Institutional Federal Compliance Report 2021

APPENDIX L2: Completion Form for Residency Requirements Resident’s Name: Date: Location: Supervisor’s Name: Requirements Attendance Requirement ( Residency Director signs off when requirement is met) Minor Presentation (9) Major Presentation (16) Grand Rounds (35 credits Affiliated Programs) (45 credits SUNY salaried Programs, including Combined Residency/Graduate Prog) Core Didactic Curriculum – Writer’s Workshop I (Evidence Based Principles & Poster Writing)

Supervisor

Director

Writer’s Workshop I (Writing a Paper) Writer’s Workshop II (Editorial Review)

Speaker’s Workshop Business Workshop Summer Friday Program attendance required for SUNY salaried residents

Presentations ( Residency Director signs off when requirement is met) Minor (20 Minutes) Major (50 Minutes)

Publishable Quality Paper ( Residency Director signs off when requirement is met) Supervisor’s Approval Editorial Review Instructor’s Approval Final Paper

Evaluations of Resident by Supervisor ( Residency Director signs off when requirement is met) 4 Quarterly Evaluations

Meditrek Evaluation of Supervisor ( Residency Director signs off when requirement is met) Mid-year and Year-end evaluation of Supervisor

Exit Survey for Resident ( Residency Director signs off when requirement is met)

Maintenance and Completion of Workload Meditrek Patient Logs (** Residency Supervisor signs off when requirement is met**)

Completion of Meditrek Activity Log throughout the year (** Residency Supervisor signs off to indicate resident completed Activity Log for all quarters**)

Completion of Faculty Evaluations on Meditrek (** Residency Supervisor signs off to indicate resident completed faculty evaluations throughout the year)

Resident has met all Advanced Competencies (** Residency Supervisor signs off to indicate all advanced competencies were met by the resident)

Resident has met all MGO (**Residency Supervisor signs off when resident met MGO requirements)

Any Program Specific Requirement Fulfillment of terms of Employment (** Residency Supervisor signs off when requirement is met**)

Completion of all Professional and Clinical Responsibilities (** Residency Supervisor signs off when requirement is met**)

For Affiliated Supervisors: Proof that Resident has obtained a state license to practice – indicate State for License ____________________

Completion of all Clinical Administration Paperwork/Requirements ( **Residency Supervisor signs off when requirement is met after consulting Clinical Admin – for in-house residents only) Updated 7-15-2020

55