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					 WEILL CORNELL MEDICAL COLLEGE, CORNELL UNIVERSITY
                 CURRICULUM VITAE

 Your Weill Cornell Medical College Curriculum Vitae (CV) Form is an important primary document
 for you to present your credentials to the Medical College offices and appointment and promotions
 committees. Please read carefully the instructions provided (highlighted in shaded boxes) for each
 section, noting the following in particular:
        All sections of the CV must be completed; do not remove any sections of the CV
        If a section does not apply to you or if you have no information to enter, you should enter
         either “Not Applicable” or “N/A”
        For dates, use either MM/DD/YYYY or November 1, 1965
        Keep the existing numbering and lettering of the various sections or titles (e.g. Name, City,
         etc.); maintaining your CV in the appropriate format will facilitate review by those who
         use the document to access the information they need
        Your data should be inserted in the tables provided, inserting additional rows as required
 Enter all the information directly on this form. WCMC-Q Staff will hide all the instruction
 boxes when your CV is ready for signature.


Date of preparation:

A.       GENERAL INFORMATION
        Provide your full name, including given name(s) and family names as they appear on your
         passport, and suffixes (e.g., John E. Doe, Ph.D., M.D., F.R.C.S.)
        Ensure that office and home address include postal/zip code, if applicable, and country
        Ensure that your telephone, fax, and mobile numbers include the country code, preceded by
         + (e.g., +974-xxxx-xxxx)
        If you hold dual citizenship, please indicate only the citizenship of the passport that you
         used, or will use, to obtain your residency visa in the State of Qatar
Required Information:
Name:
Office address:
Office telephone:
Office fax:
Home address:
Home telephone:
Cell phone:
Beeper:
Email:
Citizenship:
 If not a U.S. Citizen, do you have,
for the U.S.A., an
    Immigrant visa or
    Non-immigrant Visa
Optional Information:
Birth date:
Birth place:
Marital status:
Spouse’s name:


                                                                                              1
Children’s name and ages:
Race/Ethnicity:

B.       EDUCATIONAL BACKGROUND
 Only academic institutions – Colleges, Universities – confer academic degrees; do not list here
 licenses, certifications, or other non-academic designations (they come later in the CV)
      Degree: Enter the name(s) of each academic degree, (Bachelor degrees and above only).
          Abbreviating degree names, such as B.A., M.D., Ph.D., M.B.B.S., is acceptable, but, if your
          degree is unusual or its abbreviation is ambiguous, please provide the full degree name. If
          you hold a B.M., M.B.B.S. or a medical degree other than the M.D., do not record M.D.;
          record the actual English equivalent name of your degree.
        Institution name and location: Please enter accurately and completely the full name and
         location – city, state, country – of each academic institution that conferred your degree(s).
         Avoid abbreviations. If your degree is a Medical degree, please state the name of the Medical
         School, not simply the University, for example, Harvard Medical School versus Harvard
         University.
      Dates attended: Showing month and year is preferred.
      Year awarded: Please show the year your degree was awarded
 Insert additional rows if needed

             Degree        Institution Name and Location            Dates attended       Year Awarded




C.       PROFESSIONAL POSITIONS AND EMPLOYMENT
1.       Post-doctoral training (include residency/fellowships)
 Include here, in chronological order, internships, residencies, fellowships and postdoctoral or other
 training received after your doctorate
      Title: include full titles
      Institution name and location: include the institution’s name, city, state, and country
      Dates held: indicate when the training began and when it ended, e.g., July 1, 2000 – June
         30, 2001
 Insert additional rows if needed

         Title                            Institution name and location              Dates held




2.       Academic positions (teaching and research)
 List academic – teaching and research positions – held at academic institutions: Colleges,
 Universities and the like. Appropriate for this section are faculty appointments, e.g., Assistant
 Professor of Medicine, or non-faculty academic appointments, such as Research Scientist.
       Do not include hospital or administrative appointments here. These may be entered
         elsewhere on the CV form
       Title: include your full title. For example, include the name of the department(s) if part of
         the title (e.g., Assistant Professor of Biochemistry)



                                                                                              2
      Institution name and location: include the institution’s name, city, state, and country
      Dates held: indicate inclusive dates you held the position, e.g., July 1, 1999 – June 30, 2005
 Insert additional rows if needed



         Title                            Institution name and location             Dates held




