SAMBA Mentee SurveySAMBA Mentee Survey

1. Please complete the section below:

Please complete the section below: Name:
Institution:
City/Town:
State:
Email Address:

2. Please indicate your age

Please indicate your age 20-30 years

30-40years

3. Please indicate your stage of training

Please indicate your stage of training resident CB1

resident CA1

resident CA2

resident CA3

Fellow: specify subspecialty below

Specify

4. If you have completed your training, please indicate how long have you been practicing anesthesiology?

If you have completed your training, please indicate how long have you been practicing anesthesiology? 1 - 2 years

3 - 5 years

more than 5 years

5. If you are already in practice, please indicate the type of anesthesia practice:

If you are already in practice, please indicate the type of anesthesia practice: Academic practice

Private practice - Hospital based

Private practice - Ambulatory Surgery Center

Private practice - Office Based Anesthesia

6. If you are in academics, please indicate your academic rank?

If you are in academics, please indicate your academic rank? Assistant professor

Instructor

7. Do you hold an administrative position in your hospital?

Do you hold an administrative position in your hospital? yes

Specify

8. Please indicate if you are a member of the following professional organization:

Please indicate if you are a member of the following professional organization: ASA

SAMBA

Local Anesthesiology Society

9. Have you had a formal mentor in the past?

Have you had a formal mentor in the past? yes

10. Have you been a mentor in the past?

Have you been a mentor in the past? yes

If yes, describe mentorship experience

11. Would you like to be assigned a SAMBA mentor?

Would you like to be assigned a SAMBA mentor? yes: Please proceed to additional questions below

no: Thank you for completing the survey

12. Are you seeking guidance regarding issues relating to academic practice in anesthesiology?

Are you seeking guidance regarding issues relating to academic practice in anesthesiology? yes

13. Are you seeking guidance guidance regarding issues related to private practice in anesthesiology?

Are you seeking guidance guidance regarding issues related to private practice in anesthesiology? yes

14. Are you seeking guidance regarding research issues?

Are you seeking guidance regarding research issues? yes

15. Are you seeking advice regarding manuscript publication?

Are you seeking advice regarding manuscript publication? yes

16. Are you seeking guidance regarding work/life issues?

Are you seeking guidance regarding work/life issues? yes

17. Are you seeking guidance regarding time management issues?

Are you seeking guidance regarding time management issues? yes

18. Are you seeking advice regarding professional negotiation?

Are you seeking advice regarding professional negotiation? yes

19. Are you seeking networking opportunities?

Are you seeking networking opportunities? yes

SAMBA Mentee Survey
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1. SAMBA Mentee Survey

SAMBA Mentee SurveyExit this survey

1. SAMBA Mentee Survey

SAMBA Mentee Survey
Exit this survey