The Small Grants Program will award four grants which evaluate ABIM PIMs
and four grants which evaluate other quality improvement tools.

Will you use an ABIM PIM? Please answer yes or no.
Select Yes No

If yes, what ABIM PIM will you use?
(The Self-Directed PIM and the Physician/Peer Assessment Module
are not eligible for this grant.)
Select a PIM Asthma Care of Vulnerable Elderly Clinical Preventive Services Colonoscopy Communication - Primary Care Communication - Subspecialists Communication with Referring Physicians Diabetes HIV Hepatitis C Hospital-Based Patient Care Hospital - Prevention of Ventilation-Associated Pneumonia Hypertension Osteoporosis Preventive Cardiology

If you are not using an ABIM PIM, is there a specific QI tool that you
will use and evaluate?
Please describe it here:

First name:

Last name:

Post graduate year level:
Select Year PGY-1 PGY-2 PGY-3 Fellow Other
If other, please explain:

Email:

Phone:

Future career goal of trainee 1
(if trainee is the one proposing the project):

Principal Investigator
(All applications must include a principal investigator who is a faculty member.)

First name:

Last name:

Title:

Email:

Phone:

Name of training program:

Address of training program:

City:

State or Province

Zip or Postal Code:

Country: