AIUM Mentor Program Survey

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* 1. Please provide your contact information.

Name: *

Title: *

Educational Institution/Practice Name: *

Specialty: *

City/Town: *

State:

Email Address: *

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* 2. Are you currently associated with a local medical school?

Yes

If yes, please specify name of school. If no, would you consider working with one nearby?

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* 3. Would you be willing to serve as a mentor for medical students or residents?

Yes

Maybe

Comments:

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* 4. There are many ways to teach ultrasound within the medical school curriculum. Please indicate the ways in which you could see yourself contributing. You may choose more than one.

Champion – Creating and organizing an educational curriculum, scheduling lecture and hands on sessions, teaching, working with administration and overseeing the course.

Co-Champion – As above but would prefer to divide activities between two or three champions.

IT Expert – Help with creating, updating, and uploading to course website

Small Group Instruction – Run cases and probe time in small groups

Lecturer – Classroom lecturer to medical students or create a recorded lecture that could be posted to a course website

Hands On Instructor – Help lead probe time with several other instructors

Advocate – Work with medical school administration to promote US integration into the medical curriculum.

Coffee with an Expert – Meet with medical students to discuss ultrasound over coffee or lunch.

Mentor – Provide individual advice/guidance to a medical student or resident

Other (please specify)

Questions 5-9 inquire about financial aspects of compensated medical student ultrasound instruction. This information will be collated and available to medical schools on an aggregate basis rather than on an individual basis. Individuals responses to these questions will not be released.

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* 5. Would you consider teaching ultrasound to medical students on a volunteer basis?

Yes

Comments:

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* 6. Would you consider teaching ultrasound to medical students if compensated?

Yes

Maybe

Comments:

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* 7. What is the maximum number financially UN-compensated hours you would volunteer each month?

1-2 hours

2-4 hours

4-6 hours

6-8 hours

8-10 hours

10-14 hours

15+ hours

Comments:

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* 8. “Theoretically”, if compensation from the medical school is possible, what is the maximum number financially compensated hours you would commit to each month?

1-2 hours

2-4 hours

4-6 hours

6-8 hours

8-10 hours

10-14 hours

15+ hours

Comments:

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* 9. For the above mentioned compensated hours (in question #8), what would be the expected compensation:

2% clinical time

4% clinical time

6% clinical time

8% clinical time

10% clinical time

15% clinical time

20% clinical time

Other (please specify)

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* 10. Would it be acceptable for AIUM to give your contact information to a medical school in your region?

Yes

If yes, please provide your phone # or e-mail address (whichever is your preferred method of contact)

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* 11. Ultrasound integration into the medical student curriculum is a complex, fluid, yet to be standardized process and we welcome any further comments or suggestions. Thank you for your interest in the AIUM Mentor Program. A member of the subcommittee with be in touch with you in the next few weeks.

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* 12. Do you give permission for your name and email address to be posted as a mentor volunteer on the Ultrasound in Medical Education Portal website?

Yes

Other (please specify)