Weill Cornell Medical College

Weill Cornell Medical College

Cornell University

DOCUMENT CHECKLIST AND PREPARATION GUIDANCE

FOR

ACADEMIC APpointment and Promotion

TABLE OF CONTENTS

Introduction to the Weill Cornell Medical College Curriculum Vitae Form 3

Weill Cornell Medical College Curriculum Vitae Form (Required Format for Faculty Academic Staff) 5

Weill Cornell Medical College Curriculum Vitae Form (Required Format for Non-Faculty Academic Staff) 14

Supplemental Documents 17

Statement of Key Contributions Template 18

Teaching Activities Report Template 19

Educator’s Portfolio Template 26

Clinical Portfolio Template 28

Letters of Evaluation 31

Guide to Completing the Weill Cornell Medical College Curriculum vitae Form 37

Introduction to the Weill Cornell Medical College Curriculum Vitae Form

Your Weill Cornell Medical College Curriculum Vitae (CV) Form is a crucial document in presenting your credentials to Medical College offices and appointment and promotion committees. The CV, together with supplemental documents described below, provide the opportunity for you to highlight your accomplishments in teaching, clinical care, administration, and research. The CV also is a “form” that holds some of your historical and demographic data, information that the Medical College needs to record and process your faculty or non-faculty academic appointment.

Faculty and non-faculty academic staff members need to complete the CV when they are initially recommended for an academic appointment. A current and updated CV also may be requested for other appointment actions, including promotions or changes in title. You must sign your CV to verify the contents. Please note that the CV form for non-faculty academic staff is a shortened version of the CV for faculty. The most current versions of both can always found on the Office of Faculty Affairs website: www.med.cornelledu/ofa. Please always use the most current version.

Faculty candidates and current members will want to consider using supplemental documents, which are a good way to present extensive activities and accomplishments in teaching, clinical care, research and administration. Keep in mind that there are areas on the CV form that can be used to present these activities and accomplishments but the supplemental document templates may be used instead when they are beneficial for the dossier.

In addition to the CV form (required) the following supplemental documents are in use:

· Teaching Activities Report (TAR) – for all faculty except education scholars on the Pathway Recognizing Academic Achievement and Scholarship, with area of excellence in Educational Leadership;

· Clinical Portfolio (CP) - personal statement plus a report on clinical activities;

· Statement of Key Contributions (SKC) – 1-2 page summary of major accomplishments in research, clinical care, grant funding, scholarship, teaching;

· Educator’s Portfolio (EP) – in depth report for education scholars on the Pathway Recognizing Academic Achievement and Scholarship, with area of excellence in Educational Leadership

There are blank document templates in this toolkit for you to use: CV, TAR, CP, SKC, and EP, and guidance on preparing them. The blank templates are editable (Word files) and you can complete these documents, save them, and print them if needed. Refer to the guidance pages as you complete the CV and supplemental forms.

Please note the following as you prepare your documents:

· Retain the format of the CV form throughout; please do not delete a section if it does not apply to you;

· If you have no information to enter in a CV section, enter “Not Applicable” or “N/A”;

· Please do not delete the numbering or lettering of the various sections or titles (e.g. Name, City, etc.);

· If you choose not to use the supplemental templates, there is no need to include blank versions in your materials submission;

· Please submit only the pages of supplemental documents that contain your information; there is no need to include pages with guidance, instructions, or examples

The Office of Faculty Affairs is available to help you with your CV and with any other questions or concerns you may have about your Weill Cornell Medical College academic appointment. Feel free to call (646-962-8770) or email us (). We would appreciate your comments or suggestions for improving this guide. Look for updates on the OFA website (www.med.cornell.edu/ofa). Thank you.

Weill Cornell Medical College Curriculum Vitae Form (Required Format for FACULTY Academic Staff)

Signature (required):
Version date:

A. GENERAL INFORMATION

Required Information:

Name: First, Middle, Last
Office address:
Office telephone:
Office fax:
Home address:
Home telephone:
Cell phone:
Beeper:
Work Email:
Personal Email:
Citizenship:
If not a U.S. Citizen, do you have: / Immigrant visa (green card) ?
Non-immigrant Visa?
Type:

Optional Information (not required but helpful):

Birth date: see preparation guide
Birth place:
Marital status:
Race/Ethnicity: please refer to preparation guide

B. EDUCATIONAL BACKGROUND

1. Academic Degree(s): B.A. and higher; institution name and location; dates attended; date of award. Expand the table as needed.

