Speed Mentorship Enrollment HM17

The Society of Hospital Medicine will hold a "Speed Mentorship Activity" for academic hospitalists at SHM's HM17 annual meeting on May 2, from 12:00-1:00 pm. It is open to the first 20 people who complete this survey. You will receive a confirmation email with more details in the coming weeks.

Question Title

Please provide your contact information.
(Required.)

Name

Organization

Email address

Phone number

Question Title

Please select the title that is closest to yours: (Required.)

Instructor

Assistant professor

Associate professor

Question Title

How many years have you been in your current role? (Required.)

Less than 1

1-2

2-3

More than 3 years

Question Title

Please mark your area(s) of interest: (Required.)

Education - skill development

Education - research and scholarship

Research - clinical

Research - health services

Research - basic science

Research - translational

Administration - leadership

Quality improvement and patient safety

Question Title

Please provide 2 specific questions that you would like to have addressed through this session. This will greatly enhance the value of your conversation with your mentor. If you are a researcher seeking mentorship on a research project, please include a statement of research aims or goals. (Required.)

Question Title

* Please provide your contact information. (Required.)

Question Title

* Please select the title that is closest to yours: (Required.)

Question Title

* How many years have you been in your current role? (Required.)

Question Title

* Please mark your area(s) of interest: (Required.)

Question Title

Question Title

* Please copy and paste a brief bio or CV in the space below. (Required.)

Please provide your contact information.
(Required.)

Please select the title that is closest to yours: (Required.)

How many years have you been in your current role? (Required.)

Please mark your area(s) of interest: (Required.)

Please copy and paste a brief bio or CV in the space below. (Required.)