Family Medicine Clerkship Preceptor Availability Form

We're recruiting for clerkship preceptors for the Class of 2025, during the 2024-2025 academic year. Incoming clerks will be completing the 4+4 Family Medicine Clerkship starting in February (4 weeks Urban + 4 weeks Rural). Please fill out the table below with the number of clerks you feel you can take per block, clerks will need to be in your clinic for 4 consecutive weeks, 5 days a week and can be shared with a fellow physician at your clinic to cover 5 clinic days per week (please let us know in the comments below if you plan to share with a colleague). 

Questions? Contact Us! More Information about Clerkship
Physician Information
Please provide us with your contact information and a few details about your clinic. 
Do you currently have a CSM faculty appointment?
Would you be interested in running small group academic sessions?
Small group academics will typically be on Thursday mornings, in person at the Health Sciences Centre. Remuneration is set by the UME at $125 per hour of teaching for payment eligible faculty. If you select yes, we will reach out to provide you more information and confirm your availability. 
Would you be interested in learning more about ways to incorporate a sustainable/planetary healthcare approach to office operations and clinical care?
Block Availability
Please list the number of clerks you are able to take under each block

Universal Elective block Sep 9 - 22, 2024

Students on fall break from Oct 21-27, 2024

Learners will be off for Winter Break between Dec 22, 2024 - Jan 5, 2025

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.