BTR Mentoring Program

First, so we may compare your pre and post-training responses, please enter the last four digits of your phone number. This code will be used for internal tracking only and will not be shared or used for identification purposes.(Required)

Gender identity with which you most identify:

Other gender identity (if not listed above)(Required)

Race/Ethnicity:

Other Race/Ethnicity (if not listed above):(Required)

Age(Required)

How many years post training are you?

Do you have any advanced degrees besides an MD?(Required)

How much protected research time do you currently have?

What is your current job satisfaction?

Do you feel adequately supported by your department?(Required)

Yes

Any additional comments on your departmental support:

How many formal research mentors do you have at your institution?(Required)

Do you feel adequately supported by your institutional mentors?(Required)

Yes

Any additional comments on your institutional mentor's support:

Do you have any formal research mentors outside of your institution?(Required)

Yes

Other

Have you previously interacted with your assigned mentor?(Required)

Yes

Other

Do you currently have external funding?(Required)

Yes

If Yes, please describe:

Do you currently have a career development award?(Required)

Please indicate your effectiveness at the following [1 indicates Not Effective; 5 indicates Expertise]:

	1	2	3	4	5
Obtaining adequate departmental and institutional support
Time management
Developing a research plan
Deciding which grant to apply for
Writing Specific Aims
Deciding which meetings to attend – surgical and scientific
Deciding which academic societies to participate in
Developing a national network

Please let us know your reasons for participating in the AAS-SUS BTR Mentorship Program:(Required)

Comments

This field is for validation purposes and should be left unchanged.

BTR Pre-Mentorship Survey

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