Curriculum Vitae

NAME Degree

Date prepared:

Name

Address

Office:

Phone:

FAX:

Home:

Education

Medical School

Postdoctoral Training

Date / Speciality / Position / Institution

Licensure and Certification

Date / Board/certificate / Number

Academic Appointments

Date / Academic Title / Institution

Hospital Appointments

Date / Hospital Title / Institution

Other Appointments

Date / Position Title / Institution

Committee Assignments

National

Organization 1 alphabetical

Date / Position Title / Committee

Organization 2 alphabetical

Date / Position Title / Committee

Organization 3 alphabetical

Date / Position Title / Committee

Organization 4 alphabetical

Date / Position Title / Committee

Institutional

Organization 1 alphabetical

Date / Position Title / Committee

Organization 2 alphabetical

Date / Position Title / Committee

Medical School Committees

Date / Position Title / Committee

Departmental Committees

Date / Position Title / Committee

Memberships

Date / Society

Journal Referee Activities

Date / Journal / Role (editor, adhoc reviewer etc)

Awards and Honors

Undergraduate

Date / Award / Significance (e.g. awarded for top grade in biology)

Medical School

Date / Award / Significance (e.g. voted by faculty as top student in school)

Postgraduate

Date / Award / Significance (e.g. voted by students best teacher)

Current Research Interests

Research Funding

Past

Date / Grant title, grant agency, grant amount, % FTE, PI/Co PI

Present:

Date / Grant title, grant agency, grant amount, % FTE, PI/Co PI

Teaching Experience

Undergraduates

Date / Course / Activity / Title / Learners / Time
(hrs) / Frequency?
Eg. RAD502 / e.g. lecture / e.g. Dartmouth undergrads / e.g. annual

Preclinical Medical Student Education

Direct teaching activities

Date / Course / Activity / Title / Learners / Time
(hrs) / Frequency?
Eg. RAD502 / e.g. lecture / e.g. Dartmouth undergrads (6) / e.g. annual

Other pre-clinical teaching activities (e.g. course administration, mentoring, Radiology Interest Groups_

Date / Activity/Role

Clinical Medical Student Education

Direct teaching activities

Date / Course / Activity / Title / Learners / Time
(hrs) / Frequency?
Eg. RAD502 / e.g. lecture, small group / e.g. 3rd year students (60-80) / e.g. 2 hrs / e.g. annual

Other clinical teaching activities (e.g. course administration, curriculum design mentoring, Radiology Interest Groups

Date / Student year / Activity/Role

Residents and Fellows

Direct teaching activities

Date / Course / Activity / Title / Learners / Time
(hrs) / Frequency?
Eg. RAD502 / e.g. lecture, small group / e.g. 3rd year students (60-80) / e.g. 2 hrs / e.g. annual

Other resident/fellow teaching activities (e.g. course administration, curriculum design mentoring,

Date / Learner / Activity/Role

Post Graduate Students

Direct teaching activities

Date / Course / Activity / Title / Learners / Time
(hrs) / Frequency?
Eg. RAD502 / e.g. lecture, small group / e.g. Pharm PhD students / e.g. 2 hrs / e.g. annual

Other Post graduate teaching activities (e.g. course administration, curriculum design mentoring,

Date / Learner / Activity/Role

Invited Presentations

Institutional

Date (d/m/yr) / Talk title and conference title

Regional

Date (d/m/yr) / Talk title and conference title

National

Date (d/m/yr) / Talk title and conference title

International

Date (d/m/yr) / Talk title and conference title

Scientific/Educational Session Moderation at National Meetings

Date (d/m/yr) / Session title and conference title

Bibliography

Original Peer Reviewed Articles

1.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

2.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

3.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

Letters to the Editor

1.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

2.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

3.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

Non-Peer Reviewed

1.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

2.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

3.  OWN NAME IN BOLD. Other names, Title. Journal Date; page reference

Oral Presentations at National Meetings

1.  OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date; page reference

2.  OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date; page reference

3.  OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date; page reference

Poster Presentation at National Meetings (Peer Reviewed)

1.  OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date; page reference

2.  OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date; page reference

3.  OWN NAME IN BOLD. Other names, Title. Conference name and date. If published - Journal Date; page reference

Book Chapters

1.  OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

2.  OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

3.  OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

Book Editor

1.  OWN NAME IN BOLD. Other names, Book Title. Chapter title. Page. Publisher name and City

Electronic Resources (see Teaching Portfolio for details)

1.  Name of resource. Any co’authors. Description of resource. Hyperlinks to resource, MedEdPORTAL or webpage if available. Date developed.

2.  Name of resource. Any co’authors. Description of resource. Hyperlinks to resource, MedEdPORTAL or webpage if available. Date developed

3.  Name of resource. Any co’authors. Description of resource. Hyperlinks to resource, MedEdPORTAL or webpage if available. Date developed

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