VMS Peer-to-Peer Support Network:
Peer Mentor Agreement
The Vermont Medical Society realizes that during this time medical practitioners are under a lot of stress. In order to provide the best care for patients, health care professionals need to first take care of themselves. VMS has organized a network of support via a Peer-to-Peer model between VMS member volunteers (often retired or semi-retired members) and physicians & physician assistants who are treating patients amidst the COVID-19 pandemic.
What could this look like?
A regularly scheduled phone call or video chat between you and a practitioner who has expressed need. Flexibility and confidentiality is required.
A Peer Mentor would need to maintain a willingness to just listen and not judge what they hear.
A Peer Mentor should offer practical or personal advice when appropriate, based on their experience as a health professional.
These informal conversations should be a safe, positive space held for practitioners who may want to share what’s been happening since the outbreak began and are looking for guidance or community when practicing during these unique situations.
1.
Are you volunteering to be a Peer Mentor?
Yes
No
Other (please specify)
2.
What is your first name?
3.
What is your last name?
4.
What is your preferred phone number?
5.
What is your preferred email address?
6.
What is your preferred contact method?
Phone call
Email
Video chat
Other (please specify)
7.
Your County?
8.
Your Specialty?
9.
What are the preferred days and times for you to be contacted? Check all that apply.
Weekday mornings
Weekday afternoons
Weekday evenings
Weekend mornings
Weekend afternoons
Weekend evenings
Other (please specify)
10.
Will you allow Vermont Medical Society employees to share your contact information with VMS members interested in connecting with peer support? (Interested VMS members would contact you directly and you will be responsible for arranging between yourselves mutually convenient times, methods and frequency of communication).
Yes
No
Other (please specify)
11.
We ask all Peer Mentor volunteers to respect the following guidelines.
Do you agree to participate as a Peer Mentor, fully acknowledging that this initiative is NOT….
A clinical counseling service
A ‘helpline’
An opportunity to provide legal or detailed practice management advice
An opportunity to assist in diagnosing or treating patients
Yes
No
12.
Do you have additional questions, comments, or concerns for Vermont Medical Society staff?
Vermont Medical Society - 134 Main Street - Montpelier, VT, 05601
(802) 223-7898 - ealessi@vtmd.org
Visit
www.vtmd.org
for additional COVID-19 resources
