International Rotations

International Rotations

Any BCM program requesting to have a resident or fellow rotate to international sites will need to fill out this questionnaire.

Practitioner Name*

Resident/fellow first and last name.

Practitioner Type*

Select or enter value

PGY Level*

Select or enter value

BCM Training Program*

Rotation Start Date*

Rotation End Date*

Activities During Rotation*

Briefly describe what the resident/fellow will be doing during the rotation.

BCM Program Director and Program Coordinator*

Include their email addresses.

Name of Person Submitting Request

Host Institution's Primary Contact/s*

Include their names, email addresses, and phone numbers.

Rotation Site Hospital or Clinic Name*

Rotation Site Country and City*

Is the Trainee on a Visa? *

Select

Emergency Contact Information*

Include name, relationship, and contact information.

Is this Rotation Clinical or Non-Clinical*

If non-clinical (research-only, observership only), please fill this form out and send to Keyasha.Mills@bcm.edu

Select

Amount of Clinical Work (%)*

Estimate the percentage of time that will be spent doing clinical work.

Is the host site an institution under BIPAI?*

BIPAI (Baylor International Pediatric AIDS Initiative)

Select or enter value

Will the Host Institution Cover Malpractice*

If you select "no," GME will work with Risk Management to see if international insurance coverage under BCM is an option.

Select or enter value

If the host is covering malpractice, please upload proof here.

Drag and drop files here or

Send me a copy of my responses