Graduate Lab Report Template by jxy60427

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									** DRAFT: Version 6 - Joseph Faculty, MD, PhD - DRAFT **
Sample Annual 3D Faculty Activity Report for Fiscal Year 2008-2009
Department of XX
  (Automatically Generated: Available year-round in "year-to-date" form. Final Actual Report Available by September 30 each year)
                                                                                            Calculated    Expected
Education                                                                       Hours         FTE           FTE      Variance
Total Annual Expected Education FTE (provided by Dept Chair)
 1
   Didactic Teaching & Course Admin (med school, graduate)                                                    0.15
 1
   Other Teaching (Undergraduate, non-IUSM, etc.)                                                              -
 1
   Mentoring, Program Admin, Service, Other Ed Activities                                                     0.10
Total Annual Expected Education FTE                                                                           0.25

Measurable Education Effort:
  Didactic Teaching & Course Admin (med school, graduate)
    2
      Didactic Teaching - (hours do not incl. prep time)                       12 hours            0.06
    2
      Course Administration - (expected hours)                                200 hours            0.08
  Total Didactic Teaching & Course Admin FTE                                                       0.14       0.15        (0.01)


     Medical School Teaching Activity
      1
        Clinical Teaching - Number of Med Students Taught                     24 students
      1
        Clinical Teaching - Total Estimated Contact Hours                     196 hours
      2
        Clerkship Director                                                            N
      2
        Elective Director (active in FY)                                              N
      2
        Competency Director                                                           Y

     Graduate School Teaching Activity
       2
         Number of PhD/MS candidates assigned to lab                          2 students
       2
         Number of Dissertation/Thesis Committee Memberships                  3 committees
       2
         Graduate Program Director                                                    N

     Graduate Medical Education
       1
         Clinical Teaching - Number of Residents Taught                       3 residents
       1
         Clinical Teaching - Total Estimated Contact Hours w/ Residents       2000 hours
       1
         Clinical Teaching - Number of Fellows Taught                         1 fellow
       1
         Clinical Teaching - Total Estimated Contact Hours w/ Fellows         100 hours
       2
         Residency/Fellowship Director                                                 N

     Participation in Other Education Activities
       2
         Dept Allocation for service (competency dir, committee chair)        $20,000 dept alloc
       3
         Undergraduate Teaching (not incl. prep time)                         10 hours
       3
         Didactic Clinical Teaching (clerkships, electives)                          -
       3
         Resident/fellow Core Lectures (not incl. prep time)                  5 hours
       3
         Graduate/undergraduate teaching for other schools                           -
       3
         Course Director for other programs                                            N
       3
         Formal advising/mentoring - number of learners                       4 learners
       3
         Significant Curriculum Development in FY                                      N
       3
         Other internal educational programs/projects                                  N
       3
         CME Teaching                                                                  Y
       3
         Mentor in formal faculty mentoring program                                    N
       3
         Development of faculty development program                                    N
       3
         Performed Peer Assessment of core educational activity                        N
       3
         Attendance at IUSM faculty development program                                Y
       3
         Attendance at other faculty development program                               N
       3
         Number of Educational Technology Products or Postings                       -
       3
         Number of Educational Presentations - National level                        -
       3
         Number of Educational Presentations - Local & IUSM/IU                3 presentations

 3
     Membership in IUSM/IU Education Committees
       Admissions

 3
     Teaching Awards: (list)




          1. Provided by Department Head or delegate
          2. Provided by central office
          3. Reported on ASR                                                                                     Printed 11/14/2010: Page 1
** DRAFT: Version 6 - Joseph Faculty, MD, PhD - DRAFT **
Sample Annual 3D Faculty Activity Report for Fiscal Year 2008-2009

                                                                                                Department      School      Department    School
Education (continued)                                                             Individual     Average       Average        Rank        Rank
 2
     Teaching Evaluation Data
        Instructor
                                                      ICM II- Clinical Teaching         3.8              4.1         4.1     36 / 44      52 / 63
                                               Medicine Clerkship- Outpatient           5.0              4.5         4.5     1 / 177      1 / 353
                                                 Medicine Clerkship- Inpatient          4.5              4.5         4.4    104 / 207    309 / 710
                                   Medicine Sub-Internship Clerkship- Inpatient         4.1              4.5         4.4    161 / 207    516 / 710
         Course
                                                          ICM II- Basic Science         3.8              3.8         3.9     10 / 18     77 / 125
         Competency
                                                          ICM II- Basic Science         3.6              3.8         3.7     13 / 18     84 / 125




