Section 4
Program for Away Rotation (PAR) / Date: January 2014, May 2015
4.12 Application: Program for Away Rotation / Page 1 of 3

Saint Louis University Office of Graduate Medical Education

Program for Away Rotation (PAR) Application

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Section I:To be completed by trainee.

Name of Applicant______PGY level______

Department______Program______

SLU Away Rotation Faculty Mentor______

Away Rotation Information

Proposed Rotation Dates (maximum 28 days):______

Country______City______

Name of School/Organization/Program (if applicable)______

Off-Site Supervisor/Evaluator______

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Section II:Please respond to each question(to be completed by trainee--max 200 words each).

  1. Describe the daily/weekly work on this rotation including specific hospital/clinic sites, didactic experiences, procedures, and duties that will be performed. Indicate whether observation or active clinical activities will take place and how supervision will be provided.
  1. Describe how this experience will enhance your education in your discipline and why this experience can’t be obtained locally at Saint Louis University.
  1. Describe how this experience will be shared with and benefit your peers and training program upon your return to Saint Louis University.
  1. Describe your qualifications, experiences and strengths which would make you a strong candidate to receive approval for a GME funded away rotation.

Section 4
Program for Away Rotation (PAR) / Date: January 2014, May 2015
4.12 Application: Program for Away Rotation / Page 2 of 3

Section III:The trainee and PD must initial each statement below, indicating agreement to and understanding of the following terms of the program.

______The GME office will cover the costs of the trainee’s stipend andbenefits, and for U.S.-based rotations the malpractice coverage,for up to 28 days during the rotation through the usual payroll process. No additional stipend is provided directly to the trainee. Up to $1000 will be reimbursed after the rotation to offset international airfare expenses and up to $500 will be reimbursed to offset U.S.-based airfare/transit expenses.

______The trainee and/or program will be responsible for additional travel costs, lodging, meals, vaccinations, prophylactic medications, purchasing of SLU international health insurance (required—via website: fees associated with processing, licensing or credentialing at the away site, or additive malpractice coverage (optional).

______Upon return, the trainee will provide a grand rounds-type educational presentation of the experience, complete a brief post-rotation report for the GME office, and serve as a resource for other trainees interested in away rotation experiences.

______The trainee’s clinical performance must be evaluated by the away rotation supervisor at the end of the rotation.

______The trainee, faculty advisor, and program director are responsible for completing all paperwork and travel arrangements related to this rotation including a Program Letter of Agreement between Saint Louis University and the away site (U.S.-based rotations) at least 1 month prior to the departure date for the rotation.

______The trainee must obtain the proper passport, visa, licensure, immunizations, travel medications, credentialing, and approvals as needed at least 1 month prior to the departure date for the rotation.

______The trainee’s absence must not place undo clinical or service stress on other trainees or compromise patient care.

______The trainee must not be required to extend residency training as a result of participation in the away rotation and that the rotation must provide a certifiable educational experience as outlined by ACGME.

Required signatures: I have read and understood the requirements of the Program for Away Rotation.

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TraineeDate

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Program DirectorDate

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SLU Away Rotation Faculty Mentor (if different from PD)Date

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Departmental ChairmanDate

Section 4
Program for Away Rotation (PAR) / Date: January 2014, May 2015
4.12 Application: Program for Away Rotation / Page 3 of 3

Saint Louis University Office of Graduate Medical EducationProgram for Away Rotation (PAR) Application

Section IV:Supplemental materials to be submitted by Program Director.

Please complete and attachthe below items and submit with the application to the GME Office. Applications will be reviewed twice a year. The deadline for all application materials is May 1 and November 1and must be at least 60 days prior to the departure date of the rotation.

  • Rotation description (approximately 1 page)including: goals, competency-based objectives, clinical responsibilities, and the supervision and evaluation process. Thismust meet ACGME RRC requirements as a qualifying educational experience for the trainee’s discipline.
  • Letter of support from the trainee’s Program Director indicating that:
  • The trainee is in good standing with the school and program
  • The trainee is qualified to perform the clinical duties of the away rotation
  • The away experience will provide an educational benefit to the trainee and program
  • The PD has communicated with the off-site supervisor and that supervisor is aware of the requirements of the away rotation program
  • A copy of the evaluation form that will be used by the away rotation supervisor to evaluate the trainee’s performance
  • A copy of the trainee’s CV
  • A brief budget outlining expected travel costs of the trainee for this rotation

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Section V: Additional Information

  • Prior to any off-site training, the trainee and program director must also complete the required institutional “Application For Saint Louis University Residents Rotating to Other Institutions for Electives” forms.
  • Trainees holding visas or with immigration-related travel restrictions must get appropriate authorization prior to off-site rotations.Trainees participating in U.S.-based rotations rotations must obtain a temporary training license for the state in which the rotation will take place.
  • Trainees participating in U.S.-based rotations must ensure that all paperwork and affiliation agreements for the accepting hospital/GME Office/University are completed in advance of the rotation.