LMRC- Version 1.0 Site Selection Application
Thank you for your interest in becoming a site for the Lifestyle Medicine Residency Curriculum!

The Lifestyle Medicine Residency Curriculum (LMRC) Version 1.0 will launch in the Summer of 2019.

If you are interested in becoming a site for the LMRC and a Lifestyle Medicine Board Eligible residency, please fill out the following application by May 31, 2019.

Any questions, please contact:

Dennis Muscato, LMRCP/Co-Director LMEd
DMuscato@westernu.edu

Email address *
First Name
Your answer
Last Name
Your answer
Residency Specialty
Your answer
Total Residents in your department
Your answer
Total Faculty in your department
Your answer
What LM teaching is already in your curriculum - who is in charge of this curriculum, who delivers it and how many total hours per month are dedicated to this project?
Your answer
Hours per month available to support the adoption of the LM residency curriculum?
Your answer
Number of practice sites/clinical sites for LM application with patients (Please briefly describe each clinical site noted in your response)?
Your answer
How many residents will participate in the LM residency curriculum?
Your answer
Have you identified residents who would champion the adoption of the LM residency curriculum?
Your answer
How many faculty will support the LM residency curriculum? Is your Department Chair supportive? Is your Program Director supportive? If not, what are your plans to engage them?
Your answer
Does your program fund other outside curricula for the residents (ex FEMA training, IHI, LMCC)? If yes, please describe and indicate the cost of the curricula adopted. Does your department have funding for curriculum adoption such as this one?
Your answer
Would institutional or individual faculty and resident access to the LM residency curriculum be more desirable?
Your answer
How many residents are interested in taking the LM board exam offered by the American Board of Lifestyle Medicine (ABLM)?
Your answer
Number of LM board certified faculty? Do other faculty have plans to become certified in the next 2-4 years?
Your answer
Anything else you want to add to help us in our selection process?
Your answer
What is your medical institution or academic facility?
Your answer
A copy of your responses will be emailed to the address you provided.
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