Medicine Grand RoundsABIM MOC Part 2Reflection Statement Form

Medicine Grand Rounds

ABIM MOC Part 2

Reflection Statement Form

Last Name*

First Name*

Degree*

DOB in month and day format (MM/DD)*

*Required to send MOC credits to ABIM

I provide permission for my MOC completion information to be shared and transmitted to the Accreditation Council for Continuing Medical Education (ACCME) and participating certifying boards.*

Agree

Disagree

Session Date*

Reflection Statement*

To be eligible for ABIM MOC Part 2 credit, please provide a written reflective statement on your take away from this session.

What will you commit to change/maintain about your practice?

* Reflective statements will be reviewed by the Medicine Grand Rounds Committee and the Stanford CME Office. After your statement has been reviewed and approved, you will receive notification from the Stanford CME office indicating that your ABIM MOC Part 2 credit has been added to your transcript.

Send me a copy of my responses

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