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Learning Center

RESIDENCY APPLICATION

Full Listing Questionnaire

The following questionnaire will be completed by each participating residency program at the time of listing and reviewed annually at renewal.

Step 1 of 3

33%

Your Personal Information

Program Name:(Required)

Medical Specialty(Required)

Sponsoring Institution(Required)

Number of Residents per year:(Required)

Program Director(Required)

First Last

Program Director's Title(Required)

Program Director's Email(Required)

Is the billing contact different from the program director?

Yes - Billing is handled by someone else.

No - The program director handles billing.

Billing Contact (if different from the Program Director)

First Last

Billing Contact's Title

Billing Contact's Email

Program Website:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

ACGME Program ID:(Required)

Curriculum

Describe unique features of your program (fellowship options, tracks, other unique offerings):(Required)

Does your program offer Sub-internship opportunities?(Required)

Yes

Provide a link to Sub-internship opportunities:(Required)

Does your program offer global health rotations or international mission opportunities?(Required)

Yes

Please describe your global health rotations or international mission opportunities:(Required)

How many current faculty have practiced medicine internationally?(Required)

How many former residents have gone on to work internationally?(Required)

Are there opportunities to rotate with faith-based hospitals or organizations abroad?(Required)

Yes

Please describe opportunities to rotate with faith-based hospitals or organizations abroad:(Required)

What underserved populations does your program serve, and what structured opportunities exist for residents to engage in that work?(Required)

Are there curricular opportunities to learn about Natural Family Planning or to partner with a pregnancy resource center?(Required)

Yes

Natural Family Planning (NFP) training?(Required)

Yes

Pregnancy resource center partnership?(Required)

Yes

Faith and Culture

Describe the overall Christian faith culture and community within the residency program:(Required)

Which of the following are components of the faith community within your program?

Regular Christian gatherings

Resident Bible study

Organized church community

Prayer group

Other

Christian mentorship: Formal

Christian mentorship: Informal

Estimated Christian faculty:(Required)

Estimated Christian residents:(Required)

What is the hospital and/or residency’s view on praying with patients and talking with patients about spiritual matters if appropriate to the situation?(Required)

Is there a local faith-based medical organization chapter? (e.g. CMDA, Christ Community Health Fellowship, Catholic Medical Association)(Required)

Do you have a Christian faculty member or resident willing to share his/her contact information with prospective students?(Required)

Yes

Christian faculty member or resident's email:(Required)

How does your program support residents who would choose to opt out of certain experiences that interfere with their conscience?(Required)

Conscience opt-out available for (check all that apply):

Contraception/sterilization

Abortion

Transgender medicine

Assisted dying/end-of-life interventions

Terms and Conditions(Required)

Terms and conditions placeholder.

I have read the CMDA Program Listing Agreement and agree to be bound by its terms on behalf of the program.

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RESIDENCY APPLICATION

Full Listing Questionnaire

Your Personal Information

Curriculum

Faith and Culture

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