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Select a training program by clicking on the drop-down menu in Column 1 and choosing one of the training program options.
Example: If you are reporting on an individual who is a Plastic Surgeon, the Individual’s Profession would be “Medicine” and the Individual’s Discipline/Specialty would be “Plastic Surgery”. Example: If you are reporting on an individual who is studying to be an Occupational Therapist, the Individual’s Profession would be “Allied Health – Student” and the Individual’s Discipline/Specialty would be “Occupational Therapy”. Example: If you are reporting on an individual who is a Clinical Social Worker, the Individual’s Profession would be “Behavioral Health” and the Individual’s Discipline/Specialty would be “Clinical Social Work”.
If you are reporting on an individual who is a Plastic Surgeon, the Individual’s Profession would be “Medicine” and the Individual’s Discipline/Specialty would be “Plastic Surgery”.
Example with Principal AND Interprofessional Trainees at the same site: In this example on this page as below. At site 1, the School of Dentistry’s DDS degree program trained 24 dental students at North Regional Hospital. As part of Interprofessional team-based care, the School of Dentistry’s DDS program also trained 2 Family Medicine residents and 3 graduate students in Psychology (rows 1-3). At a second site, the DDS program trained 14 of its dental students alongside 4 General Dentistry residents who were part of interprofessional team-based care at the Community Dentists' site (rows 4 and 5).
Example with Principal AND Interprofessional Trainees at the same site: In this example on this page as below.
Example with Principal Trainees ONLY (no interprofessional trainees) at any site: In this example, the dental students from the DDS program do not have interprofessional experiences. The dental students trained at 3 different clinical training sites.
At the first site, there were 24 dental students and no interprofessional trainees at North Regional Hospital (row 1).
At the second site, there were 10 dental students and no interprofessional trainees at Community Dentists (row 2).
At the third site, there were 4 dental students and no interprofessional trainees at the Dentist’s Clinic (row 3).
Example with Principal AND Interprofessional Trainees at the same sites: In the example on this page are below.
At the first site, the School of Dentistry’s DDS degree program trained 24 of its own dental students at North Regional Hospital. As part of Interprofessional team-based care, the DDS program also trained 10 dental students from non-HRSA funded programs (not part of the Predoctoral Training in Dentistry grant program), 2 Internal Medicine residents and 5 pharmacy students (rows 1-3).
At a second site, the DDS program trained 10 of its own dental students alongside 8 dental students from different DDS programs as well as 4 General Dentistry residents who were part of interprofessional team-based care at the Community Dentists site (rows 4 and 5).
To Complete the Form: Click on the “Save and Validate” button located on the bottom right corner of your screen. If no errors are found, the BPMH system will automatically route you to the next required subform.
