LSU SCHOOL OF MEDICINE - SHREVEPORT
Teaching Portfolio
Example Packet
Pat Doe, MD
This packet is for demonstration purposes only. It contains
examples and explanations for creating your Teaching Portfolio.
Summary tables are also examples, and in this sample portfolio it
will not the match data listed.
Adjust the dates in each table to match your personal data.
When 2 identical tables are present on the same page, use the
second one to continue dates from the first one. The second table
may be deleted if it is unused.
Use the blank packet to develop your own portfolio, not the
sample packet.
I. Teaching Responsibilities and Skills
I. Teaching Responsibilities
A. List teaching activities to date grouped chronologically using the following format:
Repetitive Ongoing Teaching Responsibilities at LSUHSC
Dates
1990 –
present
1990 –
present
1990 –
present
1990 –
present
1990 –
present
1990 –
present
1990 –
present
1990 –
present
1990 –
present
1992 –
present
Activity Title
SAHP 3116 - Allied Health Medical Conditions Course
Osteomyelitis
Cellulitis
Infections I
Infections II
Clinical Teaching - Junior and Senior Clinical Precepting
Medical Students in LSUMC – S Outpatient Clinic
CCC 211 Course (Medical Students): Biopsychosocial Model
of Medicine
CCC 231 Course (Medical Students): Pelvic exam and vaginal
infections
Attending Residents and Students on the LSUMC Family
Practice Wards
Clinical Teaching and Precepting – Residents Clinical
Precepting in the LSUMC-S Medicine Clinic
Family Medicine Colposcopy Clinical Clinical Precepting
Teaching and Precepting of Residents
Ob/Gyn Resident Introduction Lectures:
The Papanicolaou Smear
The Myers-Briggs Personality Inventory
Contact
Hours
Method
1 hour/ year
1 hour/ year
1 hour/ year
1 hour/ year
200 hours/
year
1 hour / year
Slides
Slides
Slides
Slides
Guided Instruction
5 hours/
year
112 hours/
year
200 hours/
year
200 hours/
year
Slides, Small
Group Discussion
Teaching for ward
teams
Guided Instruction
1 hour / year
1 hour / year
Slides
Case-Based
Learning
Neurosurgery Grand Rounds
5 hours/year
Slides
Slides & Group
Discussion
Slides
Colposcopy Training Series (Residents)
20 hours/
year
Slides & Casebased
Non-LSUHSC and Nonrepetitive Teaching
Dates
11/1992
9/1993
5/1993
6/1993
Activity Title
Louisiana Internal Medicine Retreat - Guest Speaker.
"LEEP in Practice." Alexandria LA
Participant in the "Call 3 Community Help Line" program at
KTBS television
American Academy of Physicians - Basic and Advanced
Colposcopy Course: Including Cryotherapy and Loop
Electrosurgery. New Orleans LA.
