GIMSPP Preceptor Availability Form 2025

GIMSPP Preceptor Availability Form 2025

Eligibility Requirements:

Preceptor must be board certified in internal medicine with a current Texas medical license
Preceptor must practice at least 40% as a general internal medicine physician apart from any other subspecialties
Preceptors are expected to provide daily personal instruction and supervision to a medical student
Preceptor time commitment ranges from two (2) to four (4) weeks during the Summer

Please enter your contact information below

Full Name*

Practice Name*

Practice Address*

Practice City*

Practice State*

Practice Zip Code

Email Address*

We communicate primarily by email. Please use an email address you check regularly.

Phone Number*

Please enter your office administrator's contact information here.

We will contact them to verify affiliation agreements, paperwork, training, etc needed for students to precept with you

Adminsitrator Name*

Administrator Email Address*

Administrator Phone Number*

Have you ever precepted with the General Internal Medicine Statewide Preceptorship Program before?*

Yes

Are you affiliated with a healthcare system or hospital other than the one listed in your contact information?*

Yes

Which one(s)?

Do you spend at least 40% of your time practicing general internal medicine?*

Yes

Is Internal Medicine your primary specialty or subspecialty?*

Primary Specialty

Subspecialty

Neither

Please list any specialties you have other than Internal Medicine*

Were you invited to participate in GIMSPP by a student? Please let us know their name to faciliatate the match process

How many students will you accpet at one time?*

How many students can you accept over the course of the summer?*

Do students need to speak another language to participate effectively in your practice?*

Select or enter value

If yes, please specify which language

Summer Preceptorships

Matches are made between May - August

Please list dates below if there are any dates that you would not be available to accept students. If you have open availability, please leave this question blank.

Preceptorships last two (2) to four (4) consecutive weeks during the summer and begin on a Monday and end on a Friday.

Our most requested dates from medical students are in during June and July, but preceptorships can take place anything through mid-August.

If you have any dates that you would be unable to participate during the Summer, please let us know below. We will always confirm match dates before we finalize a match, but this helps us plan in advance

Unavailable Start Date 1

(Please use format: 01/01/2025)

Unavailable End Date 1

(Please use format: 01/01/2025)

Unavailable Start Date 2

(Please use format: 01/01/2025)

Unavailable End Date 2

(Please use format: 01/01/2025)

Please let us know if there is anything else students may need to know or provide beofre beginning their preceptorship.

Examples have but not limited to vaccination records, HIPPA training, an application for the hospital to approve

Do you have a colleague you could recommend to the program? If so, please list their name and contact information below.

Send me a copy of my responses

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