3.      Hospital positions (e.g., attending physician)
 List hospital positions, such as attending positions - assistant attending, associate attending, or
 attending physician - or other comparable hospital positions if the name differs at your institution
 (e.g. consultant, specialist, professional associate, independent health care professional, etc.).
       Do not list administrative positions here, such as Director, Vice-President, etc.
       Title: include the full title(s)
       Institution name and location: include the full institution’s name, city, state, and country
       Dates held: include the inclusive dates you held the position, e.g., July 1, 2000 – June 30,
          2004
 Insert additional rows if needed

         Title                             Institution name and location            Dates held




4.      Other Employment
 List any other employment for which you were compensated, full-time or part-time, but which are
 not postdoctoral training; not academic appointments; nor hospital appointments. Here you may
 list administrative employment, other non-academic employment, or consulting positions.
       Title: include the full title(s)
       Institution name and location: include the full institution’s name, city, state, and country
       Dates held: include the inclusive dates you held the position, e.g., July 1, 2000 – June 30,
         2004
 Insert additional rows if needed

         Title                            Institution name and location             Dates held




D.      LICENSURE, BOARD CERTIFICATION, MALPRACTICE

 This Section is pertinent to physicians and other practicing health care professionals. If you are a
 researcher or early-career physician for whom the information does not apply, simply note N/A or
 Not Applicable, for each item, and leave the format of the section intact
1.      Licensure

         a. State                    Number              Date of issue          Date of last



                                                                                               3
                                                                                  registration




         b. If no license:
         1. Do you have a temporary certificate?
         2. Have you passed the examination for
            foreign medical school graduates?

         c. DEA number (Optional):

2.      Board Certification
 Show each certification and the conferring Board separately. This will help us record your Board
 certifications accurately, which in turn will ensure that they are listed correctly on College websites.
      List the full name of the Certifying Board
      Do not abbreviate or conjoin board names in a case where you have 2 certifications from
          sub-boards
      List the certificate number and the date the certification was issued or last reissued
      Use a full date: Month, Day, and Year. Failure to give a complete date might make it
          necessary for us to record an approximation
 Insert additional rows if needed

         Full Name of Board                        Board Certificate          Date of Certification




3.      Malpractice insurance
 Answer: YES or NO; or N/A if it is not relevant
      Give the provider’s name; avoid abbreviations
      Show who pays your malpractice premiums - choose one of these three options: Self,
         Group, institution
          If Group or Institution please state the name


        Do you have Malpractice Insurance?
        Name of Provider:
        Premiums paid by:

E.      PROFESSIONAL MEMBERSHIPS (medical and scientific societies)
 Distinguish the different types of involvement with societies and other professional groups, e.g., as a
 Member or Officer, which would point to leadership roles.
      For individuals in the early stages of their career there may be relatively few or no entries
         here.
      For mid-career and senior faculty members, this section is a key place to demonstrate the
         extent to which you participate in extramural activities as they relate either to service or
         leadership roles in your particular professional community. This is an important way to
         document meeting College criteria for appointment or promotion at the upper ranks.
 Insert additional rows if needed


                                                                                                 4
          Member/officer          Name of Organization                        Dates held




F.       HONORS AND AWARDS
This is another key section for demonstrating your reputation locally, regionally, nationally and
internationally, among peers, students, patients, colleagues, and others.
     Examples include teaching awards, patents, research awards, best‑ paper awards, book
         awards, membership in honor societies, etc. Entries in Who’s Who, Best Of listings, etc. could
         be listed here.
Insert additional rows if needed.

          Name of award                                                       Date awarded




G.       INSTITUTIONAL/HOSPITAL AFFILIATION
The Institutional/Hospital Affiliation information is important relative to your academic appointment
as it may have an impact on the type of appointment you are eligible for.
      For those in clinical practice who have attending or other professional designations at a
        hospital, show here your hospital affiliations
         For non‑clinical individuals, show here your institutional affiliation(s) other than Weill
          Cornell Medical College
         If you have no Hospital or other institutional affiliations, denote this with Not Applicable or
          N/A


         1. Primary Hospital Affiliation:
         2. Other Hospital Affiliations:
         3. Other Institutional Affiliations:


H.       EMPLOYMENT STATUS
Because of the WCMC system of appointment on tracks and the relationship of appointment on
those tracks to employment status, in particular for faculty members who come to the College
through affiliate institutions, it is important for us to ask about employment status.
     Provide the name of your current employer; if you are currently unemployed, state so
     It is permissible to list Weill Cornell as your employer in cases where employment by the
        College is anticipated, but do not list Weill Cornell in those cases without qualifying it as
        “upon approval” or “expected”
     Avoid using the name of your mentor or faculty member at the College with whom you may
        be working; please do not use abbreviations
     Choose an employment status using the alphabetical letters or simply type in the status
        based on the choices below (or use another description if none fit):
        a.       Full-time salaried by Cornell
        b.       Full-time salaried at Cornell-affiliated hospital
        c.       Part-time salaried at Cornell
        d.       Part-time salaried at Cornell-affiliated hospital
        e.       Voluntary (self-employed or member of a P.C.)