The Papanicolaou Smear
LEEP - History and Basic Electrosurgical Principles
Post-menopause / Post-cryotherapy
Treatment of Non-cervical HPV
LEEP - Case Discussions
Testing - Written Test
American Academy of Physicians - Basic and Advanced
Colposcopy Course: Including Cryotherapy and Loop
Electrosurgery. Seattle WA
The Papanicolaou Smear
LEEP - History and Basic Electrosurgical Principles
Contact
Hours
Method
1 hour
Slides
1 hour
Lay media
1 hour
½ hour
3 hours
½ hour
½ hour
3 hours
Slides
Slides
Case Discussion
Slides
Case Discussion
Written Test
1 hour
½ hour
Slides
Slides
1994
12/1994
12/1994
1995
1/1995
9/1995
11/1995
12/1995
12/1995
12/1995
1996
4/15/96
4/10/96
8/1996
11/8/96
12/4/96
4/20/97
8/14/97
10/16/97
Post-menopause / Post-cryotherapy
Treatment of Non-cervical HPV
LEEP - Case Discussions
Testing - Written Test
Guest on "Talk of the Town" radio program concerning health
care issues
Red River Pharmacists Association Quarterly Meeting CME:
Advances in Oral Contraceptives, Shreveport, LA
Northwest Society of Surgeons CME: Hormone Replacement
Therapy, Shreveport, LA (Practicing physicians)
Guest on "Talk of the Town" radio program concerning health
care issues
Willis-Knighton Dept. of Family Physician CME: Hormone
Replacement Therapy, Shreveport, LA (Practicing physicians)
Procedural Faculty - American Academy of Physicians
Scientific Assembly. Anaheim CA
Basic Colposcopy - Abnormal Cervical Findings
Cervical Electrosurgery
Panel Discussion with Questions and Answers
Contraception Update: Norplant
Contraception Update: Hands-on Breakout
Cervical LEEP - Equipment, Preperation, and Safety
Cervical Loop Electrosurgery - Hands-on Breakout
Colposcopy Skills Testing Station
3 hours
½ hour
½ hour
3 hours
4 hours
Case Discussion
Slides
Case Discussion
Written Test
Lay Media
1 hour
Slides
1 hour
Slides
7 hours
Lay Media
1 hour
Slides
1 hour
1 hour
30 minutes
2 hours
2 hours
3 hours
3 hours
3 hours
Procedures Equipment Station - Colposcopy
Barksdale Air Force Base Medical CME - Hormone
Replacement Therapy
WK Rural Fellowship Program CME The Pap Smear and
Cervical Dysplasia
NorthWest Society of Physicians
Depo-Provera
Contraception
Gregg County Medical Society The New Progentins in
Contraception
Guest on "Talk of the Town" radio program concerning health
care issues
Medicine 222 - Souphmore Clinical Diagnosis Class - Sexually
Transmitted Diseases
American Academy of Physicians Colposcopy Update and
Review Course: St. Petersburg, FL Course Chairman
How to perform LEEP
Difficult Case Discussions
Post-menopause / Post-cryotherapy
How to Teach Colposcopy
Louisiana AHEC Resident and Student Job Fair. Medical
Student EGD and Colposcopy Workshops. New Orleans, LA
Colposcopy: A Step Beyond the Basics
What’s New in Cervical Cytological Screening
Distinguishing LG-CIN from HG-CIN
Colposcopy of the Pregnant, Postmenopausal and Post
treatment Patient
Nursing CME: Women Forever: Women’s Health Throughout
the Life Span. Tx & Follow-up of Abnormal Pap Smears
North La. Seminar for Pharmacists. Dysfunctional Uterine
Bleeding and Oral Contraceptive Pills
Schumpert Department of Family Medicine CME - Follow-Up
of The Abnormal Pap Smear
Univerity of Texas Ob/Gyn Journal Club Lecture. Tyler, Texas
3 hours
1 hour
Slides
Slides
Group Discussion
Slides
Lab /Models
Slides
Lab with Models
Hands-on Skill
Testing
Demonstration
Slides, Discussion
1 hour
Slides
1 hour
Slides, Discussion
1 hour
Slides, Discussion
5 hours
Lay Media
1 hour
Slides
45 minutes
40 minutes
3 hours
45 minutes
2 hours
Slides
Case Discussion
Case Discussion
Group Discussion
Slides & Lab with
models
1 hour
1 hour
3 hours
Slides
Slides
Workshop
1 hour
Slides and
Discussion
Slides and
Discussion
Slides
Discussion
Slides /
Discussion
1 hour
0.5 Hours
1 hour
B. List teaching materials development activities to date grouped chronologically by using the
following format:
Date
1990now
1993now
1994now
1994now
1994
1995
1995now
4/15/96
1996now
1996now
8/1996
11/8/96
12/4/96
2/97
4/20/97
1997-9
1998-9
1998
Title of Activity
Course Handouts for: SAHP 3116 - Allied Health Medical Conditions Course; Osteomyelitis, Cellulitis,
Infections I, Infections II; CCC 211 Course: Biosocial Models of Medicine; CCC 231 Course: Pelvic Exam and
Vaginal Infections; Obstetrics and Gynecology Student Lecture: The Papanicoloaou Smear; Family Practice
Resident Introduction Lectures: The Papanicolaou Smear; Computers in Medicine, The Myers-Briggs
Personality Inventory, Introduction to Procedures - Colposcopy, Endoscopy, and LEEP; Family Medicine
Grand Rounds; and Obstetrics and Gynecology Grand Rounds
Doe, J. Pelvic exam and vaginal infections. In: Outpatient Management Manual, Comprehensive Care Clinic.