Degree
(abbreviation) / Institution Name and Location / Dates attended / Year Awarded

2. Post-doctoral training (include residency/fellowships): In chronological order beginning with post-doctoral training positions; include full titles, ranks and inclusive dates held. Expand the tables as needed.

Title / Institution name and location / Dates held

3. Continuing Medical Education Courses/Certificates

Certificate or Course / Institution Name and Location / Dates attended

4. Other Educational Experiences

Description / Institution Name and Location / Dates attended

C. LICENSURE, BOARD CERTIFICATION, MALPRACTICE

1. Licensure: Every physician appointed to the Hospital staff, except interns, and aliens in the US via non-immigrant visas, must have a New York State license or a temporary certificate in lieu of the license.

a. State / Number / Date of issue / Date of last registration
b. If no license:
1. 1. Do you have a temporary certificate? / Yes/No/NA
2. Have you passed the examination for foreign medical school graduates? / Yes/No/NA
c. DEA number (optional):
d. NPI number (optional):

2. Board Certification:

Full Name of Board / Certificate # / Dates of Certification (mm/dd/yyyy) –
Start and End Dates

3. Malpractice Insurance:

Do you have Malpractice Insurance? / Yes / No / Anticipated / N/A
Name of Provider:
Premiums paid by (choose one):
Self
Group (name):
Institution (name):

D. PROFESSIONAL POSITIONS AND EMPLOYMENT

1. Academic positions (teaching and research):

Title / Institution name and location / Dates held

2. Hospital positions (e.g., attending physician):

Title / Institution name and location / Dates held

3. Other Employment:

Title / Institution name and location / Dates held

E. EMPLOYMENT STATUS (current or anticipated)

Name of Employer(s):
Employment Status (choose one, delete the others):
Full-time salaried by Weill Cornell
Full-time salaried by Cornell-affiliated hospital
Part-time salaried by Cornell
Part-time salaried by Cornell-affiliated hospital (show percentage of full time effort, e.g., 50%)
Voluntary (self-employed or member of a P.C.)
Other salaried
Other non-salaried
Sessional Weill Cornell

F. INSTITUTIONAL/HOSPITAL AFFILIATION

1. Primary Hospital Affiliation:
2. Other Hospital Affiliations:
3. Other Institutional Affiliations:

G. PERCENT EFFORT AND INSTITUTIONAL RESPONSIBILITIES

CURRENT % EFFORT / (%) / Does the activity involve WCM students/researchers? (Yes/No)
TEACHING
CLINICAL
ADMINISTRATIVE
RESEARCH
TOTAL / 100%

FOR NEW MEDICAL COLLEGE FACULTY: IT IS VERY HELPFUL TO HAVE THIS TABLE REPEATED, SO THAT THE COMMITTEE OF REVIEW CAN SEE THE EXPECTED RESPONSIBILITIES AND EFFORT AT WEILL CORNELL MEDICINE (WCM)

WCM ANTICIPATED % EFFORT / (%) / Does the activity involve WCM students/researchers? (Yes/No)
TEACHING
CLINICAL
ADMINISTRATIVE
RESEARCH
TOTAL / 100%

INSTITUTIONAL RESPONSIBILITIES

1. Teaching (e.g., specific teaching functions, courses taught, dates): For guidance refer to Teaching Metrics table (http://weill.cornell.edu/handbook/ Appointment and Promotion of Faculty, page 2.84). You may report your teaching activities in the 4 areas of teaching shown below.

You may use instead the Teaching Activities Report template, or the Educator Portfolio template if your area of excellence is in Educational Leadership (strongly encouraged). Then refer to your report here as an attachment (e.g., see attached), and attach it to the CV.

Didactic teaching: (e.g., lectures, continuing medical education courses, grand rounds, professional development programs, seminars, tutorials)
Dates
Mentorship: (e.g., mentor for medical student, graduate student, resident, clinical or postdoctoral research fellow or junior faculty projects; service as graduate student thesis advisor or committee member)
Dates
Clinical teaching: (e.g., teaching in the clinic or hospital including bedside teaching, teaching in the operating room, preceptor in clinic)
Dates
Administrative teaching leadership role: (e.g., residency or fellowship director,
course or seminar director or co-director)
Dates

2. Clinical care (duties, dates): To document your clinical activities you may use the table below.

You may use instead the Clinical Portfolio template when you have extensive clinical activities and accomplishments (strongly encouraged). Then refer to your report here as an attachment and attach it to the CV.

Clinical Activities / Contributions / Dates

3. Research (duties, dates): Describe your research interests, activities, and career trajectory using dates, in the table below. Prepare a Statement of Key Contributions; refer to it here and attach it to the CV. You may annotate key grants and publications here also.

