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ABOM Medical Director
1.
First Name
2.
Last Name
3.
In which country do you currently live?
United States
Canada
Another country
4.
In which of the following fields did you complete residency training?
Family Medicine
Internal Medicine
Internal Medicine - Pediatrics
Pediatrics
Another medical field
5.
How many hours per week do you typically spend delivering clinical care of any type?
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65+
6.
How many hours per week do you typically spend practicing Obesity Medicine?
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65+
7.
How many years have you been practicing Obesity Medicine?
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15+
8.
Do you have any prior experience in writing questions for a certification exam (item writing) or participating in the development of a certification exam?
Yes - 12 months of experience or more
Yes - less than 12 months of experience
No
Unsure (please explain)
9.
Do you have previous leadership experience and demonstrated ability to build effective teams?
Yes
No
10.
Do you have prior training in media relations or experience with public speaking to media or lay audiences?
Yes
No
11.
Do you have experience as a medical educator or a mentor to healthcare professionals?
Yes
No
12.
Do you have experience in clinical research, quality improvement or evaluation? Relevant prior experiences may include developing and implementing surveys, conducting qualitative studies, overseeing statistical analyses, and publishing articles in peer-reviewed journals.
Yes
No
13.
Email Address
14.
Mobile Phone Number
15.
Please upload your CV as a pdf.
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