WINTHROP UNIVERSITY HOSPITAL
RESIDENCY COORDINATORS’ PAGE
APPLICATION PACKET FORMS AND TEMPLATES
All of the forms listed in this section must be included in each application packet received by Academic Affairs. Incomplete packets will be returned to the program for completion.
Checklist for American Medical School Graduates
Checklist for International Medical School Gradutes
Each application must have, as a cover, one of the Checklist forms above. Use of the checklist form will enable you to ascertain that you have included all of the required documents in the packet.
Complete the appropriate checklist, and have the Program Director sign and date it. The second page of the Checklist form is the Chronological listing of time by month from the applicant’s graduation from medical school up to the start of the applicant’s program at Winthrop. There can be no gaps. The Residency Coordinator must ensure that there is documentation for each time period listed on this form. When completed, the Residency Coordinator signs and dates the form.
Appointment Attestation Form
The ACGME requires that “candidates who have been invited to interview for programs must be informed, in writing or by electronic means, of the terms, conditions and benefits of their appointment…”. This information is contained in the Sample Contract on the Application Procedures page of the Graduate Medical Education section of the Winthrop website. Coordinators must either direct their applicants to the site, or print out the Sample Contract for them to review. Once the applicant has reviewed the sample contract, the coordinator must have them sign the Appointment Attestation form, confirming that they have been made aware of the appointment terms.
External Clerkship Attestation Form
New York State regulations state that GME training programs cannot accept international medical school graduates who have done more than 12 weeks of clerkship training outside of the country where the medical school is located. (There is a list of international medical schools that are exempt from this regulation; the list is included on the External Clerkship Attestation Form). The coordinator must have all international medical school graduates who are applying for positions complete and sign the External Clerkship Attestation form.
Winthrop Referee Verification Letter
Programs are required to do primary source verification of the reference letters submitted as part of the residency application. This requires that the program contact each individual who has provided a letter of reference for the candidate to verify that they have written the letter. A template for this referee verification letter is provided above. Each coordinator may adapt the letter to their own program needs.
Winthrop Residency/Fellowship Application
Most Winthrop programs now participate in ERAS, the Electronic Residency Application System sponsored by the AAMC, and the ERAS application is submitted as part of the packet. However, for those programs who do not participate in ERAS, a generic Winthrop Residency/Fellowship paper application must be completed and included in the application packet.
BENEFITS INFORMATION FORMS FOR INTERVIEWEES
Below are general information sheets on Winthrop benefits for distribution to your interviewees.
2010 Benefits IM
2010 Benefits OB
2010 Benefits Pathology
2010 Benefits Pediatrics
2010 Benefits Radiology
HOUSE STAFF FORMS
Below are forms used by current house staff.
- Request for Off-Site Elective Rotation Residents who wish to do an elective rotation outside of Winthrop must complete this form, have their program director approve it, and submit it to the Director of Academic Affairs for approval.
- Health Club Reimbursement Request Form Winthrop House Staff are entitled to reimbursement of one hundred dollars (before taxes) per year for gym/health club membership. To apply for this reimbursement, house staff must fill out this form, and attach a copy of their gym/health club contract, and a cancelled check or other proof that they have spent a minimum of $100 on this membership. The form and documentation should be submitted to the Office of Academic Affairs. The reimbursement will appear in the resident’s regular paycheck
WINTHROP GMEC POLICIES
To view and access a complete list of Winthrop’s Graduate Medical Education (GMEC) policies, please go to:
GMEC Policies Link