                                                                                                5
         f.      Other salaried
         g.      Other non-salaried

       Name of Current Employer(s):
       Employment Status:

I.     CURRENT AND PAST INSTITUTIONAL RESPONSIBILITIES AND
       PERCENT EFFORT

 This section is highly important for upper level appointments and promotions and it is
 here that you can demonstrate how you meet the criteria for appointment or
 promotion.
     Take the time to carefully work on your responses to this section.
     It is with this section that you will be able to communicate to your peers and review
        committees the breadth and depth of your academic activities at the Medical College and
        other academic institutions or hospitals
     The four categories – Teaching, Research, Clinical Care, Administration – are those areas of
        service upon which the criteria for all academic faculty and non-faculty appointments and
        promotions are based
     Use this section as a place to create a narrative between yourself and reviewers who will be
        seeking to understand how you meet the criteria for appointment or promotion

       1. Teaching (e.g., specific teaching functions, courses taught, dates)
 List here the types of teaching you have done, and are currently doing. This may include classes you
 teach or have taught in classroom settings, didactic lectures, or instruction in team teaching
 settings. Examples are shown in blue.
       Show your role in multidisciplinary courses or in course development
       Show your role as mentor or supervisor to medical students, graduate students, fellows and
          postdoctoral associates
       Be sure to include dates of participation in each teaching entry you create; use inclusive
          dates with a start and end date
       Make sure to include the institution, even if WCMC-Q, where duty is performed
       Use of a Teaching Portfolio is encouraged especially when teaching is a major component of
          your accomplishments and activities. Include the Portfolio as an attachment and indicate
          under this heading that a Teaching Portfolio is attached.
 Insert additional rows if needed.

         Course, role, institution, etc.                                           Dates
         e.g.: Course Director, “Advanced Biomedical Sciences (ABS)                September
         Course for 4th Year Medical Students”, Weill Cornell Medical              2006-present
         College in Qatar.
         e.g.: Lecturer, “Medicine Patient and Society II”. Weill Cornell          2004-present
         Medical College in Qatar
         e.g.: Supervisor of trainees for the 1st and 2nd Grade                    January 2008–
         Specialization Examination in Radiology. Department of                    December 2009
         Cardiovascular and Interventional Radiology, Institute of
         Radiology, Hospital Clinico, Madrid, Spain.




                                                                                             6
        2. Clinical care (duties, dates)


Break out your clinical care responsibilities, if applicable, by specific duties, inclusive dates, and
institution. Examples are shown in blue.
     Avoid excessive brevity: for example, rather than stating: “Clinic, 2 days per week”, expand
         upon the nature of the clinic and your role(s) in the clinic
       Provide information about your area of expertise in the clinical setting and where you provide
        clinical care, how often, for how many patients, etc.
       It is understood that in many clinical settings, teaching occurs. Be sure to delineate teaching
        activities that happen in the clinical setting. If you fail to provide the information that you are
        teaching during clinical care, it may appear that you are lacking in teaching. In particular, for
        the Clinical and Voluntary tracks, clinical care and teaching are primary activities.
Insert additional rows if needed

         Duties                                                                        Date
         e.g.: Consultant. Conquest Hospital, Department of                            January 2008 –
         Radiology, Hospital of St. John, Rome, Italy - Performing whole               December 2010
         spectrum of diagnostic radiological procedures in 12 sessions
         per week, including:
              General Radiology
              Full spectrum of head and body CT Imaging
              Ultrasonography including Colour Doppler studies
                 (adult and pediatric patients)
              Vascular Radiology
              On call rota (1: 6) with the use of Teleradiology and
                 PACS




        3. Administrative duties, including committees, dates
The duties listed in this section should be institutional, and not administrative duties related to
professional societies, or other extramural activities, which are best listed under Section K -
Extramural Professional Responsibilities. Examples are shown in blue.
     Include committees, dates, and the locations (i.e. institution) for your administrative duties
Insert additional rows if needed

         Duties                                                                        Dates
         e.g.: Associate Dean for Medical Education, Weill Cornell                     July 2006-June
         Medical College in Qatar: Oversight and management of Medical                 2010
         Education program, including on-going curriculum oversight;
         participation in faculty and staff recruitment, hiring, and
         professional development; budget preparation; and
         participation in Executive and Curriculum Committees.



