DI Fireside Self Assessment

Fireside Self Assessment:

Please forward your completed Image Interpretation, Professionalism and Burnout Questionnaire directly to the program administrator(s).

You may reach out to the PGME Wellness Office at any time if you need assistance (403.210.6525 or residentwellness@ucalgary.ca).

Name

Select Fireside

Fellowship Plans

Yes - Name of Fellowship

Employment Plans:

Yes - Where

Education

Case Rounds Presentation

Haven't Presented Yet

Presented Case Rounds: Topic and Preceptor

Grand Rounds Presentation

Haven't Presented Yet

Grand Rounds Presentation Topic and Preceptor

Research

Major Research Project

Provide Topic, Supervisor and Presentation event (presented at or planned)

QA Research Project

Provide Topic, Supervisor and Presentation event (presented at or planned)

Forms

Have you completed your Image Interpretation forms:

Yes

Still Pending

Have you completed your Professionalism form:

Yes

Still Pending

Have you completed your Burn Out Questionnaire:

Yes

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.