Today M-D-Y
Thank you for requesting an EDP consult. Please note consults are addressed on a first come basis. Consults require advance planning. Please see the list below and the proposed time line
EDP Curriculum design and evaluation - 1 month
EDP Educator peer review and coaching - 1 month
EDP Medical educational research project - 1 month
EDP Workshop request - 3 months
EDP RATL - Residents as Teachers and Leaders - 1-2 months
EDP Educator career mentoring session - 1 month
EDP Development of enduring educational materials - 1 month
EDP Scholars track - annual selection (See detail description below).
1. Person requesting the EDP consult
Name (last, First):
* must provide value
Degree:
* must provide value
Department:
* must provide value
Email:
* must provide value
Confirm Email:
* must provide value
Contact Number:
* must provide value
10 digit
*2. I am a:
* must provide value
Faculty member, instructor level
Faculty member, assistant professor level
Faculty member, associate professor level
Faculty member, professor level
Trainee (Resident)
Trainee (Fellow)
Post-doc (Fellow)
Student (medical, graduate, nursing, etc.)
Nurse educator
Other
Faculty member, instructor level
Faculty member, assistant professor level
Faculty member, associate professor level
Faculty member, professor level
Trainee (Resident)
Trainee (Fellow)
Post-doc (Fellow)
Student (medical, graduate, nursing, etc.)
Nurse educator
Other
*3. Is this the first time you have requested EDP services?
* must provide value
Yes
No
4. How did you learn about the EDP consult services?
* must provide value
5. What is your timeline for the EDP consult?
* must provide value
Please specify if this is an urgent request and why.
* 6. Please indicate the purpose of your request: (upon selecting a main category, more options will display)
Please select one item from the list of available EDP consults. If you need another consult, you will need to complete another request form. Thank you.
* must provide value
A. Curriculum Design and Evaluation (developing lectures, workshops, writing objectives, etc.)
B. Educator Peer Review and Coaching (required - 3 visits minimum)
C. Medical Education Research Project
D. Workshop Request for Department/division, etc.
E. RATL (Residents as Teachers and Leaders)
F. Educator Career Mentoring Session (1 hr)
G. Development of Enduring Educator Materials (poster development, teaching tools, pocket cards, cases, etc.)
H. Educator Scholars Track
I. Other (describe below)
A. Curriculum Design and Evaluation (developing lectures, workshops, writing objectives, etc.)
B. Educator Peer Review and Coaching (required - 3 visits minimum)
C. Medical Education Research Project
D. Workshop Request for Department/division, etc.
E. RATL (Residents as Teachers and Leaders)
F. Educator Career Mentoring Session (1 hr)
G. Development of Enduring Educator Materials (poster development, teaching tools, pocket cards, cases, etc.)
H. Educator Scholars Track
I. Other (describe below)
Other (Describe your request in the space provided.)
Q1: Please describe your curriculum design and evaluation project and specify what assistance is requested:
Q1. Is this a mandatory peer review and coaching session? (Meaning - leadership mandated your peer review. e.g., program director, division head, chair, etc.)
* must provide value
No
Yes (If yes, who is mandating the peer review and coaching? Provide name below.)
No
Yes (If yes, who is mandating the peer review and coaching? Provide name below.)
Q2. Please select the focus of your peer review session. (e.g., teaching effectiveness, presentation skills, including learners in bed-side teaching activities, etc.)
Q3. Please select the teaching setting for your peer review and coaching:
Q1. Please describe your educational research project and provide a detailed description of services requested:
Q1. Department Requesting Consult:
Please select your department from the drop down menu to the right. If you select "other," please describe.
Medicine Pediatrics Surgery OB/GYN Neurology Emergency Medicine PM&R Basic Science Department (describe below) Other (Describe below)
Department
Basic Science Departments or Other Department
Q2. Rate your past experience creating educational workshops.
Novice
Intermediate
Advanced
Expert
Novice
Intermediate
Advanced
Expert
Q3. For consultation on workshop development for an external conference, select the options.
Please provide the name of the conference/organization. (E.g., SGEA, AHA, etc.)
Other options are considered based on description (please specify)
Please select which RATL program you are requesting. Please review descriptions below for selecting your best option. 1. Department Specific RATL Training Workshop: This is a specifically designed workshop for your department/specialty - (This option requires a faculty level request.) 2. Full - Blended RATL Learning Program - This program is the best program option and includes completing 4, self-directed learning modules on your own time, followed by a 1-hour, fast paced workshop to build teaching skills. These are offered in the fall of each year (5-6 pm) and participants completed 1 module and one workshop each week for four weeks. This program receives high evaluations and comments from participants. 3. The Flipped Classroom RATL Program: This program is offered in the spring of each year - In this program, participants complete the four RATL Self-learning modules, then participates in a 2-hour session where the participants guide the need of the session based on 11 different categories of teaching content and skills. Because this session is participant driven, not all content is covered in the 2 hour session. 4. RATL On-Line Self-Learning Modules Only - Participants selecting this option will receive access to the self-learning modules for a 3 month period of time. There is no workshop or practical hands-on training with this option, but participants can complete the modules on their own timeline within the 3-month period. This option provides excellent knolwedge of teaching but no practical skills development.
Departmental Specific RATL Training Workshop
Full - Blended RATL Learning Program (Four Self-study Modules and 4, Individual Hands on Training Workshops)
The Flipped Classroom RATL Program (self-learning modules with 2-hour workshop on most requested content)
RATL On-Line Self-Learning Modules Only
Departmental Specific RATL Training Workshop
Full - Blended RATL Learning Program (Four Self-study Modules and 4, Individual Hands on Training Workshops)
The Flipped Classroom RATL Program (self-learning modules with 2-hour workshop on most requested content)
RATL On-Line Self-Learning Modules Only
Q1. Please select your best option for RATL Training Sessions (select only one)
1 hour workshop
2 hour block workshop
1 hour workshops
4 hour (1/2 day) block workshop
1 hour series of workshops
Full day workshop
Flipped classroom/blended learning program (self-learning modules with 2 hour workshop)
On-line self-learning modules only
1 hour workshop
2 hour block workshop
1 hour workshops
4 hour (1/2 day) block workshop
1 hour series of workshops
Full day workshop
Flipped classroom/blended learning program (self-learning modules with 2 hour workshop)
On-line self-learning modules only
Please describe the goal for your mentoring session:
Q1. Please select the number of sessions/type of support you need.
A single, 1 hour consultation session
On-going consultation until my project is submitted
A single, 1 hour consultation session
On-going consultation until my project is submitted
Q2. Briefly describe the educational tool(s) or materials you wish to develop.
Q1. I am requesting an EDP session to discuss the EDP Scholars Program?
Yes
No