OPPA Mentoring Network - MENTORS

Mentor Application

Thank you for volunteering to make a difference in the lives of medical students and psychiatrists by serving as a mentor for OPPA's Mentorship Network.

Typically, mentors are senior leaders in a particular area, however, they may be only modestly more advanced than a mentee. OPPA's Mentoring Network provides an opportunity for medical students, residents, fellows, early career psychiatrists and general members to connect with an OPPA member who would like to share their knowledge, experience, and support as a mentor.

Mentoring is a reciprocal and collaborative process or relationship in which a more experienced person (Mentor) provides guidance, support, and encouragement to a less experienced person (Mentee). It is a relationship-based, trusted professional activity, grounded on commonality, consideration, and confidentiality and a meaningful commitment to promote the mentee’s growth, learning, and career development.

In order to match OPPA mentors with potential mentees, we appreciate your thoughtful responses to the following questions.

Question Title

* 1. Please indicate your level of training/experience:

Resident

Fellow

Early Career Psychiatrist (first eight years following completion of a training/fellowship program)

9 - 15 years

16 to 25 years

26 to 35 years

More than 35 years

Comments

Question Title

* 2. What is (or was if retired) your practice setting (select all that apply):

Academic

Collaborative care

Inpatient hospitalization

Community mental health center

Jail/prison

Private practice

State hospital

Telepsychiatry

Transitioning from residency into practice

Veteran's Administration

Other (please specify)

Question Title

* 3. In what area(s) of focus would you be interested in serving as a mentor (select all that apply)?

Academic

Addiction

Advocacy

Child and adolescent

Clinical care

Collaborative care

Community

Consult liaison

Forensic

General

Geriatrics

Jails/prisons

Leadership

Transitioning from residency into practice as an attending

Other (please specify)

Question Title

* 4. Please indicate if you have a preference for the training and experience level of the mentees you would like to mentor (check all that apply):

Medical Student

Resident

Fellow

Early career (in the first eight years following the completion of a residency or fellowship program)

General members who have been out of training for between 9 and 15 years

General members who have more than 15 years of experience

I am interested in mentoring any mentee if the fit seems appropriate

Comment

Question Title

* 5. Please indicate what you expect and/or are looking for in a mentee?

Question Title

* 6. Please indicate your preferred method(s) of mentoring (check all that apply):

In-person

Phone

Videoconferencing

Other (please specify)

Question Title

* 7. What is the maximum number of mentees you would prefer to mentor at any one time?

One

Two

Three

Four or more

Comment:

Question Title

* 8. How much time are you willing to devote to mentoring a mentee?

One to two hours per week

More than two hours per week

One to two hours per month

More than two hours per month

However much time my mentee and mentor agree upon

Undecided at this time

Question Title

* 9. Availability - days/times when you are typically available for mentoring (check all that apply):

Weekdays (9 a.m. to 5 p.m. Eastern)

Weekday evenings (5 p.m. to 9 p.m. Eastern)

Saturday (prior to Noon)

Saturday (between Noon and 5 p.m.)

Saturday (5 p.m. to 9 p.m.)

Sunday (prior to Noon)

Sunday (between Noon and 5 p.m.)

Sunday (5 p.m. to 9 p.m.)

Comment:

Question Title

* 10. What is your current practice status?

Full-time practice

Part-time practice

Semi retired

Retired

Other (please specify)

Question Title

* 11. What specific goal(s) do you hope to achieve in serving as a mentor?

Question Title

* 12. Name :

Question Title

* 13. Title (optional):

Question Title

* 14. Academic affiliation (if any):

Question Title

* 15. Email (if possible, please provide a personal email rather than an institutional email, which most often do not allow messages to get past a firewall):

Question Title

* 16. Phone number (including area code):

Question Title

* 17. Zip code, city, and/or area of state where you practice/live:

Question Title

* 18. Are you an IMG?

Yes

Question Title

* 1. Please indicate your level of training/experience:

Question Title

* 2. What is (or was if retired) your practice setting (select all that apply):

Question Title

* 3. In what area(s) of focus would you be interested in serving as a mentor (select all that apply)?

Question Title

* 4. Please indicate if you have a preference for the training and experience level of the mentees you would like to mentor (check all that apply):

Question Title

* 5. Please indicate what you expect and/or are looking for in a mentee?

Question Title

* 6. Please indicate your preferred method(s) of mentoring (check all that apply):

Question Title

* 7. What is the maximum number of mentees you would prefer to mentor at any one time?

Question Title

* 8. How much time are you willing to devote to mentoring a mentee?

Question Title

* 9. Availability - days/times when you are typically available for mentoring (check all that apply):

Question Title

* 10. What is your current practice status?

Question Title

* 11. What specific goal(s) do you hope to achieve in serving as a mentor?

Question Title

* 12. Name :

Question Title

* 13. Title (optional):

Question Title

* 14. Academic affiliation (if any):

Question Title

* 15. Email (if possible, please provide a personal email rather than an institutional email, which most often do not allow messages to get past a firewall):

Question Title

* 16. Phone number (including area code):

Question Title

* 17. Zip code, city, and/or area of state where you practice/live:

Question Title

* 18. Are you an IMG?

Question Title

* 19. Brief bio:

Question Title

* 20. Please share any additional information or experiences that might be relevant to your role as a mentor: