective may be cancelled if this number of students is not registered) ______ and maximum _______ number of students per rotation.

7. Length of elective (check all that apply):

____ 2 weeks; ____ 4 weeks; ____ 6 weeks; ____ 8 weeks; ____ Other


8. Circle periods elective will be offered - refer to Periods on Calendar

10. Course content: On a separate sheet write a general description of rotation including goals and objectives of the elective; what teachers expect the student to learn described in terms of knowledge, skills and attitudes.

11. Is a 4th-year student allowed to take time away to interview during this elective?

Attendance at Elective activities is mandatory.

• Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
• With supervisor's preapproval, students are allowed to take off up to 1 day per week (or 4 days during a 4-week elective rotation) to interview between November 1 and February 1. Some electives do not allow time off to interview - remember to check the description or with the supervisor.
  • Specific days missed must be approved by the Attending on Service.

12. Suggested preparatory reading (if any): __________________________________


13. On the first day the student should report to: Person: _______________________

Place: _______________________________; Time: _______________________


14. What time does student workday generally begin ________ and end _________?


15. Student responsibilities: Time:

_____________________________________________________________


17. Who is responsible for observing the student's knowledge, skills, and attitudes displayed in the performance of assigned tasks?

_____ Elective supervisor listed above

_____ Attending on service when elective is taken

_____ Resident on service when elective is taken

_____ Other


18. Who is responsible for evaluating the student's knowledge, skills, and attitudes?

_____ Elective supervisor listed above

_____ Attending on service when elective is taken

_____ Other
(Note: Student evaluations must be signed by an Attending, Fellow or Chief Resident; residents may contribute observations to an evaluation but cannot sign the evaluation form.)


19. I want to offer this elective to the current 4th year class.

If yes, is it supplied by the department?

Yes

No

21. Is it necessary for the student to have access to MIS

The Clinical Medicine Committee will review your proposal and the Chair's letter at their next meeting and notify you of the status - approved, rejected or pending further information which we will then request from you.

For Office Use Only:

________Approved; ________ Rejected; ________ Pending Date ________:

Elective Number: _________; web number _______ (assigned by Electives Coordinator)

Type of Elective: Lottery or Arranged

Approved as 2 wk ________ and/or 4 wk _________ rotation

Credits ______ (To be assigned by the Clinical Medicine Committee based on above information. In general, 40 hours of clinical work per week earns one credit.)