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AAP Pediatric Surgery Mentorship Survey
1.
Name
2.
Email
3.
Preferred phone number
4.
Institution
5.
What time zone are you located in?
Eastern
Central
Mountain
Pacific
International
6.
What is the present level of your career?
Resident physician
Pediatric Surgery fellow
Other surgical subspeciality fellow
Junior faculty (<5 years of practice)
Senior faculty (5 or more years of practice)
7.
Are you interested in being a Mentor or Mentee? (note: Pediatric Surgery fellows and Faculty eligible to be mentors, while residents/fellows/junior faculty are eligible to be mentees). If you interested in being both a mentee and mentor, please fill out this survey twice.
Mentor
Mentee
8.
Please select the areas of interest that you would like to discuss with your mentor or mentee.
Matching into Pediatric Surgery
Wellness
Work/life balance
Finding a job
Building a private practice
Building an academic practice
Developing a clinical program
Basic science /translational research
Clinical research
Other research
Education
Leadership
Career Development
Other (please specify)
9.
What are your clinical / research interests?
General Pediatric Surgery
Trauma
Oncology
Thoracic Surgery
Health Informatics
Public Health
Global Health
Basic Science
Identify Basic Science Topics or other research topics:
10.
Would you prefer to be paired up with someone of the same gender and/or underrepresented minority?
Yes
No
Other (please specify)
11.
Is there anything else you would like us to know?
Current Progress,
0 of 11 answered