USU Family Medicine

Fourth Year Family Medicine Elective Rotations

Thank you for your interest in USU Family Medicine 4th year elective rotations. This form should easily walk you through the process:

Step 1: Find a preceptor/location. I must have the name and address of your preceptor (Form 1304 Line 6). This is the person who will be responsible for evaluating your performance and returning the grading sheet (USU Form 650) to me. Complete enclosed USU Form 1304. Be sure to complete the objectives and description section Return this form either to me (mstephens@usuhs.mil) or my administrative assistant (preferred) Ms. Cummings (ccummings@usuhs.mil) as MS Word file; or by fax 301-295-3100.

Step 2: Determine if the site has an existing MOU with USU for 4th year rotations. Many do not. An MOU is not hard to set up. Here is what you'll need:

Mr Ed Hawkins is the POC (ehawkins@usuhs.mil)

Your complete name (including middle initial) and your Uniformed Service.
The Department at USUHS that is sponsoring your rotation and the faculty member in that Department who has approved it.
The dates of your proposed rotation (e.g., 22 Nov - 19 Dec 2007).
The complete name of the institution where your training will occur.
The complete address, including zip code, of your training institution.
The full name, academic/medical degrees (if any), and military rank (if applicable)of the person at the training institution with whom you have arranged this rotation (the point of contact).
The complete address address, including zip code, of your point of contact at the training institution.
The commercial telephone number (not DSN) of your point of contact at the training institution.
The point of contact's e-mail address.
Finally, are you paying for the costs of this rotation (e.g., travel, lodging, meals)? If you aren't then who is?

Step 3. Complete the Request for 4th year elective in Family Medicine with location, dates and on-site coordinator's name and fax to 301-295-3100 (or send .pdf to ccummings@usuhs.mil or mstephens@usuhs.mil).

Step 4. Review the 4th year Family Medicine elective/clerkship handbook for students.

Step 5. Give a copy of the USU Form 650 to your site-coordinator/preceptor to complete and return at the end of the rotation.

Step 6. Make sure that this evaluation form (USU Form 650) is returned to ccummings@usuhs.mil or mstephens@usuhs.mil or 301-295-3100 (preferred) at the conclusion of your elective rotation.

Welcome aboard. Click here for Course Offerings and Descriptions

Mark Stephens
CDR Mark B. Stephens
mstephens@usuhs.mil
Associate Professor of Family Medicine
4th Year Elective Coordinator
Family Medicine Interest Group (FMIG) Faculty Advisor