New Elective Proposal

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To ensure that the PLFSOM meets the Liaison Committee on Medical Education (LCME) standards for accreditation, please answer each of the questions below. Forward completed forms to the Assistant Dean for Clinical Instruction by Dec. 15 of the year prior to the anticipated initial offering. Note fourth-year electives follow an academic year that spans from June to May.

Elective course title

Academic year to begin offering

Elective course director

Name and title

Contact information

Name of faculty drafting the proposal

Contact information

Sponsoring department

Additional faculty and title(s) (if applicable)

Course length

2 weeks4 weeks2 or 4 weeks

Electives are currently offered in 2 or 4-week formats.

Proposed meeting location(s) (note that this is subject to change based on faculty affiliations and availabilities)

Maximum number of students/offering

Type of experience/encounter

Please specify if selected "Other"

Brief course description

Course goals and objectives

Description of how student performance will be assessed (include any specific criteria for honors)

Does this course include intentional opportunities for interprofessional collaboration?

yesno

Does this course include interaction with non-faculty instructors?

yesno

See relevant policy

For clinical rotations, please ensure that the faculty involved are familiar with the clinical supervision policy.

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