Handbook> Electives > Information > Proposing a New Elective

Electives - Introductory Information

For Faculty: How to Propose a New Elective

 

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

 

1. Title of Elective: ________________________________________________ (maximum of 60 character & spaces)

2. Type of Elective: Lottery, Arranged, Research, International 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. Research electives are scheduled by supervisor's approval of a research proposal at least one month prior to the beginning date. Away electives are supervised by physicians who are not UVA faculty members.)


3. Supervisor: ______________________________________________________

Office location and box number: ________________________________________

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 Rotations on Calendar

-- 1 -- 2 -- 3 -- 4 -- 5 -- 6 -- 7 -- 8 -- 9 -- 10 -- 11 -- 12
(if only 2 week rotation, indicate whether it will be 1st 2 weeks "a" or 2nd 2 weeks "b" of Rotation)


9. I would like to have this elective designated as an Advanced Clinical Elective (ACE)

Yes
No


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?

Yes
No

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. Learning Objectives: _____________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________


13. Suggested preparatory reading (if any): __________________________________


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

Place: _______________________________; Time: _______________________


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


16. Student responsibilities: Time:

Direct patient care

___________ hours/week - % of time

Indirect patient care (observation of attending and/or housestaff)

___________ hours/week - % of time

Rounds (clinical teaching and case discussions)

___________ hours/week - % of time

Didactic sessions

___________ hours/week - % of time

Other (specify) ________________________

___________ hours/week - % of time

Total hours/week

___________ hours/week - % of time

Night call?

YES NO

Weekend rounds?

YES NO

Weekend call?

YES NO


17. Work: Specific tasks (e.g., H&Ps, assisting in OR, writing orders, counseling families, etc.); related reading, presentations, lectures, papers _____________________________________________________________

_____________________________________________________________


18. 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

_____ Chief Resident on service when elective is taken

_____ Other


19. 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.)


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

Yes
No

If you respond YES, the description will be uploaded to the web and students will begin adding into the rotation. If you respond NO, the description will appear in the next elective book and students will not begin scheduling until the next academic year begins.


21. Is it necessary for the student to have a pager during this rotation?
Yes
No

If yes, is it supplied by the department?
Yes
No



 

The Director of the Electives/Selective Program will review your proposal and the Chair's letter 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; Arranged; Research or Away

 

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

 

Credits ______ (To be assigned by the Director Elecitves/Selective Program based on above information. In general, 40 hours of clinical work per week earns one credit.)