Fourth Year Planning Reflection

Name:

Preferred specialty? Considering more than one? If so, which?

Alternative or back-up specialty or plan?

Have you been in contact with any ‘core’ residency advisors in your
specialty(s) of choice? If so, who?

Considering a year off? If so, describe:

Scholarly Project (brief title):

Mentor:
Plan to/ need elective month(s) to complete on schedule?

Plans for any other research months?

Do you need to move any clerkships within periods 1-6 (May-October)?

Required AI: Med_____ Med ICU________ Peds_____ Fam.Med_______ Surgery_______

Considering Away elective(s)?: If so describe:

Considering international electives?: If so, describe:

What are areas that you think are ‘gaps’ or areas to work on, either clinical skills or
specific content? (it may be helpful to refer to the Entrustable Professional Activities
sheet)

List those courses you feel are essential as part of getting ready for the residency
application process, including away electives:

List courses you feel are important/possibly helpful as part of your ultimate
preparation for entering residency:

*Please fill out this questionnaire and attach it to your Advising Portfolio. Also
bring a copy to your AD meeting*