                                                                                                 7
         e.g.: Chair, Promotion and Graduation Committees, WCMC-Q                    March 2010 -
                                                                                     present
         e.g. Head of Division, Department of Pediatrics, HMC                        May 2005 -
        Responsible for the provision of medical care to patients and the quality    present
        of patient care in the section, including reviews of the quality and
        appropriateness of treatment; in coordination with the department
        Chairperson, oversee and participates in approval of training programs
        for students /interns/residents and maintain adequate continued
        education activities for department members; in consultation with the
        concerned departmental committees, evaluate and recommend the
        hiring, promotion, and dismissals of medical staff in the department.

         e.g. Program Director, Department of Pediatrics, HMC                        Sept 2009 -
         Oversee and ensure the quality of didactic and clinical                     present
         education; approve the selection of program faculty and evaluate
         existing program faculty; oversee and organize the educational
         activities of interns and residents in all institutions that
         participate in the program; monitor resident supervision at all
         participating sites; evaluate residents; prepare all information
         required by the ACGME




        4. Research
Provide a brief description of your research interests, activities, and career trajectory with dates.
Examples are shown in blue.
     IRB protocols (both active and inactive) may be included under this subsection
     Note that the information provided here is a general commentary on your research work; the
        following section, J - Research Support, is the area to list awarded and pending grants and
        contracts
Insert additional rows if needed

         Description                                                                  Dates (if
                                                                                      Applicable)
         e.g.: My research interests are multidisciplinary with emphasis on           2000- present
         studying the epidemiology and ecology of infectious diseases using
         analytical and computational approaches in addition to conventional
         epidemiologic study designs. I was the lead author or co-investigator of
         several high impact studies in recent years such as in relation to
         HIV/AIDS, tuberculosis, and SARS. My current main research interests
         include studying the spread of sexually transmitted infections such as
         HIV/AIDS, HSV-2, and HPV; investigating the role of biological
         cofactors in HIV epidemiology; assessment of the impact of different
         HIV interventions such as vaccines and male circumcision; studying the
         epidemiology of HIV/AIDS in the Arab and Muslim Worlds; studying
         tuberculosis epidemiology and assessing the impact of novel TB
         diagnostics, drug regimens, and vaccines; simulation of community
         randomized controlled trials; and studying the ecology of multiple-strain
         infectious diseases.




                                                                                             8
Complete the following and answer the accompanying question.
    Calculate your time/effort in each area based on a 35/hr week and convert to a percent
    If you are new to WCMC-Q, you may use your anticipated effort

                               Current Percent Effort (%)     Does the activity involve WCMC
                                                              students/researchers? (Yes/No)
        Teaching
        Clinical Care
        Administration
        Research
               TOTAL: 100%

J.      RESEARCH SUPPORT

Include all funded extramural and intramural research. Examples are shown in blue.
     For current research support, list the source, dollar amount, duration of the support (dates),
        name of the Principal Investigator, individual’s role in project, and percentage effort (note
        that the percentage effort of all your current research cannot be greater than the total current
        research percentage effort that you indicated above)
     Summarize past research support
     Clearly mark past, current, and pending research support by using headings
 Copy and paste the table below as many times as needed for current research support

        e.g. Current Research Support:
         Source                                    Amount                      Duration of support
                                                                               (dates)
         Qatar Foundation                          1,000,000 USD               2011 - 2013
         Name of Principal Investigator:           Dr. Joe Doe
         Individual's role in project,     Co-Principal Investigator – 20% effort
         including percent (%) effort:
         Title or Subject (Optional): Modulation of the respiratory rhythm generation by
         gap junction blockers. The respiratory rhythm is generated in the pre-Bötzinger
         Complex of the medulla. While inhibitory synaptic transmission prevail compared
         to excitarory connections, the question rises to which degree gap junctions could
         contribute to generate and maintain the respiratory rhythm.

        e.g. Past Research Support:
         1993 – 2003: Bayer, Novartis, and Daiichi Sankyo. Amount: $5,000,000. These
         awards were to support a clinical trials program in cardiovascular disease, including
         hypertension. Established and directed the clinical trials unit at the University
         Hospital Heidelberg, Germany. During this period 5% of my time was dedicated to
         clinical trial work.

