Johns Hopkins University
General Internal Medicine
Housestaff Research Awards
Letter of Support
Letters of Support must be received no later than Monday, September 9, 2013.
Please complete and return this form via email to: Mary Cay Reynolds ()
Name of Applicant: ______
Your Name: ______
Relationship to Applicant: ______
Title and Dept: ______
Institution: ______
Address: ______
Telephone: ______
Email: ______
A. Please rate the applicant in the following areas, compared to the typical house officer in your training program.
Rate on a 1-4 scale (1=Average; 2=Above Average; 3=Among top 3 residents in his/her year; 4=Among top 3
residents over past 5 years)
1. Clinical ability ______
2. Teaching ability ______
3. Communication skills ______
4. Quantitative skills ______
5. Biomedical knowledge base ______
6. Scientific reasoning/insight ______
7. Academic motivation ______
8. Collegiality ______
9. Medical altruism ______
10. Honesty/integrity ______
B. Please rate the applicant’s contribution to the research project which is the subject of his/her application. Rate on
a 1-4 scale (1= Done by other team members; 2= Done mainly by other team members with the applicant's
help; 3= Done mainly by applicant with help from other team members; 4= Done solely by applicant; n/a = not
applicable or unknown)
1. Conception of Project ______
2. Literature Review ______
3. Protocol Development ______
4. IRB Application ______
5. Intervention or Clinical Maneuvers ______
6. Data Form Creation ______
7. Data Collection ______
8. Data Management ______
9. Statistical Analysis ______
10. First Draft of Manuscript ______
11. Presentation at National Meeting ______
C. Which statement below best describes the applicant's commitment to a career in academic general internal
medicine (GIM)? ______
a) Is firmly committed to academic GIM and/or is applying for fellowships, grants, or jobs in academic GIM.
b) Has told me that he/she intends to pursue a career in academic GIM.
c) Not firmly committed to a career path yet; academic GIM is a possibility.
d) Not likely to pursue a career in academic GIM.
D. Please use the space on this page to comment further on the applicant, his/her research project, and his/her long-
term interest in academic GIM.