Please review Guidelines for Fourth-Year Electives.


TITLE: _________________________________________________________________________________


DEPARTMENT: ________________________________________________________________________



Sign Up Codes:


Does student need elective director’s approval to list this elective on the course preference            Yes ____   No ____

                   form during initial sign-up procedure during third year?   (*Coded “I” in catalog)


Does student need to see elective director immediately after receiving computer-generated             Yes ____    No ____

schedule and at least 30 days prior to beginning of elective?   (*Coded “II” in catalog)


* Electives may be coded either  I  or  II,  both  I  and  II,  or  “none.”


Faculty Member(s) in Charge of Course:   (i.e., elective director)    _____________________________________


Participating Faculty:    (Faculty in addition to the elective director who might be working with students on this elective)


            _____________________________________________        _____________________________________________


                   _____________________________________________        _____________________________________________


Location of Elective:    (i.e., Hermann Hospital, LBJ, Hermann Professional Building, etc.)




Offered:             Each month _______________        (Normally July thru May although a few students take electives in June.)


If not offered each month, when will it be offered: _________________________________


Maximum # of Students Per Month:   ____________





Please address as completely as possible.   Use separate sheet(s) if necessary.   Your discussion should include:


·      The clinical and didactic experiences planned for the course must be designed to accomplish the objectives.

·      The elective involves at least 30 hours per week of time with at least 10 hours structured (clinical, conference, lecture).

·      The objectives of the elective are defined and indicate by specific topics the body of knowledge to be mastered.  It is strongly recommended that these be given to students in writing at the beginning of the elective period.







Material Covered:





Skills Acquired:







·      The elective involves significant teaching by faculty.

        At least five (5) hours per week are aimed at the MS IV level.

·      The students are evaluated based on the demonstration of their accomplishment of the objectives.









Number of new patients/student/week?                        _______________________________________


Responsibilities of Student for Assigned Patients:


Does history/physical:                                                                     Yes _____ No _____


Who critiques: (If yes to preceding question)                                    ______________________________________________


Follows patients, with appropriate notes as needed:                   Yes _____ No _____


Who supervises:                                                                                ______________________________________________


Does student see ambulatory patients:                                          Yes _____ No _____


Performs or observes procedures:   (If “yes,” list and check under “Observe” or “Perform” as applicable)


Procedures                                                                            Observe         Perform




Scheduled Duties of Student:


Frequency of rounds on patients:                                                   ______________________________________________


Presents patients to preceptor or attending physician:             Yes _____ No _____


Weekly schedule of required teaching sessions:                       ______________________________________________



Description of Optional Rounds & Activities:             _______________________________________


Other Required Activities:


Reading/review of current literature:                                           Yes _____ No _____    

Writing or presenting a paper:                                                      Yes _____ No _____


Other:                                                                                                  ______________________________________________



·      Students are observed closely enough by faculty to evaluate their performance meaningfully.

·      Mid-rotation feedback is encouraged for all students, but feedback in writing is required for any students identified as having deficiencies, as soon as the deficiency is identified.







How Student is Evaluated:                                            _______________________________________


Who Evaluates Student?                                               _______________________________________


Unique Features of this Elective:   (optional)                       




Name of Department Elective Coordinator:                _________________________________________


Signature of Department Elective Coordinator:          _________________________________________