Clerkship Preferences Survey
Please share your preferences for upcoming clerkship rotations. Your responses will help us better schedule and match you to your preferred specialties and locations.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Current Academic Year
*
Please Select
3rd Year
4th Year
Other (please specify)
Preferred Clerkship Specialties (Select all that apply)
*
Internal Medicine
Surgery
Pediatrics
Obstetrics & Gynecology
Psychiatry
Family Medicine
Emergency Medicine
Other
Rank your top 5 clerkship specialties in order of preference (1 = most preferred)
Preferred Clerkship Locations (Select all that apply)
*
Main Teaching Hospital
Community Hospital
Rural Site
Outpatient Clinic
Other
Preferred Rotation Periods (Select all that apply)
*
Spring
Summer
Fall
Winter
Please rate the importance of the following factors in your clerkship preference decisions.
*
Rows
Not Important
Somewhat Important
Very Important
Specialty Interest
1
2
3
Location Proximity to Home
4
5
6
Reputation of Site
7
8
9
Learning Opportunities
10
11
12
Work-life Balance
13
14
15
Mentorship Availability
16
17
18
Are you willing to travel for a clerkship placement?
*
Yes
No
Maybe
Do you have prior experience in any specialty?
*
Yes
No
If yes, please specify which specialty/specialties and describe your experience.
Additional Comments or Special Requests
Submit Preferences
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