Resident-Student Education:
One of the critical success factors in the planning and implementation of educational interventions for Residents & Students is the identification of their educational needs. FAFP needs your help in determining these educational needs to provide a foundation upon which a course or workshop can be built, and to ensure that FAFP resident & student educational offerings are relevant, attainable, and applicable in the practice/work setting.

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* 1. Name of Submitter(Full Name)

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* 2. Submitter Contact Information

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* 3. Family Medicine Topic Area(s)
Identify Family Medicine relevant topic(s); select from the list below.

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* 4. Who are your primary target audience(s) for this topic area? Please select all that apply.

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* 5. Other topic area(s) not listed but highly relevant to the educational needs of the primary target audience.

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* 6. Presentation Title

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* 7. Presentation Overview/Description
In 200 words or less, describe the relevance of the content to the audience and how it will address educational, practice or performance gap

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* 8. Learning Objectives: list 3 measurable learning outcomes
Upon completion of this session, participants will be able to:

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* 9. Presentation Format
Specify ideal format to present content that will maximize learning 

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* 10. State what this topic was designed to change in terms of residents' and/or students' competence or performance or patient outcomes.

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* 11. Other information you want to communicate regarding this topic? 

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