LSUMC-S 1993: 179-87. Revised and reprinted in 1994 to present
Developed and instituted the "LSUMC-S Clinical and Academic Server" on the Internet. It is a growing pool of
information on procedures, patient education, educational aids for medical students, internet resources, and
LSUMC-S residency information. The World Wide Web address is "HTTP://LIBSH.LSUMC.EDU/fammed/default.html". Project started in 1994 and is ongoing.
American Academy of Physicians Scientific Assembly. Handouts and Workshops
Basic Colposcopy
and Cervical Cryotherapy, Abnormal Cervical Findings, Cervical Electrosurgery, Cervical Loop Electrosurgery
- Equipment, Preperation, and Safety, Cervical LEEP - Hands-on Breakout
Contraception Update: Norplant. 1994. Modified and reprinted in 1995
Doe, J. "Treatment of non-cervical HPV infection." in Colposcopy, Cryotherapy, Androscopy, and Loop
Electrosurgery: An Ilustrated Syllabus. Newkirk G (ed), American Academy of Physicians, Kansas City, MO.
Used as handouts for AAFP Scientific Assembly
Doe, J. American Academy of Physicians Scientific Assembly: Colposcopy Skills Testing Station - Procedures
Equipment Station and Written Test- development of standardised skills testing
Medicine 222 - Souphmore Clinical Diagnosis Class Handouts: Sexually Transmitted Diseases
American Academy of Surgery Colposcopy Update and Review Course: Course Chairman, Handouts&
workshops: How to perform LEEP, Post-menopause / Post-cryotherapy, How to Teach Colposcopy, Dificult
Case Discussions, Colposcopy of the Pregnant Patient, Cervical and Uterine Cancer, HPV Diagnosis and
Treatment, New Technology
American Academy of Internal Medicine - Primary Care in Women’s Health Course: Handouts & Workshops:
The Abnormal Papanicolaou Smear, Abnormal Uterine Bleeding, Hormone Replacement Therapy, Choosing
Birth Control , Menopause/Perimenopause, Cervical and Uterine Cancer, How to Perform LEEP, HPV
Diagnosis and Treatment, Eating Disorders, Birth Control Issues
Louisiana AHEC Resident and Student Job Fair. Medical Student EGD and Colposcopy Workshops
Colposcopy: A Step Beyond the Basics - Handout materials and workshop models: What’s New in Cervical
Cytological Screening, Distinguishing LG-CIN from HG-CIN, Colposcopy of the Pregnant, Postmenopausal
and Post treatment Patient
Nursing CME: Women Forever: Women’s Handouts: Health Throughout the Life Span
American Society for Colposcopy and Cervical Pathology Comprehensive Colposcopy Course. Handouts and
Workshops. Colposcopy - The Procedure, Rational Approach to HPV Treatment, Colposcopy in Pregnancy,
Colposcopy of the Male Patient, Electrosurgical Loop Excision of the Cervical Transformation Zone, Colpo,
Biopsy, ECC and instuments, Case Studies, HPV, LGSIL, HGSIL, CA, Slides, Assessing and Grading Cervical
lesions, LEEP Hands on
North La. Seminar for Prarmacists Handouts: Dysfunctional Uterine Bleeding and Oral
Contraceptive Pills
Medical College of Wisconsin Colposcopy Update Course. Handouts and Workshops. New colposcopic
