To Clinical Preceptor,

My name is Edmarine Bailey, Credential & Affiliation Coordinator for the Clinical Education Department at Touro in Harlem, New York. The point of contact for the Department of Clinical Education, Harlem, NY campus are; Dr. David Forstein, Dean & Professor, Dr. Barbara Capozzi, Clinical Dean, Dr. Bernard Lanter, Director of Clinical Rotations, Ms. Cynthia Figueroa, 3rd Year Student Coordinator for Clinical Rotations, and Jemma Rajpaul, 4th Year Student Coordinator for Clinical Rotations.

TouroCOM, Harlem would like to start by saying “thank you” for your continued support. The Department of Clinical Education looks forward to working with you. We would like to provide you with a variety of resources, including:

A digital copy of the Clinical Rotations Manual & Syllabi: The Clinical Rotations Manual isa guide of what should be expected from both the rotation experience and the medical student.

CME Certification form is attached for submission for credit. Please contact Ms.Meghan Bennett if you have any questions. (Contact information denoted on the form)

New Innovations (web link): at the end of each clinical rotation the Department ofClinical Education requires a student evaluation, from the preceptor be completed.This evaluation will be completed online through New Innovations. (information anddirections attached) Your feedback and praise will help to develop our futurephysicians. (Your access to New Innovations and the Touro Online Library isdependent on a successful credentialing process.)

The Shelf Exam will be given during 3rd year rotations on the last business day of themonth unless the students are otherwise notified. The official schedule will be postedon New Innovations. Students will not be expected to participate in the clinicalrotation that day.

If you have concern, that a student is experiencing anxiety or stress and needsadditional emotional support. We urge you to contact the Department of ClinicalEducation. The overall wellbeing of all of our students is very important, as theycontinue their clinical education.

We are excited the students have the opportunity to work with a talented individual like you. In recognition of your dedication to medical education we would like to invite you to become a part of our Academic Medical Faculty. Please complete the one page application, and

Touro College of Osteopathic Medicine ◦ 230 West 125th Street ◦ New York, NY 10027Department of Clinical Education

Office:646.981.4526 ◦ Email:Edmarine.Bailey3@touro.edu

attach the following, a copy of your most current curriculum vitae, and copy of Board Certification Certificate(s), current malpractice certificate coverage, and current state medical license registration.

Please don’t hesitate to call, email, or contact us in anyway. We are honored and privileged to have you join us in guiding a compassionate, professional and culturally diverse generation of prospective colleagues.

Sincerely,

Edmarine BaileyCredential & Affiliation Coordinator Clinical Education Department Touro College of Osteopathic Medicine 230 West 125th Street 3rd Floor, Room 323New York, New York 10027

Attached:

I. Clinical Rotations Manual- InstructionsII. CME Certification Form

III. Application to join our Academic Medical FacultyIV. New Innovations – InstructionsV. Sample Student Evaluation

Touro College of Osteopathic Medicine ◦ 230 West 125th Street ◦ New York, NY 10027 Department of Clinical Education

Office:646.981.4526 ◦ Email:Edmarine.Bailey3@touro.edu

Harlem - NYEDUCATING CARING PROFESSIONALS TO SERVE, TO LEAD, TO TEACH

230 125th Street . New York, NY 10027 . 646.981.4526 . www.touro.edu/med

Dear Prospective Preceptor,

The Department of Clinical Education at Touro College of Osteopathic Medicine thanks you for your continued commitment to our students and your interest in receiving credentialing and/or faculty appointment.

In order to present your file to the Rank and Credentialing Committee we need:

- A Complete Application for Appointment/Credentialing (Attached)

- Your Most Recent Curriculum Vitae

- Copies of Board Certification Certificates (If Applicable)

- Current Malpractice Certificates of Coverage

- Current State Medical License Registration

Please email your documents to Edmarine Bailey at Edmarine.Bailey3@touro.edu or fax (646)495-3819 Attn: Edmarine Bailey as soon as possible to present your file at the next Rank and Credentialing Committee meeting.

