APPLICATION FOR MEDICINE AND THE HUMANITIES CREDITS Student name * Email * Date of submission Date of submission * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20162017201820192020 Approval type requested * Pre-approval of activity Post-activity approval of credits *Category of activity Title of the activity Brief description of the activity Description of the link with the Humanities Your role as a student in the activity Reflection of approx. 250 words on the activity’s educational value to you as a developing physician (See page 2 for modified ePortfolio guidelines for your reflection.) Number of credits requested (1 hour of activity = 1 credit; maximum of 30 credits) Please note: Final approval will depend on proof of completion of the activity. The Medicine and the Humanities Committee may ask for further reflection and/or information before granting the final number of approved credits. A separate application must be made for the special project required for the Certificate of Excellence in Medicine and the Humanities. *Category of activityCurricular componentLeadership curriculumInterprofessional education activityAesculapian Society or Student interest group activityFaculty of Medicine organized initiativeElective Guidelines for ePortfolio posts modified for MHPThe reflective process involves a number of steps. As you reflect and construct your ePortfolio post, consider the following steps:1. Review the Felt Experience:a. What were the essential elements of the experience (event/situation)? How would you describe it?b. What were your initial thoughts and feelings about this experience?2. Critical Analysis:a. What questions does this experience raise for you as a future physician?b. What answers are you exploring?3. Reflective Outcome:a. What conclusions are you drawing from your reflection?b. How will these affect your future practice/behavior?c. What goals and/or future plans do you have as a result of this reflection?