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Schedule Request for Interns 2018-2019

Dear Incoming Intern,

Please complete this form to submit your requests for your block schedule for the 2018-2019 academic year.  We do our best to accommodate requests that impact your medical education, career, and significant personal life events.  Day-to-day scheduling (e.g. attending an important wedding) will be arranged in the future by the Chief Residents.  Requests will be prioritized based on the order they are received.

Required responses are marked “required.” If you have any trouble with this form, please email Dr. Ta at vta@dhs.lacounty.gov.

The deadline for schedule requests is Sunday, April 15, 2018.

    Let's start with your information

    Personal Email:(required)
    Please use an email address that you will continue to use after graduating medical school. Medical school emails may be deactivated or are often left inactive or unchecked after graduation. You will be assigned a new work email once you start at Olive View.

    We'd like to learn more about you

    ...because you're here to be become an outstanding physician and we're here to help get you there. As part of our mentorship program, we'd like to gather some information that will help us pair you with a mentor during internship. Don't worry, nothing is set in stone. We know interests and future plans change, and you may seek additional mentors. But this will give us a start.

    Hobbies and interests:(optional)

    Important things in your life:(optional)

    Career Plans: Which of the following career paths are you most interested in?

    Subspecialties:

    Other Interests:

    Now, let's consider some factors for scheduling

    VA: Are you interested in rotations at the West Los Angeles VA (general medicine wards for interns)?(response required)

    Do you anticipate any personal life events?
    (response optional but may help with planning)

    When do you expect this? Please add any additional comments.

    And finally, let's discuss some specific scheduling requests

    We will continue with our 4+1 schedule, meaning your schedule will follow a pattern of a four-week rotation (or 2 two-week rotations) followed by one week of Ambulatory Medicine ("+1" or "Amb week") every fifth week.

    These rotations will follow the block schedule that you can view here. The chart identifies the block starting dates for the entire academic year. The blocks generally start on Thursday and end on Wednesday, with the exceptions being the first and last blocks of the academic year.

    Please use the rest of this form to place your vacation requests. Each housestaff receives 4 weeks of vacation per year, split into 2 two-week blocks. You may choose a specific set of blocks or a general time frame when you would like vacation. Please note that the number of vacationers during specific blocks will be limited, so please indicate if certain dates are very important. We will do our best to try to accommodate requests.

    Based on your vacation requests, you will be assigned to a Pod, which determines when you will be on +1 Amb week for the entire year and residency.

    Block Schedule Dates for 2018-2019

    First Request: Vacation 1

    Timing Option 1:
    Timing Option 2:
    Timing Option 3:
    Comment:

    Second Request: Vacation 2

    Timing Option 1:
    Timing Option 2:
    Timing Option 3:
    Comment:

    Prioritize your requests

    Arrange the requests above from most to least important.

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