Dear Mentor,
We encourage you, as a mentor, to use this survey to assess your own mentoring skills and areas in which
you would like to improve. You may use this Self-Reflection survey to discuss your mentoring practices
with your mentee to identify skills that you would like to build.

Responses on the form will not be stored and are for your own personal use.


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* 1. Name of Mentee (optional):

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* 2. Department (optional):

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* 3. Academic Title (optional):

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* 4. Phone/Email (optional):

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* 5. Type of mentoring you provide (check all that apply):

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* 6. Please rate YOURSELF on a 1 to 7 scale. 1: 'Not at all Skilled' ; 4: 'Moderately Skilled' ; 7: 'Extremely Skilled'; 8: 'Not observed'

Please rate how skilled you feel you are in each of the following areas with your mentee(s):

  Not at all Moderately Extremely Not Observed
1. Active listening
2. Providing constructive feedback
3. Establishing a relationship based on trust
4. Identifying and accommodating different communication styles
5. Employing strategies to improve communication
6. Coordinating effectively with other mentors with whom the mentee works
7. Setting clear expectations of the mentoring relationship
8. Aligning your mentee's expectations with your own
9. Considering how personal and professional differences may impact expectations
10. Working to set clinical, educational or leadership goals
11. Helping to develop strategies to meet clinical, education or leadership goals
12. Accurately estimating your mentee's level of scientific knowledge
13. Accurately estimating your mentee's ability to conduct clinical, education or leadership goals
14. Employing strategies to enhance your mentee's understanding of the clinical, education or leadership goals
15. Motivating your mentee
16. Building your mentee's confidence
17. Stimulating your mentee's creativity
18. Acknowledging your mentee's professional contributions
19. Negotiating a path to professional independence for your mentee
20. Taking into account the biases and prejudices you may bring to your mentor/mentee relationship
21. Working effectively with mentees' whose personal background is different from your own (age, race, gender, class, region, culture, religion, family composition, etc.)
22. Helping your mentee network effectively
23. Helping your mentee set career goals
24. Helping your mentee balance work with their personal life
25. Understanding your impact as a role model
26. Helping your mentee acquire resources
Source: University of Wisconsin, Madison

http://mentoringresources.ictr.wisc.edu/

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