Technologies, LEEP has replaced Cryotherapy for CIN Tx, The ECC is not part of the Colpo Exam,
Cerviography is a valable adjunct to the Pap smear, LEEP: Practical Pointers for the Practioner, HPV Update,
Debate: HPV testing is clinically useful, Colposcopy in Pregnancy, Colposcopy Review: Normal to Cancer,
Colposcopy Pearls
National Procedures Institute Office Gyn Courses: Handouts and Workshops. Optimizing the Pap Smear, New
Cervical Screening Techniques,Diagnosing Ectopic Pregnancy,Cervical LEEP and Cryotherapy, Optimizing
the Pap Smear, Cercical Polyps, Oral Contraceptive Pills, Vulvar and Vaginal Lesions, Vaginitis, Abnormal
Uterine Bleeding, Understanding Pap Smear Reports, Depo-Provera, Bartholins Cysts and Word Catheters,
EMB Workshop, Barrier Contraceptives, IUDs, Norplant
American Society for Colposcopy and Cervical Pathology Comprehensive Colposcopy Course: Handouts and
Workshops. Cervical Cancer & Bethesda System, Colposcopy on DES Daughters, Rational Approach to HPV
Treatment, Colposcopy of the Male Patient, Case Studies, VAIN, VIN, DES, Patient Education & Psychosocial
Issues, Case Studies, Normal Cervix, Assessing and Grading Cervical lesions, Hands on Practicum
SECTION I A
LSUMC Teaching Activity Summary Report by Academic Year
List conference contact hours (not including hospital rounds) for each category of teaching activity
(Hospital attending activities are credited in the service portion of the CV packet.)
Activity
Type
Lay Media
H.S./
College
Medical
Student
Teaching
Rounds
House Staff
/ Graduates
Faculty
State
Meeting
Regional
Meeting
National
Meeting
Prior
90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02*
Years
-
-
-
-
1
4
7
6
5
4
6
8
5
4
4
4
4
4
5
4
2
2
2
2
2
2
50
50
50
50
50
50
55
55
55
55
56
54
65
112
224
224
112
112
112
112
112
112
112
112
112
112
-
24
66
66
66
66
88
88
67
55
66
66
88
5
5
5
5
5
9
9
6
8
7
6
6
8
-
-
-
-
-
-
-
2
-
3.75
-
-
-
-
-
-
1
-
-
2
-
-
-
-
-
-
-
-
-
28.5
37
15.3
28.5
49
41
46.5
48.75
<<Use table below for additional dates>>
Activity
Type
Lay Media
H.S./
College
Medical
Student
Teaching
Rounds
House Staff
/ Graduates
Faculty
State
Meeting
Regional
Meeting
National
Meeting
* Year to date as of submission.
62.75 45.25
SECTION I A
LSUMC Teaching Method Summary Report by
Academic Year
List contact hours for each category.
Only include actual time in direct teaching - not assigned or preparation hours.
Activity
Type
Prior
90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02*
years
Lecture
16
16
26
16
36
23
43.5
38
39.5
~ video
-
-
-
-
-
-
-
-
-
-
1
-
1
~demonstration
-
-
-
-
-
-
-
-
-
4.5
4
4
4
~ Problem/
Case Based
-
-
10
10
10
10
10
20
20
26
26.75
20
27
~ Discussion
2
2
2
3
10
1.5
17.5
21
34
33
18.75 19.75
~ Lab
-
-
-
-
2
1
2
13
10
22.5
7.5
15
14
224
224
224
112
112
112
112
112
112
112
112
112
112
112
112
112
112
112
122
114
114
114
114
116
114
118
-
-
-
-
22
22
13
16
9
2
7
9
10
~ slides/OH
44.25 40.75 37.25
37.5
Small
Group
~ Hospital
Rounds
22.5
One-onOne
~ Clinical
Precepting
~ Guided
Instruction
OTHER:
OTHER:
OTHER:
* Year
to date as of submission.
