Resident’s Name

What is your hometown?

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Where did you attend medical school?

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What other educational credentials do you have?

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What are your particular clinical interests and why?

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What inspired you to pursue a career in family medicine?

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Why did you choose the Community Based Family Medicine Residency program?

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Have undertaken any research in the past?

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Please provide details of any previous Poster Presentations you have done in the past:

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Do you have any publications?

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Please outline any honors or awards you have received in the past:

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What are your hobbies and interests outside of medicine?

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Resident’s Name