Application form for inclusion in June 5th Medical Education Week poster session

Thank you for your interest in presenting your work! Please fill out this form completely and submit it by April 14, 2023. If you have any questions, please contact Kelly Anastasio at kanasta2@bidmc.harvard.edu.

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* 1. Please tell us about yourself:

Name: *

Professional degree(s): *

Department: *

Division (if applicable): *

Email Address:

Cell Phone Number:

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* 2. Role:

Student

Intern/Resident

Fellow

Attending/Faculty

Allied Health Professional (e.g., RN, NP, Social Work, RRT, PHA)

Other

Allied Health Professional or Other - please specify here:

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* 3. Please list your co-authors here, if applicable

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* 4. What is the category of your poster? (check all that apply)

Clinical Education (includes bedside teaching, teaching during rounds, precepting, etc.).

Classroom Education (includes lectures, small group discussion learning, etc.).

Assessment

Procedural learning

Leadership/Education Policy

Diversity, Equity and Inclusion

Simulation

Other - please specify:

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* 5. Title of Project

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* 6. Abstract (250-300 words)

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* 7. Can you or one of your colleagues commit to attending the June 5, 2023 poster session from 4-5:30pm?

Yes