Sincerely,

Dr. David Forstein, Dean & ProfessorTouro College of Osteopathic Medicine- New York, NY

Adjunct Clinical Credentialing Application2018

Harlem – New York EDUCATING CARING PROFESSIONALS TO SERVE, TO LEAD, TO TEACH

230 W 125th Street, New York, NY 10027 (646)-981-4526 http://tourocom.touro.edu

Preceptor Application

**This Application is for: Adjunct Clinical Instructor Adjunct Clinical Assistant Professor

Adjunct Clinical Professor Adjunct Clinical Associate Professor

Name: Please Print Clearly

Preferred Mailing Address:

City: _______________________________ State: __________________________ Zip:

Office: Mobile: Fax:

Email: Credentialed by Hospital: Yes No Please Print Clearly

Specialty: Current Position

Terminal Degree: Years of Practice: Gender: Male Female

Board Certified: Yes No Board Certification __________________ Certificate Number:

Certification Date: _________ Recertification Date: _______ If not board certified, are you board eligible:

Medical License Number/State: DEA Number:

Faculty Position at other Medical School: Rank From: To:

Primary Hospital Affiliation(s): __________________________________________________________________________________

Private Practice/Outpatient Affiliation(s): __________________________________________________________________________

Previous Teaching Experience:

Undergraduate Medical Education: _____________________________________________________________________________

Graduate Medical Education: __________________________________________________________________________________

Other previous teaching position(s): ____________________________________________________________________________

I consent to a National Practitioner Data Bank Inquiry (if applicable) by

Signature Date

Please Send to: Edmarine Bailey, Credentialing & Affiliation Coordinator Department of Clinical Education Touro College of Osteopathic Medicine- Harlem, NY 230 West 125th Street, Room 323, 3rd Floor New York, NY 10027 Email: Edmarine.Bailey3@touro.edu Fax (646)495-3819

Appointment and Credentialing Application 2018

Please Attach the Documents Mentioned Below to Complete This Application 1. Most Recent CV 2. Malpractice Certificates of Coverage 3. Copies of Board Certification Certificates

4. Current Copy of New York State Medical License Registration.** Final decision on Rank and Appointment is made by the Dean and Rank and Credential Committee**

Touro College of Osteopathic Medicine | Clinical Clerkship Faculty Evaluation of Student | Revised 7/2018

Class of: ______________

Student Name: ____________________________________________ Core OR Elective

Rotation Subject: ______________________________ Date of Rotation: ___________________

Hospital or Clinical Site Name: ___________________________________________________________

The Likert scale will be use by the Department of Clinical Education when determining the students grade.

1 2 3 4 5 6 7 Not

Observed Unacceptable Poor Marginal Adequate Competent Excellent Outstanding

U C B A

Patient Care: Skills: Performs patient interviews; uses judgment; is respectful of patient preferences.

1 2 3 4 5 6 7 Not Observed

Medical Knowledge: Skills: Degree of knowledge base; committed to life-long learning, has understanding of complex problems

1 2 3 4 5 6 7 Not Observed

Practice Based Learning and Improvement: Skills: Self assesses; uses new technology, accepts feedback

1 2 3 4 5 6 7 Not Observed

Interpersonal and Communication Skills: Skills: Establishes relationships with patients/families, educates and councils

patients/families, maintains comprehensive, timely, legible medical records.

1 2 3 4 5 6 7 Not Observed

Professionalism: Skills: Shows compassion, respect, and honesty, accepts responsibility for errors, and considers needs of

patient/colleagues.

1 2 3 4 5 6 7 Not Observed

System-Based Practices: Skills: Practices cost-effective healthcare; assists patient with in dealing with system complexities,

coordinates various resources.

1 2 3 4 5 6 7 Not Observed

Osteopathic Principles and Practice: Skills: Correlates osteopathic philosophy into disease entities; can complete a

structural exam; utilizes osteopathic manual skills.

