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ILMA-USA mentorship questionnaire for mentors
ILMA USA
ILMA-USA mentorship questionnaire for mentors
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Please complete this form to the best of your ability
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Email
*
Your email
Preferred email address
*
Your email
Highest degree
MD
PhD
MPH
MS
MA
Other:
Other:
Full name
*
Your answer
Location : City, Country
*
Your answer
Specialty
Your answer
Type of practice
Clinical
Research
Administrative
Private
Consultant
Concierge
Academic
Hospital
Other:
Other:
Academic rank
Lecturer
Instructor
Assistant professor
Associate professor
Full professor
N/A
Other:
Other:
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Current practice institution
Your answer
Current academic affiliation
Your answer
Mentorship information (Do you have experience in mentorship)
Yes
No
Whom did you mentor?
Undergraduate
Graduate
Doctoral
Residents
Fellows
Junior faculty
Peers
Other:
Other:
Duration of your mentorship experience Round to the nearest year
Your answer
Particular areas of interest for mentorship? Please choose one
Basic research (e.g. designing a study, developing skills, data analysis)
Clinical research (e.g., patient recruitment, study design, funding)
Career development- transitioning from training to staff or faculty, areas of interest, and specialty choice and preparedness
Training advice (e.g., navigating residency and applications)
Writing skills (e.g., grants, manuscripts, abtracts, personal statement, communication)
Personal development (e.g., leadership/negotiation, CV)
Please choose the career development focus
Academic
Hospital-based
Private solo
Private group
Global health/Advocacy
Assuming one-hour mentorship, how many sessions can you allocate? One mentee is allocated per mentor
Once weekly
Once every 2 weeks
Once every 3 weeks
Once every 4 weeks
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How did you hear about the mentorship program?
Social media
Word of mouth
Email communication
ILMA section
Other:
Other:
What is your preferred mode of communication?
In-person, face-to-face (only in the USA)
Telephone
E-mail
Virtual meeting
Biographic questions Briefly explain your career trajectory and interest in mentorship
*
Limit 1000 characters
How do you expect mentorship to enhance your professional career?
*
Limit 1000 characters
Submit
