GIMSPP Student Application Summer 2019

Thank you for your interest in GIMSPP 2019. We will review your application and do our best to accommodate a match based on availability. Please note, applications do not guarantee matches. If your application is approved for processing, we will contact you to let you know your application is approved and we are working to facilitate a match for you and additional steps will follow (set by the Physician Office and/or GIMSPP).
 

Please contact the chapter office at 512-370-1508 with questions.

This application officially opens on January 30, 2019.

Applications will be time-stamped and must be received starting on January 30 until available positions are filled (If application deadline is extended, this form will remain active).

For questions about GIMSPP, please refer to the Frequently Asked Questions here: txacp.org/GIMSPP/FAQ first!

The application deadline for summer 2019 GIMSPP is February 28 or until matches are completed. Any applications that are not initially matched will be added to a waitlist for summer preceptorships and you will be contacted by the chapter office by April/May if there is an opening this summer.

 

Part I : Personal Information

First name *
Last name *
Nickname
Gender
Ethnicity
Date of birth (MM/DD/YY) *

Your Address While at School

Address 1 *
Address 2
City *
State *
Zip *

Permanent Address

Address 1 *
Address 2
City *
State *
Zip *

Contact Information

Cell/Primary Phone *
Email *

School Information

You must be currently enrolled in a Texas medical school in order to apply for the program.

Texas Medical school *
Year of medical school: *
In what field do you intend to practice? *

Match Information

Students are able to "name their own preceptor" by giving us the contact information of a doctor you wish to work with, that you have a relationship with already, and have informed about this opportunity.  Preceptors must be Board Certified in internal medicine, have no license restrictions, and practice 40-50% internal medicine apart from any sub-specialties.

Do you already have your own preceptor? *

Clear Selection

If yes, please also fill out the dates of the agreed rotation, city and zip of your preceptor as "1st Choice" below.

Preferred Preceptor's Full Name
Practice Name
Preferred Preceptor's Phone Number
Preferred Preceptor's Email

Please list your top TWO date and location preferences between May and August. Pick 3-4 consecutive weeks with start dates on Mondays, and end dates on Fridays.

If you have difficulty scheduling consecutive weeks during the summer, would you be willing to participate in a semester-long preceptorship (weekly visits with your preceptor during the school year)? *

First Choice

Begin date (MM/DD) *
End date (MM/DD) *
City *
Zip *

Second Choice

Begin date (MM/DD) *
End date (MM/DD) *
City *
Zip *

Every effort will be made to meet at least ONE of your preferences above. However, if we are NOT able to accommodate ANY of the above preferences, are you willing to:

Be flexible on dates? *
Relocate for your preceptorship? *
If you can relocate, will you accept placement in a medically underserved, rural or urban area? *
Please list any preceptor requests, special interests or needs, transportation issues, or any other items that will help us find the best placement (900 character limit).

Part II: Personal Learning Styles & Objectives

This information will help your preceptor know your learning objectives and areas of interest.

Please select how important it is for you to:

Learn about the role of IM in relation to other medical fields
Learn about primary care in IM
Learn about the relationship between primary and subspecialty medicine
Learn about the organization and economics of practice management
Learn about preventative medicine
Learn about patient education
Develop history-taking and physical examination skills
Develop communication skills
Develop skills in developing a differential diagnosis
Obtain hospital experience
Obtain experience with emergency medicine
Describe briefly the type of learning experience desired from your preceptorship (900 character limit) *
How do you learn best? (900 character limit) *
What stifles or hinders your learning? (900 character limit) *
Describe the qualities of an effective teacher (900 character limit) *
In submitting this application, I understand that should a match be made, it is my responsibility to inform the GIMSPP office if a conflict arises at least one month prior to my preceptorship start date. Failure to do so will prevent me from applying for the GIMSPP in the future. This application and the contents therein will be used by the GIMSPP office for scheduling purposes only and may be updated in the chapter's match database pending my match status. *

Clear Selection


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Member Feedback Requested on ACP Resolutions

The 2019 Fall BOG Meeting is in September and members are encouraged to provide feedback via chapter survey by August 31.

Mark Your Calendar!

Texas Chapter Annual Scientific Meeting
October 25-27, 2019, JW Marriott San Antonio