10/2017

Visiting Student Program International Senior Student Clinical Clerkship Application

Instructions 1. Complete Sections 1 and 2 and return ORIGINAL to: Visiting Student Program, UC San Diego School of Medicine, Room

120 Medical Education & Telemed Bldg, 9500 Gilman Drive #0606, La Jolla CA 92093-0606, USA. 2. Please type or print. 3. Affix school seal as indicated. 4. Questions? Contact us at visitingstudents@ucsd.edu.

SECTION 1 (To be completed by applicant)

NAME (last, first): ________________________________________________________________________

MAILING ADDRESS: ________________________________________________________________________

________________________________________________________________________

EMAIL ADDRESS: ________________________________________________________________________

MEDICAL SCHOOL: ________________________________________________________________________

YEAR IN MED SCHOOL: ______________________ DATE OF GRADUATION: __________________________ TOTAL NUMBER OF ELECTIVES YOU WISH TO TAKE (MAX. 3): _______ LIST ELECTIVE(S), INCLUDING ALTERNATE(S) (MAX. 6): LIST DATE(S), INCLUDING ALTERNATE(S):

____________________________________________ _____________________________________________

____________________________________________ _____________________________________________

____________________________________________ _____________________________________________

____________________________________________ _____________________________________________

____________________________________________ _____________________________________________

____________________________________________ _____________________________________________

SECTION 2 (To be completed by Dean of Students or designated official at applicant’s school) The above named medical student is a senior in his/her final year and in good standing at the above institution. Malpractice insurance and personal health insurance is in effect while the student is away from this school, and documentation of such is attached. The student is authorized to take this clinical instruction and will receive academic credit for the experience. Confirmation by school official:

NAME: _____________________________________________________

TITLE: _____________________________________________________

SIGNATURE: _____________________________________________________

DATE: _____________________________________________________

SCHOOL ADDRESS: _____________________________________________________ _____________________________________________________

_____________________________________________________

AFFIX SCHOOL

SEAL

2017- 2018 Electives Available to International Students

Visiting Student Program

Elective descriptions may be viewed at: https://meded-oasis.ucsd.edu/public/courses/index.html?yid=2017&slid=6

Course ID Course Name

ANES 402 PAIN MEDICINE EVALUATION & INTERVENTIONAL CLERKSHIP

EMED 420 SUBINTERNSHIP IN EMERGENCY MEDICINE

EMED 423 EMERGENCY MEDICINE / MEDICAL TOXICOLOGY

FPM 441 FAMILY MEDICINE SUBINTERNSHIP

MED 426 CLINICAL CARDIOLOGY CLERKSHIP

MED 434 INTERNAL MEDICINE PRIMARY CARE CLERSKHIP

MED 438 CLINICAL PULMONARY PHYSIOLOGY LABORATORY

MED 467 MEDICINE SUBINTERNSHIP

NEU 427 NEUROLOGY OUTPATIENT

OPHTH 426 OPHTHALMIC PLASTICS AND RECONSTRUCTIVE SURGERY

ORTHO 428 SUBINTERNSHIP IN RECONSTRUCTIVE ORTHOPEDICS

ORTHO 429 SUBINTERNSHIP IN ORTHOPEDIC SPINE SURGERY

ORTHO 450 SUBINTERNSHIP IN OUTPATIENT PHYSICAL MEDI & REHAB

PATH 401A PATHOLOGY CLERKSHIP/AUTOPSY

PATH 401B PATHOLOGY CLERKSHIP/CYTOLOGY

PATH 401C PATHOLOGY CLERKSHIP/LABORATORY MEDICINE

PATH 401S PATHOLOGY CLERKSHIP/SURGICAL

PEDS 428 SUBINTERNSHIP IN NEONATAL/PERINATAL MEDICINE

RAD 401 GENERAL RADIOLOGY

RAD 427 VASCULAR & INTERVENTIONAL RADIOLOGY

RAD 428 BODY COMPUTED TOMOGRAPHY

RAD 434 CHEST RADIOLOGY

RMAS 429 RADIATION THERAPY CLERKSHIP

SURG 425 SUBINTERNSHIP IN TRAUMA UNIT

SURG 427 SURGICAL/ANES CRITICAL CARE

SURG 428 SURGICAL ONCOLOGY

SURG 429 SUBINTERNSHIP/MINIMALLY INVASIVE AND COLORECTAL SURGERY

SURG 431 SURGICAL TRANSPLANTATION (ABDOMINAL)

SURG 437 SUBINTERNSHIP IN CARDIOTHORACIC SURGERY

SURG 443 SUBINTERNSHIP IN UROLOGY

SURG 445 SUBINTERNSHIP IN PLASTIC SURGERY

SURG 454 SUBINTERNSHIP IN NEUROSURGERY

SURG 466 SUBINTERNSHIP IN BURN SURGERY