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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Age in years

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* 5. Gender (optional)

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* 6. Race – Please check all which apply (optional)

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* 7. In what country do you work?

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* 8. If you answered the United States for Question 7, please indicate in what state or U.S. territory you currently work.

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* 9. Level of Training

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* 10. Current/future occupation

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* 11. Current/future subspecialty(ies) – Please check all which apply

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* 12. How many ACC CardioNerds Narratives recordings have you watched prior to this one? (1-18)

For each of the following questions, please select the single best answer.
Diversity

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* 13. A more diverse cardiovascular medicine workforce would lead to better patient care.

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* 14. I feel that diversity of the cardiovascular medicine workforce is adequate.

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* 15. I feel that my program/place of work values diversity among the workforce.

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* 16. I feel comfortable openly discussing or asking others about factors that make them different from myself like their race, religion, ethnicity, gender, sexual orientation, immigration status, etc.

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* 17. I feel comfortable openly discussing factors that make me different from others like race, religion, ethnicity, gender, sexual orientation, immigration status, etc.

Cardiology

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* 18. I feel that cardiology as a field is accommodating of good work-life integration.

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* 19. I feel that I have adequate opportunity for mentorship and professional development in cardiology.

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* 20. I would be likely to choose cardiology as a career going forward (if you are pre-cardiology fellowship) or choose cardiology again if given another opportunity (if you are already in training or practicing).

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* 21. Please add any additional comments.

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