1 2 3 4 5 6 7 Not Observed

Clinical Clerkship Faculty Evaluation of Student Please print neatly

Please return the student evaluation to:

evaluations.clinical@touro.edu

Touro College of Osteopathic Medicine | Clinical Clerkship Faculty Evaluation of Student | Revised 7/2018

Student Name: _______________________________________ Rotation: ___________________________

This evaluation was completed:

Independently or Cumulatively

Preceptor Name: ________________________________________________

Additional Contributors:

(Please clearly print name)

Preceptor Signature: ___________________________________________

Preceptor: ___________________________________________________

Preceptor: ___________________________________________________

Preceptor: ___________________________________________________

□This evaluation has been reviewed with the student

□Yes

Attendance: 2 3 or more - Comment Required# of Shifts (Days) Missed: 1

# of Shifts (Days) Remediated: 1 2 3 or more - Comment Required

Additional Questions:

Exc

elle

nt

Go

od

Ad

equ

ate

Su

bst

and

ard

Exc

elle

nt

Go

od

Ad

equ

ate

Su

bst

and

ard

Student is properly prepared for rotations Develop a plan of treatment

Ability to present a history and physical exam Quality SOAP notes

Ability to research medical literature Clarity and quality of presentations

Demonstration of technical ability Educational Contributions

Quality of written physical and history Appearance

Clarity and quality of presentations Promptness

These comments will be noted on the students MSPE (Deans Letter). The MSPE (Deans Letter) is part of the application for residency.

Constructive comments- These comments will not be included on the students MSPE (Deans Letter) *

Student Signature: ______________________________________ (student signature acknowledges review of the evaluation with the preceptor)

Reviewed by DME: ______________________________________ (For site use only- Not required by TouroCOM)

New TouroCOM Preceptor

Email Address: ________________________________________________

*All Preceptors signing evaluations must be licenced & a TouroCOMcredentialed physician

Date: ____________________ AOA or AMA #: ___________________

A student must remediate if more than 3 days are missed

No

Harlem Campus Middletown Campus

CME Certification of Faculty Participation in Medical Preceptoring and/or Didactic Lecturing

* Only Credits from the Current CME CYCLE (January 1, 2019 - December 31, 2021) Can Be Accepted *

Name: AOA Number:

Preferred Mailing Address:

City: State: Zip:

Phone: Fax: E-mail:

The TouroCOM physician faculty member listed above attests to participation in the clinical training of medical students from Touro College of Osteopathic Medicine and has earned the following teaching hours:

CATEGORY 1A (Participation in Formal Osteopathic CME Programs / Didactic Lecturing / Formal Teaching) Course or Lecture Title Month & Year Number of Hours

CATEGORY 1B (Osteopathic Preceptoring / Activities in Non-AOA Accredited Institutions / Participation in Non-Osteopathic CME Programs) Course or Lecture Title Month & Year Number of Hours

CATEGORY 2A (Interactive, Real-time Online Programs, AMA-Accredited) Course or Lecture Title Month & Year Number of Hours

CATEGORY 2B (Journal/ Online Textbook-Type Programs) Course or Lecture Title Month & Year Number of Hours

Hours Attested by Signature:

Signature

Date

Please submit the above mentioned credits to the AOA on my behalf:

Send Completed Form(s) to: Meghan Bennett

Signature

Date

CME Certification of Faculty Participation Revised 2019

Touro College of Osteopathic Medicine 60 Prospect Avenue

Middletown, NY 10940 Office: (845)648-1213 Fax: (845)648-1019

E-mail: meghan.bennett6@touro.edu

Upon receipt and approval of your completed forms, Touro College of Osteopathic Medicine will report CME hours directly to the American Osteopathic Association

Suite 315, 230 West 125th Street, New York, NY 10012 Phone: 646-981-4532, Fax: 212-678-1787 http://tourocom.touro.edu/sirota-library/

