Emergency Medicine Foundations Site Leader Registration Form
Foundations Site Leaders,

Thank you for completing the following registration for your site. Details below will help us to better understand how the curriculum is being used and to plan for various research projects. The questions referring to “EM Foundations content” include any of the available Foundations courses. There are some questions, as noted, that ask specific questions about certain courses (Foundations I, Foundations II, EKG I or EKG II) and you only need to fill these out if your site will be using that specific course content.

Thanks,
Kristen Grabow Moore, MD, MEd
National Course Director
Emergency Medicine Foundations
www.emergencymedicinefoundations.com

What is your full name? *
Your answer
What is your preferred email? *
Your answer
What is the name of your residency program? *
Your answer
In what city and state is your residency program? (e.g. Atlanta, GA) *
Your answer
Is your residency program established or new for the coming academic year? *
Please select your residency type (PGY). *
Please select your residency type (MD/DO). *
What type of instructors will teach at your Foundations Meetings? (select all that apply) *
Required
What type of learners will receive EM Foundations content at your site? (select all that apply) *
Required
How many total learners will routinely receive EM Foundations content at your site (#, include all learner types)? *
Your answer
Which of the following Foundations extra sessions or extra resources does your site plan to use? (select all that apply) *
Required
Which of the following is your program planning to provide to your Foundations Learners for the 2017-2018 academic year? (check all that apply) *
Required
Are there any other learning resources your program is planning to provide?
Your answer
Will your site be giving asynchronous credit (III) to residents for time spent on Foundations Learning Pathway (independent study) assignments? *
If "Yes", please explain how you will assigning asynchronous credit.
Your answer
During Foundations Meetings, how will Foundations Cases usually be presented to learners? *
Are you planning on assigning your current PGY-1 residents (2016-2017) the Rosh Review End of the Year Assessment (June 2017)? *
Are you planning on assigning your incoming PGY-1 residents (2017-2018) the Rosh Review End of the Year Assessment (June 2018)? *
Is your program planning on participating in the Site Directors Slack Group to receive communication and updates from the national team about Emergency Medicine Foundations courses? *
Is your program planning on creating and using your own Site Specific Slack Group to send communication and updates to your site’s Foundations Learners and Instructors? *
Which of the following Foundations courses will your site be using? (select all that apply) *
Required
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