Learning Agreement

Learning Agreement

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Student Information / Name:John Doe
Email:
Concentration:Health Promotion and Behavior
Faculty Mentor Information / Name:Pete Walton, M.D.
Email:
Phone:502-852-4493
Practice Site Information / Name:Family Health Centers, Inc.
Address:2215 Portland Avenue
City:Louisville
State:KY
Zip code:40212
Website:
Site Mentor Information / Name:Kristin Munro-Leighton, MPH
Title:Health Educator
Email:
Phone:502-772-8588
Anticipated Student Schedule at Practice Site / Monday / Tuesday / Wednesday / Thursday / Friday
11-12 / 11-12 / 11-12 / 11-12 / 11-12 /
Additional Scheduled Events and Activities
Additional work to be done offsite- Planning, Research, Development, Evaluation (estimated at 5-l 0 hrs per week of offsite work) /
Student Supervision Plan / Days, Times, and Participants in Addition to Site Mentor
Supervision by Kristin Munro-Leighton onsite and consultation offsite/after-hours /
Student Assessment Method(s) / /
Click to enter additional assessment methods. Multiple lines enabled. /
Physical Work Space and Equipment / /
WorkwillbeconductedoffsiteandanyonsiteworkwillbewithKristinandutilize commonfacilities /

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Learning Agreement

Learning Objectives
Objective / Learning Activities / Deliverable / Target Date
Utilize data previously collected from FHC patients, practitioners and staff regarding breastfeeding attitudes to develop a breastfeeding policy.
a) Summarize data.
b) Research policy implementation for clinical practice in other practices/hospitals.
c) Develop a policy that is in line with respected organizations such as American Association of Pediatrics, CDC, etc. / Literature review, data analysis / Summary report and policy proposal / January 2012
Policy implementation/adoption and comprehensive breastfeeding program development.
a) Obtain buy-in from necessary stakeholders.
b) Communicate policy to practitioners and staff.
c) Support policy with education, literature and any additional materials. / Talk to key people, identify free or inexpensive educational sources / Official written policy, educational program/materials / March 2012
Follow up practitioner/evaluation. / Develop evaluation plan / Evaluation plan / April 2012

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Learning Agreement

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Final submission by Student forcorresponding Blackboard assignment constitutes Student’s signature on this Learning Agreement.

Email from Site Mentor stating concurrence with this Learning Agreementconstitutes Site Mentor’s concurrence.

Feedback entry of “Approve” or equivalent by Faculty Mentor forcorresponding Blackboard assignment constitutes Faculty Mentor’s concurrence with this Learning Agreement but does not imply an assessment for grading purposes.

The Learning Agreement may be modified by submitting either an entirely new agreement or a revised copy of this agreement, either of which requires the above signature and concurrences.

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