PEM CRC New Survey ListServ Member

Member Demographic Survey (< 2 min)

Hi! Welcome to the PEM CRC Survey Listserv. We are collecting baseline demographic information from you to better characterize the Survey Listserv population in aggregate form. This helps our survey Investigators describe the population of participants! Thanks for your assistance.

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* 1. First Name

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* 2. Last Name

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* 3. Preferred Institutional Affiliation

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* 4. What is your preferred e-mail address for survey studies? (consider using a generic address - e.g. gmail / yahoo - if you anticipate switching institutions in the next 3 years)

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* 5. Geographical Region of Practice

Northeast U.S.

Midwest U.S.

South U.S.

West U.S. (including Alaska & Hawaii)

Canada

Other / International

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* 6. Primary Type of Training:

Pediatrics --> PEM Fellowship

Emergency Medicine --> PEM Fellowship

Pediatrics residency only

EM residency only

Dual EM-Peds residency

PEM - Grandfathered

Other Residency

Other Healthcare Professional training

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* 7. Current majority Practice Setting

Free-standing Children's Hospital

Children's Hospital within a General Hospital

Non-Children's Hospital

Urgent Care Center

Other

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* 8. Current majority Practice Setting

Urban

Suburban

Rural

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* 9. What is your current role?

in Residency now

in Fellowship now

Attending Physician - PEM

Advanced Practice Provider / Mid-level Provider

Non-PEM Practice or Retired

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* 10. Current Hospital Types of practice (select all that apply)

University-based / Academic

Community / Academi

Community