SECTION I B
LSUMC Teaching Materials Development Summary Report
by Academic Year
Place an 'X' for each category.
Activity
Prior
91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02*
Type
years
Course
X
X
X
X
X
X
X
X
X
X
X
X
Handout
Co-author
X
X
X
X
X
X
Syllabus
Edit
Syllabus
Author
Syllabus
Educational
X
X
X
X
X
X
X
X
Software
Educational
X
Video
See attached example of educational software.
Activity
Type
Course
Handout
Co-author
Syllabus
Edit
Syllabus
Author
Syllabus
Educational
Software
Educational
Video
* Year
to date as of submission.
II. ASSESSMENT -HOW TO EVALUATE YOUR SUCCESS AS AN
INSTRUCTOR
I. Please submit an example of an evaluation form for any or all of the activities listed in
Section I. A., complete with a synopsis of all the learner evaluations received for that particular
activity.
CCC 331 Course: 1 = Strongly Disagree, 5 = Strongly Agree (See attached)
Pertinent topic for a junior medical student. mean = 4.83 sd = 0.68
Presented in a concise, practical, and stimulating manner. mean = 4.88 sd = 0.52
II. Please list written examinations you have had a substantial role in creating and
administering in chronological order. Please submit an example of an evaluation form for one
of the exams listed below, complete with a synopsis of all the learner evaluations received for
that particular exam.
Date
1990-5
1990-5
1993-5
1995-6
Type
# Contributors
SAHP 3116 - Medical Conditions Course; 12
CCC 211, 221, 223 Course
American Academy of Physicians Basic and Advanced
Colposcopy Course: Including Cryotherapy and Loop
Electrosurgery - Written Test
American Academy of Physicians Scientific Assembly.
Anaheim CA Colposcopy Skills Testing Station;
Learner
8
12
4
Allied Health
Medical Students
Practicing Physicians
3
Practicing Physicians
III. Please list any oral examinations you have had a substantial role in creating and
administering in chronological order. Please submit an example of an exam plus an evaluation
form for that exam, complete with a synopsis of all the learner evaluations received for that
particular exam.
Date
Type
Learner
None
IV. Please list any computer based testing you have created and administered in chronological
order. Please submit an evaluation form for that test, complete with a synopsis of all the learner
evaluations received for that particular test.
Date
Type
Learner
None
V. Please list any written/oral examination questions submitted for regional/national testing
in chronological order.
Date
Type
1993-7
American Academy of Physicians Basic and Advanced Colposcopy Course:
Including Cryotherapy and Loop Electrosurgery -Testing - Written Test
American Academy of Physicians Scientific Assembly. Anaheim CA Colposcopy
Skills Testing Station; Hands-on Skill Testing
9/1995
9/1996
Learner
Practicing Physicians
Practicing Physicians
VI. Please list any CME lectures/programs you have given in chronological order. Please
provide a sample evaluation form, completed as a synopsis of the evaluations received for one
of the referenced CMEs.
September 1995-2001; Procedural Faculty - American Academy of Physicians Scientific Assembly. Anaheim
CA - Colposcopy Skills Testing Station; 3 hours; hands-on skill testing. This is a new project by the AAFP to
allow physicians to perform standardized skill testing in selected procedures. I was involved in the
development of the written test (87 items) and the proctored hands-on case scenario. It was planned as a 1 year
project but was repeated because it was highly successful. The test has been reevaluated and updated yearly.
III. Advisor
A. In chronological order (academic year) within the following format, list any person(s) that
you formally advise.