Research Activity / Key Contributions / Dates

4. Administrative Activities (duties, dates): Describe administrative activities in the table below. To document administrative activities more extensively use a supplemental statement, refer to it here and attach it to the CV.

Administrative Activity / Date

H. RESEARCH SUPPORT

Past Research Support: (Summarize)

1.
2.
3.

For Current extramural and intramural research funding, provide the following for each award:

1. Source, amount, and duration of support (dates)

2. Name of Principal Investigator

3. Individual's role in project, including percentage (%) effort

Candidates are encouraged to annotate multi-investigator grants to clarify their role on the project (PI, Site PI, Project leader, Core director, etc.)

Current Research Support: (duplicate table as needed)

Source
Project Title
$ Amount
Duration (MM/YY)
Principal Investigator
Your Role in Project
% Effort

I. EXTRAMURAL PROFESSIONAL RESPONSIBILITIES

i.e. - Journal Reviewer, Editorial Boards, Study Sections, Invited Presentations

Activity / Responsibility / Dates

J. PROFESSIONAL MEMBERSHIPS

Include medical and scientific societies.

Member/Officer/Fellow/Role / Organization / Dates

K. HONORS AND AWARDS

Name of award / Date awarded

L. BIBLIOGRAPHY

Entries should follow standard journal format, listing all authors, complete titles and inclusive pagination. Please also provide a URL to each of your published works as found in a publicly available digital database such as PubMed or My Bibliography, which are maintained by the US National Library of Medicine.

Publications also may be annotated here (or in the Key Contributions Statement) to indicate the role of the candidate, where appropriate. This should be considered for co-first authorship, co-senior authorship, and in publications in which the candidate played an important role (leadership of a site, or methodology, etc.) that may not be apparent from the author order.

Number the entries and put your name in bold type. The listings must be organized in chronological order. Use the following categories:

1. Articles in professional peer-reviewed journals:

2. Reviews:

3. Books:

4. Chapters:

5. Case Reports: Optional, list 10 best or most recent

6. Other (media, DVD’s, etc.):

7. Abstracts: Optional, list 10-20 best or most recent only.

8. Presentations: Optional, other than invited. List 10-20 best or most recent only.

9. In review: manuscripts submitted or in preparation – list separately.

Weill Cornell Medical College Curriculum Vitae Form (Required Format for Non-Faculty Academic Staff)

Signature (required):
Version date:

A. GENERAL INFORMATION

Required Information:

Name: First, Middle, Last
Office address:
Office telephone:
Office fax:
Home address:
Home telephone:
Cell phone:
Work Email:
Personal Email:
Citizenship:
If not a U.S. Citizen, do you have: / Immigrant visa (green card)?
Non-immigrant Visa?
Type:

Optional Information (not required but helpful):

Birth date:
Birth place:
Marital status:
Race/Ethnicity:

B. EDUCATIONAL BACKGROUND

1. Academic Degree(s): B.A. and higher; institution name and location; dates attended; date of award. Expand the table as needed.

Degree
(abbreviation) / Institution Name and Location / Dates attended / Year Awarded

Title / Institution name and location / Dates held

3. Other Educational Experiences

Description / Institution Name and Location / Dates attended

C. PROFESSIONAL POSITIONS AND EMPLOYMENT

1. Academic positions (teaching and research)

Title / Institution name and location / Dates held

2. Hospital positions (e.g., Physician Assistant)

Title / Institution name and location / Dates held

3. Other Employment (current / past)

Title / Institution name and location / Dates held

D. EMPLOYMENT STATUS (current / anticipated at WCM)

E. INSTITUTIONAL/HOSPITAL AFFILIATION

1. Hospital, Institutional Affiliations:

F. BIBLIOGRAPHY (if available)

Entries should follow standard journal format, listing all authors, complete titles and inclusive pagination. If possible also provide a URL to each of your published works as found in a publicly available digital database such as PubMed or My Bibliography, which are maintained by the US National Library of Medicine.

Number the entries and put your name in bold type. Organize the list in chronological order.

[paste here]

Supplemental Documents

Completing one or more of the following supplemental documents and attaching them to your CV is encouraged but you will need to exercise good judgement in choosing their use. Try to avoid redundancy in your overall dossier. For example, avoid including more than personal statement. Should you need assistance or guidance please contact the Office of Faculty Affairs.

· Statement of Key Contributions

A 1-2 page summary to include: a) major accomplishments since initial appointment or last promotion; b) annotation of select bibliographic entries to highlight important roles/work; c) annotation of select grants of special importance, noting role