Aquifer Calibrate Pilot Program Application - copy

Open to MD/DO Curricular Partner Programs

Thank you for your interest in advancing health professions education as an Aquifer Calibrate Pilot Program. Those programs selected to participate in the pilot must meet and agree to the requirements outlined in the Aquifer Call for Participation. Please review these carefully prior to submitting your application.

REVIEW CALL FOR PARTICIPATION

Application Process

Applications to the pilot program for allopathic and osteopathic programs are now closed.

Official Program Name*
Note: The Aquifer Calibrate Fall 2022 pilot is limited to allopathic and osteopathic medical schools that are confirmed Curricular Partners for FY 2023 (July 1, 2022 - June 30, 2023). If you do not see your program listed, you have not yet confirmed a Curricular Partner subscription for 2023. If you need additional information, please reach out to exams@aquifer.org.
Program Type*
- Allopathic Medical School
- Osteopathic Medical School
Requesting Individual*
Note: Application to the Calibrate Pilot program must be submitted by the Aquifer Program Services Administrator (PSA) at your institution. This is the single point of contact at your institution who manages your subscription. If you are unsure who this is, please reach out to exams@aquifer.org.
I confirm I am the Program Service Administrator for this program*
- Yes
- No
Email Address*
Phone Number*
Pilot Participation Minimum Requirements*
All programs selected to participate in the Calibrate Pilot Program must agree to meet the minimum requirements as detailed in the Aquifer Call for Participation. Please review these carefully to ensure you and your institution are prepared to fully participate prior to submitting your application.
I attest that our institution meets the minimum requirements
Clerkship Details
Please provide the clerkship details for each clinical rotation you anticipate enrolling in the pilot program. Include all clerkships for which you anticipate participation at this time; final participation will be confirmed at the time of selection. As a reminder, to be eligible for the pilot the rotation start and end dates for each clerkship must allow for an early and late administration of the Calibrate assessment, within the guidelines listed above, between October 1, 2022 and January 31, 2023. Programs selected for the pilot will be asked for additional implementation details for each listed clerkship at the time of notification.
Clerkship Name*
Calibrate Assessment Selection*
Select all that apply
- Radiology
Rotation Start Date*
Month
Day
Year
Rotation End Date*
Month
Day
Year
Estimated Number of Students*
Clerkship Contact Name*
First Last
Clerkship Contact Title*
Clerkship Contact Email*
Add Another Clerkship?*
- Yes
- No
Pilot Clerkship 2
Clerkship Name*
Calibrate Assessment Selection*
Select all that apply
- Family Medicine
- Internal Medicine
- Pediatrics
- Radiology
Rotation Start Date*
Month
Day
Year
Rotation End Date*
Month
Day
Year
Estimated Number of Students*
Clerkship Contact Name*
First Last
Clerkship Contact Title*
Clerkship Contact Email*
Add Another Clerkship?*
- Yes
- No
Pilot Clerkship 3
Clerkship Name*
Calibrate Assessment Selection*
Select all that apply
- Family Medicine
- Internal Medicine
- Pediatrics
- Radiology
Rotation Start Date*
Month
Day
Year
Rotation End Date*
Month
Day
Year
Estimated Number of Students*
Clerkship Contact Name*
First Last
Clerkship Contact Title*
Clerkship Contact Email*
Add Another Clerkship?*
- Yes
- No
Pilot Clerkship 4
Clerkship Name*
Calibrate Assessment Selection*
Select all that apply
- Family Medicine
- Internal Medicine
- Pediatrics
- Radiology
Rotation Start Date*
Month
Day
Year
Rotation End Date*
Month
Day
Year
Estimated Number of Students*
Clerkship Contact Name*
First Last
Clerkship Contact Title*
Clerkship Contact Email*
Add Another Clerkship?*
- Yes
- No
Pilot Clerkship 5
Clerkship Name*
Calibrate Assessment Selection*
Select all that apply
- Family Medicine
- Internal Medicine
- Pediatrics
- Radiology
Rotation Start Date*
Month
Day
Year
Rotation End Date*
Month
Day
Year
Estimated Number of Students*
Clerkship Contact Name*
First Last
Clerkship Contact Title*
Clerkship Contact Email*
Additional Questions
The following questions will assist the selection committee to better understand your current use of Aquifer content and your experience with our summative assessments.
What programmatic aims do you hope to achieve by integrating Aquifer Calibrate into your curriculum? What problems does Calibrate potentially solve for your program?*
300-500 words
How do you currently use Aquifer cases in your curriculum?*
300-500 words
Please describe the ways you currently provide students with feedback on their individualized learning plans and/or progress. If you have a coaching program, please briefly describe below.*
300-500 words
Application Submission*
Please review and attest to the following:

By submitting this form, I confirm our Program’s understanding and agreement to the following:

This is an application for consideration to participate in the Aquifer Calibrate Formative Assessment Pilot program and is not a guarantee of selection.

We meet the minimum requirements for participation in this program and will provide the required faculty, staff, and student support and feedback as detailed above in the Aquifer Call for Participation.
I attest to the above
Email
This field is for validation purposes and should be left unchanged.

Open to MD/DO Curricular Partner Programs

Application Process

Clerkship Details

Pilot Clerkship 2

Pilot Clerkship 3

Pilot Clerkship 4

Pilot Clerkship 5

Additional Questions

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