This form is to be completed by the resident and signed by the project preceptor and submitted to the Residency Director or designee before each six month evaluation. It is a requirement for a resident once they have selected a topic.
 
 

RESIDENT NAME:
RESIDENT PRECEPTOR:
NAME OF PROJECT:
DATE OF UPDATE:

 

TYPE OF PROJECT:

›Research

›Education

›EMS

›Other

TIME TABLE: Please attach a timetable (estimate) for completion of project.
 

PROGRESS: What specific progress have you made since the last updated? (Or if this is your first what is project status?)
 
 
 
 

RESIDENT: Are there any major problems?
 
 
 
 

PROJECT PRECEPTOR: Please indicate by your signature that the project is making appropriate progress to completion.
 
 
 
 

_____________________________________ __________________________________
 

Resident Signature

Faculty Preceptor Signature