                                                                                                Calculated     Expected
Clinical                                                                           wRVUs          FTE          Amount        Variance
Total Annual Expected Clinical FTE (provided by Dept Chair)
 1
   Faculty Effort in Clinical Venues, including Clinical Teaching                                                   0.35
 1
   Contractual Sevice, including hospital service                                                                   0.10
 1
   Direct VA Appointment (8ths minus merit awards)                                                                   -
 1
   Clinical Administration                                                                                           -
Total Annual Expected Clinical FTE                                                                                  0.45

Measurable Clinical Effort:
  Imputed Billable FTE
    2
      Number of Work RVUs [a]                                                     4,265 wRVUs
    2
      Benchmark Work RVUs per FTE [b]                                             9,030 wRVUs
  Imputed Billable FTE: [a] / [b]                                                                       0.47        0.35          0.12


     Clinical Service
       2
         Clinical Service Chief                                                           N

 3
     Membership in IUSM/Clarian Committees:


                                                                                   Actual           Expected
Research                                                                           FTE                FTE      Variance
Total Annual Expected Research FTE (provided by Dept Chair)
 1
   Externally Funded Effort (FTE captured in IU payroll system)                                         0.15
 1
   Direct VA Appointment (merit awards @ 3/8 FTE)                                                        -
 1
   Internally Funded Research Effort (federal cost share, start-up protected                            0.10
       time, bridge funding, internal grants and projects, proposal prep)
 1
   Research Administration and Service, including cores                                                  -
Total Annual Expected Research FTE                                                                      0.25

Measurable Research Effort:
 2
   Externally Funded Effort (FTE captured in IU payroll system)                        0.20             0.15        0.05

 2
     Cost-Sharing Effort (FTE captured in IU payroll system)                           0.02


                                                                                                    Total $    Indirect $
                                                                                   Number           Dollars     Dollars
     Research as PI
       2
         Proposal Submissions in FY 2009 - External Peer Reviewed                           3   $    874,000   $ 275,000
       2
         Funded Awards in FY 2009 - External Peer Reviewed                                  1   $    270,000   $ 90,000
       2
         Proposal Submissions in FY 2009 - All proposals                                    4   $    964,000   $ 275,000
       2
         Funded Awards in FY 2009 - All awards                                              2   $    360,000   $ 90,000


          1. Provided by Department Head or delegate
          2. Provided by central office
          3. Reported on ASR                                                                                           Printed 11/14/2010: Page 2
** DRAFT: Version 6 - Joseph Faculty, MD, PhD - DRAFT **
Sample Annual 3D Faculty Activity Report for Fiscal Year 2008-2009

                                                                                      Total $     Indirect $
Research (continued)                                                   Number         Dollars      Dollars
     Research Participation ("award credit")
       2
         Proposal Submissions in FY 2009 - External Peer Reviewed             4   $     605,900   $ 201,967
       2
         Funded Awards in FY 2009 - External Peer Reviewed                    1   $     250,000   $ 83,333
       2
         Proposal Submissions in FY 2009 - All proposals                      5   $     720,900   $ 201,967
       2
         Funded Awards in FY 2009 - All awards                                3   $     307,100   $ 83,333

     Other Research Activities
       2
         Dept Allocation for service as chair of research committee   $4,800 dept alloc
       3
         Nbr of Peer Reviewed Publications in FY 2009                 8 publications
       3
         Nbr of Peer Reviewed Abstracts in FY 2009                    10 abstracts
       3
         Number of Patents licensed or awarded                                -
       3
         Number of Patent applications outstanding                            -
       3
         Ad hoc or Member of NIH Study Section                                  N
       3
         Peer Reviewed Manuscript Review: Nbr of Manuscripts          5 manuscripts
       3
         Invitations to Present at National Meetings                  1 invitation

 3
     Honors/Awards: (list)


 3
     Membership in IUSM/IU Committees:
       IRB
       Biomedical Research Committee, Chair

 3
     Editorial Boards: (list)


 3
     Journals as Editor, Asst/Assoc Editor: (list)


 3
     Other National Review Organizations: (list)



                                                                                      Expected
Service and Administration                                                              FTE
Total Annual Expected Service/Admin FTE (from Dept Chair)
 1
   Departmental Administration (e.g., chair, division chief)                                -
 1
   National and Community Service                                                          0.05
 1
   General Service to IU/IUSM (e.g., Promotion & Tenure Committee)                          -
Total Annual Expected Service/Admin FTE                                                    0.05



       2
           Dept Allocation for service (P&T committee chair)          $0 dept alloc
       3
           Number of National Presentations                           6 presentations
       3
           NIH Council Member                                                 N
       3
           NBME Test Writer                                                   N
       3
           LCME Accreditation Service                                         N


 3
     Membership in IUSM/IU Committees:


 3
     Offices Held in National Organizations: (list)


 3
     Memberships in National Organizations: (list)




            1. Provided by Department Head or delegate
            2. Provided by central office
            3. Reported on ASR                                                                            Printed 11/14/2010: Page 3

								
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