Foundations of Emergency Medicine Registration 2018-2019
Please complete this form to officially register your program to use Foundations content for the 2018-2019 academic year. Answer these questions based on your current plans; we understand these may change over time. If you have any questions or updates, please contact Emilie, our Communications Director, at emilie@emergencymedicinefoundations.com.
Email address *
Full Program Name *
Your answer
Short Program Name (used for the mid-year survey and other communications) *
Your answer
What is the last name of your primary Foundations Site Director? *
Your answer
What is the first name of your primary Foundations Site Director? *
Your answer
What is your primary Site Director's preferred email address? (This will be used for Foundations-related emails. You must update Emilie if this contact changes.) *
Your answer
Program Location (City) *
Your answer
Program Location (State) *
When do you plan to begin using Foundations content with your learners? (month/year) *
Your answer
Please select your residency type (PGY). *
What type of learners will receive EM Foundations content at your site? (select all that apply) *
Required
How many learners will routinely receive Foundations content at your site this year? (include only Resident/PA/NP learners) *
Your answer
Which of the following Foundations courses will your site be using? (select all that apply) *
Required
Do you plan to use the Rosh Review mini tests that coordinate with each of the Foundations I and II course units? *
Will your site be giving asynchronous credit (III) to residents for time spent on Foundations Learning Pathway (independent study) assignments? *
Do you plan to use the Google Attendance Tracking Form available on the Foundations website? *
Do you plan to assign your current PGY 1 residents (2017-2018) the Rosh Review Foundations End of the Year Assessment (June-July 2018)? *
Do you plan to assign your incoming PGY 1 residents (2018- 2019) the Rosh Review Foundations End of the Year Assessment (June-July 2018)? *
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