MSD Mentorship Participation Survey

You are invited to participate in MSD's Mentorship Program

Participating as a mentor, a mentee (or both) allows you the opportunities to establish and cultivate relationships that match your desired level of participation. Connecting one-on-one, providing/receiving support and guidance and engaging with medical professionals will benefit you at all times of your medical career.

Please take a few minutes to complete this brief survey so we can enroll you in the program and get started.

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* I am interested in being:

Mentor

Mentee

Both

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* I am interested in being a part of the MSD Mentorship Work Group to help plan activities, match mentors with mentees and provide support to this program

Yes

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* Name

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* Medical Specialty

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* Please choose the appropriate status

Medical Student

Resident/Fellow

Physician (actively practicing)

Physician (retired, emeritus)

Other (please specify)

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* Graduation/training dates

medical school graduation year

residency/fellowship completion year

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* Location of practice/training

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* Scope of Practice/Area of Practice

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* Preferred method(s) of communication (check all that apply)

Text

Phone Call

In-Person

Other (please specify)

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* Preferred interval of communication

weekly

monthly

quarterly

yearly

as scheduled basis

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* Hometown

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* Please check all mentoring topics that are of interest to you.

General Career Support & Guidance

Contracts/Salary Negotiations

Job Searching/Interviewing

Onboarding

Academia/Teaching/Working in education

Path to Roles in Administration

Leadership Skills

Health Promotion

Disease Prevention

Patient Education

Motivational Interviewing

Plan of Care Adherence Tips

Cultural Competency

Health Literacy

Communication Styles

Performance Measurement and Metrics

Performance/Productivity

Quality Metrics

Personal Effectiveness/Time Management

Work/Life Balance

Networking

Practice Ownership (getting started, supervision, hiring)

Professional Relationships with Peers or Supervisors

Research and Publishing (conducting research, getting published)

Stress Management

Life in Delaware, Moving to Delaware, Transition support if leaving the state

Personal Financial Guidance

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* Professional/Medical interests (top 3)

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* Personal Interests (top 3)

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* Please provide your contact information so we may contact you regarding next steps.

Email Address

Phone Number