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:
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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 (e.g. 11/01/1965) or Month day, year (e.g. 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
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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:
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Children’s name and ages:
Race/Ethnicity:
B.
EDUCATIONAL BACKGROUND
1.
Degrees
Only academic institutions – Colleges, Universities – confer academic degrees; do not list here
licenses, certifications, or other non-academic designations (they come later in subsection 2)
 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
2.
Institution Name and Location
Dates attended
Year Awarded
Continuing Medical Education Courses / Certificates
List here continuing education courses taken (10-20 best or most recent only) or certificates
completed at other than academic institutions. Do not list here CME courses for which you
were a lecturer or facilitator (they come later under Section K)

Certificate or Course: Enter the name(s) of each certificate or course. If the
abbreviation is ambiguous, please provide the full name.
 Institution name and location: Please enter accurately and completely the full name
and location – city, state, country – of each institution that conferred your
certificate(s) or taught the course. Avoid abbreviations.
 Dates attended: Showing month and year is preferred.
 Year awarded: Please show the year your degree was awarded
Insert additional rows if needed
Certificate or
Course
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Institution Name and
Location
Dates attended
Year Awarded
2
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
2.
Institution name and location
Dates held
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.
 Adjunct appointments should be listed here. Visiting professorships should be listed under
Section K
 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)
 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
3.
Institution name and location
Dates held
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
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Institution name and location
Dates held
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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
D.
Institution name and location
Dates held
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
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
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Board Certificate
Date of Certification
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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
Member/officer
F.
Name of Organization
Dates held
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 student scholarships, research scholarships, fellowship awards, 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
G.
Date awarded
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
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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
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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.)
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
 You may attach personal statements and summaries
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 (list names of mentees)
 Show all activities, such as institutional lectures; didactic sessions for students, residents,
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fellows; informal sessions; lecture series, journal clubs
Provide details and dates for each component
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 an Educator’s 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 an Educator’s Portfolio is attached.
Insert additional rows if needed.
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Course, role, institution, etc.
Dates
e.g.: Course Director, “Advanced Biomedical Sciences (ABS)
Course for 4th Year Medical Students”, Weill Cornell Medical
College in Qatar.
e.g.: Lecturer, “Medicine Patient and Society II”. Weill Cornell
Medical College in Qatar
e.g.: Supervisor of trainees for the 1st and 2nd Grade
Specialization Examination in Radiology. Department of
Cardiovascular and Interventional Radiology, Institute of
Radiology, Hospital Clinico, Madrid, Spain.
September
2006-present
2004-present
January 2008–
December 2009
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
Radiology, Hospital of St. John, Rome, Italy - Performing whole
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
January 2008 –
December 2010
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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
Medical College in Qatar: Oversight and management of Medical
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.
e.g.: Chair, Promotion and Graduation Committees, WCMC-Q
July 2006-June
2010
e.g. Head of Division, Department of Pediatrics, HMC
Responsible for the provision of medical care to patients and the quality
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
Oversee and ensure the quality of didactic and clinical
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
March 2010 present
May 2005 present
Sept 2009 present
4. Research
Provide a brief description of your research interests, activities, and career trajectory with dates.
Indicate your:
 Research interests/ongoing projects
 Significant research accomplishments
 Research goals
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
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Examples are shown in blue.
Insert additional rows if needed
Description
Dates (if
Applicable)
e.g.: My research interests are multidisciplinary with emphasis on
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.
2000- present
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: actively funded research, active clinical
trials, industry-sponsored research, pending/submitting grants applications, past support.
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
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Amount
Duration of support
(dates)
9
Qatar Foundation
1,000,000 USD
Name of Principal Investigator:
Dr. Joe Doe
2011 - 2013
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)
Amount
Duration of support
(dates)
Amount
Duration of support
(dates)
Name of Principal Investigator:
Individual's role in project,
including percent (%) effort:
Title or Subject (Optional):
2. Source
Name of Principal Investigator:
Individual's role in project,
including percent (%) effort:
Title or Subject (Optional):
3. Source
Name of Principal Investigator:
Individual's role in project,
including percent (%) effort:
Title or Subject (Optional):
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Past Research Support:
K.
EXTRAMURAL PROFESSIONAL RESPONSIBILITIES
Critical section for promotion or appointment to upper level ranks.
 This is a broadly defined category, but can be very useful in demonstrating academic and service
engagement outside the site of primary activity and the scope of your reputation: local, regional,
national, and international.
 This section can be populated with a variety of academic activities, such as participation as a
journal reviewer, grant review boards/study sections, invited lectures (list 10-20 best or most
recent only), continuing medical education courses as facilitator/lecturer (list 10-20 best or most
recent only), visiting professorships, conference organizer, key note speaker, consultancy,
volunteer work, community service, etc.
Insert additional rows if needed
Responsibility
L.
Dates
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
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 underreview 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.
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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.
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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