4th Annual Symposium of Teaching and Learning

April 9, 2013

TOPIC PROPOSAL FORM

Submission deadline - February 1, 2013, 5:00 pm
Presenters notified by - March 4, 2013

Title: [REQUIRED]  
Category:
Lecture-Discussion
Symposia/Panel Discussion
Workshop
Small Discussion Group
Poster
  • If selected, would you be interested in presenting this poster as part of a facilitated poster discussion session? 
     Yes       No
Principal Presenter: Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
CoAuthor(s)
CoPresenter(s) 2		 Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
CoAuthor(s)
CoPresenter(s) 3		 Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
CoAuthor(s)
CoPresenter(s) 4		 Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
CoAuthor(s)
CoPresenter(s) 5		 Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
CoAuthor(s)
CoPresenter(s) 6		 Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
CoAuthor(s)
CoPresenter(s) 7		 Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
CoAuthor(s)
CoPresenter(s) 8		 Last Name:      First Name:  MI:  
Institution: 
Degree:       E-Mail:
Section(s):

(to select more that one section, press the <control> button while clicking on sections)
AV Requirements:

NO AV NEEDS

POWERPOINT/COMPUTER PRESENTATION
 Laptop displayed on screen
 Bringing own laptop
 Need Internet Connection

OTHER
 VCR/TV
Overhead Projector (for transparencies)
 Slide Projector
Flip Chart (# needed: )
 Other: 

Room Requirements: Describe size and setup:

Abstract (250 words maximum, excluding title and authors; required for all submissions):

Please complete fields using requirements for specific presentation types.

Presentation Type

Abstract

Rationale

Objectives

Topic Outline

Methods/ Session Format:

Experience

Lecture-Discussion

X

X

X

X

X

X

Small Discussion Group

X

X

X

  

X

X

Symposia / Panel Discussion

X

X

X

  

X

X

Workshop

X

X

X

X

X

X

Poster

X

  

 

 

Rationale:  (Why the topic is important and its relevance to medical education)

Objectives: (What participants will know or be able to do as a result of this session)

Topic Outline: (Main points of discussion)

Methods/Session Format: (Indicate amount of time to be allocated to the lecture and to the interchange between lecturer and audience;  describe materials to be distributed.)

Presenter Experience: (In one sentence describe the experience of the lecturer)
Create a User ID and Password (or enter previously created User ID and Password) in order to view submittals online:*
User ID:  Password: 
*User IDs are not carried over from last year.
If you forget your User ID and/or Password, contact Jean Afflerbach.