Exit this survey >> Resident Rotation Evaluation 1. Rotation Information Question Title * 1. Please fill out the following information: Name: Preceptor: Community: Clinic/Hospital Core or Elective Rotation Question Title * 2. Rotation Dates: Start Date: Date Finish Date: Date Question Title * 3. University: McMaster University University of Western Ontario University of Toronto Queen's University University of Ottawa Northern Ontario School of Medicine Other (please specify): Question Title * 4. Rotation: Allergist Anesthesia Cardiology Dermatology Emergency Medicine Endocrinology Family Medicine Gastroenterology General Surgery Geriatrics / Gerontology Hospitalises Infectous Disease Internal Medicine Nephrology Neurology Neurosurgery Obstetrcis/Gyn. Oncology Opthalmogloy Ortho Surgery Otolaryngologist Paediatric Neurology Paediatrics Pathology Physical Medicine, Rehab Plastic Surgery Psychiatry Radiology Respirartory Medicine Rheumatology Surgery Thoracic Surgery Urology Vascular Surgery Other (please specify): Question Title * 5. Program Year PGY1 PGY2 PGY3 PGY4 PGY5 Question Title * 6. Please identify your main reason(s) for participating in a ROMP-facilitated rotation: Mandatory Rural Rotation Community-Specific (wanted experience in a specific community, close to home, etc.) Preceptor-Specific (wanted to work with a specific physician) Recommended by peers/others Received Information from Info Session/Website Other (please specify): Next >>
