Residency Manual

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) 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 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 Writer’s Workshop I (Writing a Paper) Writer’s Workshop II (Editorial Review) Exit Survey for Resident ( Residency Director signs off when requirement is met)

Supervisor

Director

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