The Sheldon L. Sirota Memorial Library staff welcome you as an adjunct faculty member of the Touro College of Osteopathic Medicine. You now have full access to many of the library’s resources. The library’s collection includes over 25,000 health science e-book titles, 50,000 electronic journals, a small print collection, and many database subscriptions. In order to access the library’s resources, you will need a barcode. To receive one, call us at 646-981-4531, email sirota.library@touro.edu, or stop by the library. Once you have your barcode, you will be able to borrow print books and access our electronic resources off campus. You can register for an off-campus access account at https://accounts.tourolib.org. To view our catalog, go to http://thmed.summon.serialssolutions.com. There you can search by keyword, author, title, etc. The catalog records contain links to electronic resources. For questions or more information about our resources or services, please feel free to contact us or view our webpages at http://tourocom.touro.edu/sirota-library. Again, welcome! Rhonda L. Altonen, MLS, MS, AHIP Director Sheldon L. Memorial Library

Sheldon L. Sirota D.O. MEMORIAL LIBRARY

TOURO HARLEM CAMPUS

New Innovations

Accessing New Innovations

Login to New Innovations

*Additional instructions will be provided as needed

(Through TouroCOM) 1. Go to: tourocom.touro.edu2. This is the homepage for Touro3. Look for “Information for:” on the top

right4. Click on “students”

a. This page is titled: “Current Students”5. Look for the “Rotations:” heading6. Click on “New Innovations”

Or directly: www.new-innov.com

1

2 & 3

4

5. New Innovations requiresyou to change your passwordin order to use the software.Please carefully read theinstructions and requirementsfor creating your newpassword.

1. On the top right of yourscreen, click on “login”

2. New Innovations-Account Login

3. Institution is: Touro

4. Your credentials aretemporary.

User Name & Password

First letter of your first name followed by your last name

ex: pprospective

5

6

6. New Innovations- Home (After successful login)

Clinical Rotations Manual

A digital copy of the Clinical Rotations Manual is available on the Touro website. The Clinical Rotations Manual is a guide of what should be expected from both the rotation experience and the medical student.

The Clinical Rotations Manual is available: 1. Go to: tourocom.touro.edu2. This is the homepage for Touro3. Look for “Information for:” on the top

right

1

2

3

4

4. Click on “students”a. This page is titled: “Current Students”

5. Look for the “Rotations:” heading

6

5

6. Click on “Clinical Rotations Manual”

* This is the cover of the Clinical Rotations Manual

CME Certification of Faculty Participation in Medical Preceptoring and/or Didactic Lecturing

Harlem CampusMiddletown Campus

* Only Credits from the Current CME CYCLE (January 1, 2016 - December 31, 2018) Can Be Accepted *

Name: AOA Number:

Preferred Mailing Address:

City: State: Zip:

Phone: Fax: E-mail:

The TouroCOM physician faculty member listed above attests to participation in the clinical training of medical students from Touro College of Osteopathic Medicine and has earned the following teaching hours:

Course or Lecture Title Month & Year Number of HoursCATEGORY 1A (Participation in Formal Osteopathic CME Programs / Didactic Lecturing / Formal Teaching)

CATEGORY 1B (Osteopathic Preceptoring / Activities in Non-AOA Accredited Institutions / Participation in Non-Osteopathic CME Programs)Course or Lecture Title Month & Year Number of Hours

CATEGORY 2A (Interactive, Real-time Online Programs, AMA-Accredited)Course or Lecture Title Month & Year Number of Hours

CATEGORY 2B (Journal/ Online Textbook-Type Programs)Course or Lecture Title Month & Year Number of Hours

Hours Attested by Signature:

Upon receipt and approval of your completed forms, Touro College of Osteopathic Medicine will report CME hours directly to the American Osteopathic Association

Please submit the above mentioned credits to the AOA on my behalf:

Signature

Signature

Date

Date

Send Completed Form(s) to: Meghan Bennett

Touro College of Osteopathic Medicine 60 Prospect Avenue

Middletown, NY 10940 Office: (845)648-1213 Fax: (845)648-1019

E-mail: meghan.bennett6@touro.eduCME Certification of Faculty Participation Revised 2/2016