Dates
1991
1992
1992
1992-94
1993
1993-96
1993
1994
1994-6
1994
1995-99
1995
1995
1995-6
1996
1996
Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Learner’s Name
Status
Resident
Med Student
Med Student
Resident
Med Student
Resident
Med Student
Med Student
Med Student
Med Student
Resident
Med Student
Med Student
Faculty
Med Student
Med Student
Your Role
Advisor
Advisor
Research Supervisor
Advisor
Advisor
Advisor
Research Supervisor
Advisor
Advisor
Research Supervisor
Advisor
Research Supervisor
Research Supervisor
Colposcopy Preceptor
Advisor
Advisor
Position of
Advisee
Private Practice
Private Practice
Deceased
Private Practice
Private Practice
Private Practice
Private Practice
Private Practice
Private Practice
Private Practice
Private Practice
Academic Practice
Private Practice
Academic Practice
Private Practice
Private Practice
B. List publications, posters, projects, or other materials prepared by students that you mentored
in a research setting. If appropriate, provide a representative publication(s).
*Doe, J, Student S. The reliability of repeat cervical smears compared to colposcopy in patients with abnormal
cervical cytology. J Medicine, 1995; 40:57-62.
**February 1994; Student B. EGD efficacy and safety in family practice: Experience at a university medical
center. [Poster] Louisiana State University Medical Center Student Research Program. Shreveport, LA.
 Student B, Doe, J EGD efficacy: Experience at a university medical center. J La State Med Soc 1994;
146:319-20.
Section III
LSUMC Advisor by Academic Year
Indicate the number of students of each type you formally advise.
Activity
Type
Prior
91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02*
years
Premedical
-
-
-
-
-
-
Medical
-
3
3
4
5
7
Resident
-
2
3
3
3
3
Medical
Fellow
-
-
-
-
-
Graduate
-
-
-
-
-
-
-
-
-
-
Postdoc.
Fellow
Junior
Faculty
-
-
-
-
-
3
3
2
3
2
2
3
4
5
5
3
3
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
3
1
0
1
1
Activity
Type
Premedical
Medical
Resident
Medical
Fellow
Graduate
Postdoc.
Fellow
Junior
Faculty
* Year
to date as of submission.
2
IV. EDUCATIONAL ADMINISTRATION
A. List in chronological order by academic year, any position you have held on educational
committees, your involvement with courses/programs, and the role you played.
DATE(S)
1990 - present
1992 – 1993
1992
1993 - present
5/1993
10/1993
1994-95
1994 - 1997
10/1994
1995-6
9/1995
4/10/96
4/11/96
9/1996
4/10/97
4/11/97
TITLE OF COMMITTEE/COURSE OR PROGRAM
Associate Residency Program Director
CME Committee, LSUMC-S Medical School
American Academy of Physicians Scientific Assembly Colposcopy
Course: San Diego CA.
Director of Research Program.
American Academy of Physicians - Basic and Advanced Colposcopy
Course: Including Cryotherapy and Loop Electrosurgery. Seattle WA.
American Academy of Physicians Scientific Assembly Colposcopy
Course: San Diego CA.
Assisted in development and implementation of student selected
learning in CCC221.
National Library of Medicine South Central Region Council of
Physicians
American Academy of Physicians Scientific Course Assembly
Colposcopy Course: New Orleans, LA
LSUMC-S Goal 1 Task Force
American Academy of Physicians Scientific Course Assembly
Colposcopy Course and Develop Cryotherapy/Electrosurgery Course :
Anaheim, CA
American Academy of Physicians Colposcopy Update and Review
Course: St. Petersburg, FL
American Academy of Physicians – Primary Care in Women’s Health
Course: St. Petersburg, FL
American Academy of Physicians Scientific Assembly Colposcopy
Course and Cryotherapy/Electrosurgery Course : New Orleans, LA
American Academy of Physicians Colposcopy Update and Review
Course: Hilton Head, SC
American Academy of Physicians – Primary Care in Women’s Health
Course: Hilton Head, SC
ROLE
Associate Director
Member
Course Development
Director
Course Development
Course Development
Member
Member
Course Development
Member
Chaiman &
Coordinator
Program Committee
Course Development
Chaiman &
Coordinator
Program Committee
Section IV
LSUMC Educational Administration Activity Report
(Please summarize the information provided in section IVA above)
Activity
Prior
91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02
Type
years
Committee
X
X
X
X
X
X
X
Member:
Department
Committee
X
X
X
X
X
X
Member:
LSUHSC-S
Coordinator
Co-Director
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Director
Activity
Type
Committee
Member:
Department
Committee
Member:
LSUHSC-S
Coordinator
Co-Director
Director
* Year
to date as of submission.
