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 [email protected].
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
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