Faculty Educational Activity Log

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The Office of Pediatric Medical Education would like to recognize our faculty for the educational activities in which they participate. To this end (and to help you maintain an ongoing record of your activities for your educator’s portfolio), we are creating a central repository of faculty educational activities. Your complete list of activities will be reported back to you at the end of the academic year or can be requested at any time from the Office of Medical Education.

Please use this short survey to log your educational activities for the current year. Note, resident and clerkship activities that are arranged through the Office of Medical Education (such as Teaching Attending, Resident Noon Conference presentations, Resident advising, continuity clinic precepting, Joint Fellow lectures, Workshop Precepting, Residency Interviewing, etc.) will be automatically recorded by the Office of Medical Education and therefore DO NOT need to be recorded here.

You will need to complete one form for each activity. When you click "Submit" you will be redirected back to the form to log additional activities.

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* 1. What is your name?

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* 2. What is your primary division/section in Pediatrics?

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* 3. Please select the activity you are currently logging for which you have volunteered time for during the 09-10 Academic Year. (Please note that Teaching Attending time, Resident Advising, Resident Noon Conferences, Joint Fellow Curriculum presentations, and Clerkship activities are automatically recorded for you by the Med Ed Office and so do not need to be additionally recorded here).

Fellow Conference Presenter (non-JFC)

Fellow Advisor

Primary Fellow Research Mentor

Fellow Scholarship Oversight Committee (SOC) member

Medical Student Advisor

Medical Student Organization Advisor/Mentor

Teach M1 Course

Teach M2 Course

Student Pathway Advisor

Student Pathway Project Mentor

Grand Rounds Presenter

Resident Conference Presenter (non-Noon Conference)

Pediatric Interest Group (PIG) Activity Participation

Facilitated a Simulation Event

Creation of an On-Line learning module for students, residents or fellows

Other (please specify)

Faculty Educational Activity Log

1. Default Section

Question Title

* 1. What is your name?

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* 2. What is your primary division/section in Pediatrics?

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* 4. How many hours in PREPARATION TIME have you spent this academic year on this activity?

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* 5. How many hours in PRESENTATION TIME have you spent this academic year on this activity?

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* 6. Date(s) of activity?

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* 7. Title of activity? (if applicable, such as a lecture title)

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* 8. Activity outcome? (if applicable, such as residency match, research publications, etc.)