V. Demonstration of Scholarly Activity in
Teaching and Educational Techniques
A. In chronological order by academic year within the following format, list any publications
on teaching and educational techniques or other topics related to education that you have
published. Indicate peer-reviewed articles, invited articles, and book chapters. (Note: only
publications on educational topics, not other publications.)
Journal
Date
Publication Title
Peer reviewed
(Yes/No)
Invited
(Yes/No)
Book /
Chapter
1993
Doe, J, Arnold J. Why family medicine first-year residents
choose their programs. Fam Med 1993; 25:253-6.
Professor, M, Doe, J, Professor, M, Goel R. Procedural
training in family practice residencies. Current status and
impact on resident recruitment. J Am Bd Fam Pract 1995;
8:189-94.
Professor, M, Doe, J, Professor, M. EGD efficacy and
safety in family practice: Experience at a university
medical center. Med 1995; 27:506-11.
Professor, M, Professor, M, Doe, J. Colonoscopy
experience at a family practice residency. Med 1997;
29:575-9.
Doe, J. Parent comprehension of polio vaccine information
pamphlets. Pediatrics 1996; 97:804-10.
Yes
No
No
Yes
No
No
Yes
No
No
Yes
No
No
Yes
No
No
1995
1995
1996
1996
B. List in chronological order by academic year, presentations at meetings such as posters,
lectures and invited plenary lectures that you have presented in the area of teaching techniques
or educational approaches. Indicate specifically if the meeting was an international, national, or
regional meeting and indicate the focus of the meeting. (Note: only presentations on
educational topics, not other publications.)
Dates
6/92
6/93
6/94
4/10/96
4/10/97
Presentation Title
Recruiting (Roundtable) - Residency Assistance Program
Workshop for Program Directors, Kansas City MO.
Issues concerning procedures in family practice residencies
(Roundtable) Residency Assistance Program Workshop for
Program Directors, Kansas City MO.
Innovative Ideas Showcase: Successful development of a family
practice residency procedural program. (lecture) Residency
Assistance Program Workshop for Program Directors, Kansas
City MO.
American Academy of Surgery Colposcopy Update and Review
Course: St. Petersburg, FL
How to Teach Colposcopy.
American Academy of Pediatrics Update and Review Course:
Hilton Head, SC
Meeting Type
National
Meeting Focus
Residencies
National
Residencies
National
Residencies
National
Residencies
National
Residencies
C. List in chronological order by academic year any funding such as grants, contracts,
scholarships, etc. you have received that involved education.
None
D. List in chronological order by academic year any meetings, conferences, symposia, or other
related activities you have organized or chaired at the international, national, or regional level.
Indicate your specific role in each.
