Pediatrics 2 Site Selection Form

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Mailing Address: OHSU Dept. of Pediatrics
Mail Code: CDRCP
707 SW Gaines Street
Portland , OR 97239-2901
Phone: 503-494-3195
Fax: 503-494-4953

Physical Location:
Child Development and
Rehabilitation Center (CDRC)
Office 2114D
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PRINTABLE VERSION

Dustin Haferbecker, fourth year medical student, on a pediatrics rotation.

Dept of Pediatrics

MSTC Pediatrics 2

Pediatrics 2 should build on and expand the knowledge and skills that were acquired in the third year. The major shift in emphasis will be to the outpatient setting, with its undiagnosed problems, quicker pace, common and mild problems and emphasis on prevention and well-child care. The rotation has been designed to have several options in order to fit the individual career goals and objectives of each student.

Pediatrics 2 Overview

Pediatrics 2 Objectives

Pediatrics 2 Site Selection Form

Pediatrics 2 Orientation

Pediatrics 2 Course Requirements and Evaluation

Pediatrics 2 Midterm Evaluation

Pediatrics 2 Materials-All Students

Pediatrics 2 Materials-Supplemental

Pediatrics 2 CLIPP Cases

Pediatrics 2 Attendance Policy

Site Selection Instructions

Please use this form to inform your decisions about site priorities in Pediatrics 2 as you fill out this form. Pediatrics 2 Site Options.

Required Components:

Play close attention to the required areas of the form. They are indicated in bold. The form can't be submitted unless these are completed.

Student Last name, Student First Name, Student Email, Student Rotation

Site Priority Ranks 1 though 10

Not Required for all students:

Please also note areas that are not mandatory but might be helpful.

Names: You may wish to share you maiden name or any preferred first name or nick name.

Create your own rotation: If you are planning to create your own rotation this is mandatory. Be sure to follow the instructions on the Pediatrics 2 Site Options sheet and complete this area of the form, otherwise, leave it blank.

Extra Priorities: If you wish you may complete all 15 Site Priority Ranks

Note on two week rankings: If you have chosen a two week option one of your site priorities, the second half of your rotation may be one of your other top ranked choices. You may also be assigned time in the Mother Baby Unit (OHSU's nursery) and/or the DCH General Pediatrics clinic to round out your experience at the discretion of the education team.

Notes: Finally, please use the text box to indicate any special circumstances, special needs, or time off requests. You will have to go to the attendance area of this website to complete a time off request.

Site Selection Form

Student Last Name:
Student First Name:
Student Maiden Name:
Student Preferred First Name:
Student Email:
Pediatrics 2 Rotation:
Please only fill out this area if you are creating your own site.
	I am creating my own site and rotation
Preceptor Name:
Preceptor Email:
	My preceptor has an OHSU Faculty Appointment
	My preceptor needs a faculty appointment
	I submitted preceptor CV to monteith@ohsu.edu
Clinic Name and Address:
Rotation Dates and Schedule:
Here is a brief description of the Rotation:
	I have approval from Ibsen or Phillipi
Every one must complete Site Priorities 1-10. Ranks 11-15 are not mandatory but might be helpful.
Site Priority 1:
Site Priority 2:
Site Priority 3:
Site Priority 4:
Site Priority 5:
Site Priority 6:
Site Priority 7:
Site Priority 8:
Site Priority 9:
Site Priority 10:
Site Priority 11:
Site Priority 12:
Site Priority 13:
Site Priority 14:
Site Priority 15:
Notes:

Last updated: July 22, 2009

Please send comments, questions, and feedback on this document to somweb@ohsu.edu