        Current Research Support:

         1.       Source                           Amount                      Duration of support
                                                                               (dates)

         Name of Principal Investigator:




                                                                                               9
         Individual's role in project,
         including percent (%) effort:
         Title or Subject (Optional):



         2.      Source                            Amount                     Duration of support
                                                                              (dates)

         Name of Principal Investigator:
         Individual's role in project,
         including percent (%) effort:
         Title or Subject (Optional):



         3.      Source                            Amount                     Duration of support
                                                                              (dates)

         Name of Principal Investigator:
         Individual's role in project,
         including percent (%) effort:
         Title or Subject (Optional):


        Past research support




K.      EXTRAMURAL PROFESSIONAL RESPONSIBILITIES

This is a broadly defined category, but can be very useful in demonstrating academic and service
engagement outside the site of primary activity.
     When it is populated with a variety of academic activities such as participation as a journal
         reviewer, grant review boards, study sections, invited lectures, consultancy, volunteer work,
         community service, etc., it can help establish one’s reputation, a critical criterion for
         promotion or appointment to upper level ranks.
Insert additional rows if needed

         Responsibility                                                            Dates




L.      BIBLIOGRAPHY


The College Committee of Review is rigorous in reviewing the bibliography section of the CV form.
For senior level appointments or promotions (associate professor and professor), this section of the
CV form is critically important. Pay extra attention to completing this section carefully. Errors or



                                                                                             10
incomplete information may cause delays, confusion, or misunderstanding
     List entries in chronological order, number the entries, and use bold type for your name so
       that the placement of your name in the authorship is clear to reviewers
     Review your entries carefully for completeness according to the example format provided for
       articles and books below
     Do not omit page numbers, dates, journal name, etc.
     If there are no entries, note it by marking the section as “N/A”

1. Articles in professional peer-reviewed journals
List peer-reviewed, original research articles or reports in professional peer-reviewed journals
      Entries should follow the New England Journal of Medicine format, listing all authors,
        complete titles and inclusive pagination; e.g., Doe J, Ford A, Smith J. Measuring the
        activities of daily living. N England J Med 1994; 331:778-84.)
      You may organize these entries by refereed or non-refereed articles, reports, etc.
      List articles that have been published or are in press only; do not list submitted or under-
        review articles – you may create a separate section for these entries
      Do not list your abstracts here (you may list them under section 3 below)
      Letters and invited publications to non-peer reviewed journals should be listed under a
        separate heading. Be careful in listing these and other similar types of publications.
      Keep in mind the difference between bona fide peer-reviewed publications and invited
        articles, certain types of letters, and other publications that represent scholarship and that
        may appear in peer-reviewed journals but, in themselves, are non-peer-reviewed
        publications. These should be listed under a separate heading.

1. Start List here
2.
3.

2. Books, book chapters and reviews.
Create separate headings (books, book chapters, reviews) with numbered entries for presentation
clarity.
      Entries should follow standard book format. E.g., Doe J., Title. New York, NY: Cornell U
         Press; 1998)

1. Start List here
2.
3.




3. Abstracts (Optional, List 10-20 best or most recent only)
In some cases, such as in the early stages of one’s academic career, listing abstracts will show
that an individual is involved in scholarly work and as such would be appropriate to list here.
     In other cases where there is a body of scholarly work spanning several years or
         decades, the value of listing tens or even hundreds of abstracts is highly questionable.
         It would be prudent in this case to select the most notable abstracts and list them only

1. Start List here
2.
3.




                                                                                              11
4. Presentations (Optional. Other than invited lectures. List 10-20 best or
   most recent only)
It may be worthwhile to list in this section poster presentation or other non-lecture type
presentations.
     The same logic used for item #3 (abstracts) should be applied here
     If there is a long list of this type of presentation, be highly selective
     If, however, most or all of your scholarship or academic engagement with your peers
        has occurred through this type of venue, then it would be worthwhile to populate the
        list

1. Start List here
2.
3.


You may consider creating other descriptive subsections here in order to list other types of
scholarly work
     This could include electronic-only publication, CDs, etc.

1. Start List here
2.
3.

Date:            ______________________________

Signature:      ______________________________




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