Dates
4/1996
Event
American Academy of Physicians Colposcopy Review and Update
Level
National
4/1996
American Academy of Physicians – Primary Care in Women’s
Health Course: St. Petersburg, FL
American Academy of Physicians Colposcopy Review and Update
National
American Academy of Physicians – Primary Care in Women’s
Health Course: St. Petersburg, FL
American Academy of Physicians Colposcopy Update and Review
Course: San Francisco, CA
American Academy of Physicians – Primary Care in Women’s
Health Course: San Francisco, CA
National Procedures Institute Contraceptive Update: Orlando FL
National
4/1997
4/1997
4/22/98
4/22/98
6/24/98
National
National
National
National
Role
Chaiman &
Coordinator
Program
Committee
Chaiman &
Coordinator
Program
Committee
Chaiman &
Coordinator
Program
Committee
Chairman
E. List the education-related professional organizations or societies of which you are a
member. Indicate the dates of membership/service. Indicate if you hold an appointed or elected
office/position in these organizations.
Dates
1994 present
1995 present
Association of Residency Directors
Appointed /
Elected
No/No
Association of Professors of Gynecology and Obstetrics
No/No
Organization / Society
Section V
LSUMC-S Educational Scholarship Activity Report
# = Please provide total NUMBER per year across row.
X = Please indicate YES or NO across row.
Prior
91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02*
years
Activity Type
Presentations #
-
-
1
1
1
-
-
-
-
-
-
Poster
Sessions
#
-
-
-
-
-
-
-
-
-
-
-
Publications
#
-
-
-
1
-
1
Grants
X
No
No
No
No
No
No
No
No
No
No
No
No
X
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
X
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
X
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
X
No
No
No
No
No
No
No
No
No
No
No
No
Education
Related Org.
Committee
Member
Committee
Chair
Elected
Position
# = Please provide total NUMBER per year across row.
Activity Type
Presentations #
Poster
Sessions
#
Publications
#
Grants
X
Education
Related Org.
Committee
Member
Committee
Chair
Elected
Position
* Year
X
X
X
X
to date as of submission.
X = Please indicate YES or NO across row.
VI. Continuing Education to Improve Your Teaching
A. In chronological order by academic year, list all activities that you have participated in that
were to improve your teaching skills or educational administrative activities. Indicate if these
activities are seminars, courses, workshops, or other activities. Also, in the activity column,
indicate the educational role(s) (lecturer, small group mentor, clinical teaching, graduate student
/ resident mentor, etc.) to which this activity best relates.
Date(s)
1991-5
4/10/96
1996
4/10/97
1997
2001
Activity
American Academy of Physicians Residency Assistance
Program Workshop for Program Directors, Kansas City
MO.
American Academy of Physicians Colposcopy Update
and Review Course: St. Petersburg, FL
How to Teach Colposcopy.
American Academy of Physicians Residency
Assistance Program Workshop for Program Directors,
Kansas City MO.
American Academy of Physicians workshop
Colposcopy Update and Review Course: Hilton Head,
SC How to Teach Colposcopy.
American Academy of Physicians seminars Residency
Assistance Program Workshop for Program Directors,
Kansas City MO.
How to be a More Effective Speaker. Wonewok, MN
Seminar / Workshop
/ Course / Other
Seminars, courses,
workshops
Workshop
Seminars, courses,
workshops
Workshop
Seminars, courses,
workshops
Workshop
Role CME
Relates To
Educator,
mentor,
administrator
Educator
Educator,
mentor,
administrator
Educator
Educator,
mentor,
administrator
Educator
VII. Honors and Awards
A. In chronological order by academic year, list any recognition of excellence in teaching that
you have received. Indicate the specific aspect of your teaching responsibilities that was
recognized, such as clinical teaching, classroom teaching, etc. Indicate the source of the
recognition, such as the professional organization, university committee, etc. Also indicate if
the award is local, regional, national, or international.
Dates
Recognized
June 1990
March 2000
Aspect of Teaching & Source
Society of Teachers of Medicine Resident Teacher Award. Given for
clinical teaching. The source of the recognition is a university committee
of faculty
American Society for Colposcopy and Cervical Pathology Award of
Merit given for service and dedication to basic colposcopy education
clinical teaching. The source of the recognition is a multispecialty
professional organization
Please see attached documents.
Recognition Type
Local award
National award