Selective Lottery

SUB-INTERNSHIP

SELECTIVE LOTTERY

Due in Office of Student Affairs, 3040 Murphy by 12:00pm on January 8, 2016

Name:______(Please Print)

Residency Specialty Interest (if more than one, please list) ______

______

Below are the 7 departmental choices for the required 4-week Sub-internship. You will have the option of doing your Sub-internship at an off-site location. Please rank number your top six choices in the boxes provided. You are not required to rank all the choices. The lottery will be done randomly. If you are completing your Sub-internship at Philmont in June, July or August, please mark PED 914 box and circle the month you are going to the left side of the box. If you plan on doing your Sub-I off-site (Away at Non-KUMC Site), please check the appropriate course number box below. Students who plan to do a non-KUMC Sub-I must complete the Subinternship Away form, obtain all required signatures, and submit the form to Laura Zeiger (3040 Murphy) at least 6 weeks prior to the start date of the scheduled Sub-I. Sub-I Lottery form due no later than Friday, January 8 at 12:00pm.

• Family Medicine

___FAPR 901 – Family Medicine Sub-internship (3 students maxper month)

___FAPR 901 - Family Medicine Sub-internship Away at Non-KUMC Site (no maximum)

___FAPR 901 – Family Medicine Sub-internship (Smoky Hill-Salina) (1 student maxin mos. noted)

(Aug., Sept. and Jan. only)

• Obstetrics and Gynecology

GYNO 901 – OB/GYN Sub-internship (rank all three below) (1 student service/month)

___REI___MFM ___ GynOnc ___UroGyn

___GYNO 901 - OB/GYN Sub-internship Away at Non-KUMC Site (no maximum)

• Medicine

___MED 908 – Medicine Sub-internship (KUMC) (5 students max per month)

___MED 908 – Medicine Sub-internship (KC – VAMC) (1 student max per month)

___MED908 - Medicine Sub-internship Away at Non-KUMC/VAMC Site (no maximum)

• Otolaryngology

___OTOR 901- Otolaryngology Sub-internship (2 students max per month)

___OTOR 901 - Otolaryngology Sub-internship Away at Non-KUMC Site (no maximum)

• Pediatrics

___PED 910 – Pediatrics Inpatient Sub-internship - KUMC (1 student max per month)

___PED 910 - Pediatrics Inpatient Sub-internship Away at Non-KUMC Site (no maximum)

___PED 914 – Philmont Adolescent Medicine Sub-internship (Circle Session – 1, 2 or 3)

___PED 918 – Pediatrics Outpatient Sub-internship – KUMC (1 student max per month)

___PED 918 – Pediatrics Outpatient Sub-internship – Away at Non-KUMC Site (no maximum)

• Psychiatry

___PYCH 901 - Psychiatry Sub-internship Away at Non-KUMC Site only (no maximum)

• Surgery

___SURG 901 – Plastic Surgery Sub-internship(1 student max per month)

___SURG 901 - Plastic Surgery Sub-internship Away at Non-KUMC Site (no maximum)

___SURG 902 – General Surgery Sub-internship (5 students max per month)

___SURG 902 - General Surgery Sub-internship Away at Non-KUMC Site (no maximum)

___SURG 909 – Neurosurgery Sub-internship (1 student max per month)

___SURG 909 - Neurosurgery Sub-internship Away at Non-KUMC Site (no maximum)

___SURG 910 – Urology Sub-internship (1 student max per month)

___SURG 910 - Urology Sub-internship Away at Non-KUMC Site (no maximum)

___SURG 915 – Orthopedics Sub-internship(2 students max per month)

___SURG 915 - Orthopedics Sub-internship Away at Non-KUMC Site (no maximum)