Samir Malkani, MD, FCE Course Director

note: This is a credit/no credit course.

FCE Course Offering NAME
Student Name*
Student Telephone
Student Email*

Faculty Sponsor*

Faculty Sponsor approved? 

Faculty Telephone
Faculty Email
Faculty Sponsor Department
If sponsor's affiliation is not listed above, please add here.
Faculty Sponsor Division (Academic Pathology - Hospital Medicine)

Faculty Sponsor Division (Immunology/Inf. Disease/Rheumatol - Vascular/Interventional)

Course Objective(s) e.g., By the end of this session students should be able to name, explain, perform, demonstrate, describe... (list 3-5 objectives)
Brief Course Description (attach further information via email, using the link at the bottom of this form)
UMMS Core Competencies (check all that apply)
Location of Elective

AY 2012-2013 Proposed Course Date (must be approved by faculty sponsor) 

Course Duration
Evaluation Criteria & Type (select at least one from each list)
click here to email further course information

Instructions for the FCE Course Offering Proposal

  • All fields are required
  • Course Objective(s): 1-2 sentences
  • Course Description: 2-3 brief paragraphs
  • Select all appropriate UMMS LInC competencies
  • Select the maximum number of students you can accommodate for your elective under the corresponding AY2012-2013 date(s)

June 11-14, total 4 days
June 19-25, total 5 days
July 24-30, total 5 days
Sept 21-27, total 5 days
Oct 26- Nov 1, total 5 days
Nov 6-9, total 4 days
Feb 4-7, total 4 days
March 8-13, total 4 days
March 26- April I, total 5 days

  • Select maximum duration of course (multiple sessions?)
  • Select minimum duration of course
    • note: It is only possible to offer 2 week electives for the June and October end blocks, but these will be interrupted by an interstitial curriculum day on 6/20/12 and 11/5/12 respectively.
  • Describe any prerequisites
  • Describe evaluation type (attendance, effort, participation)
  • Descrive evaluation criteria (clinical skills, case presentations, journal, etc.)

  • Please email me or call (508-856-3800) if you have any questions about your course or this process.

    Samir Malkani, MD
    FCE Course Leader