Speed Mentorship Enrollment HM16

The Society of Hospital Medicine will hold a "Speed Mentorship Activity" for academic hospitalists at SHM's HM16 annual meeting on March 7, from 12:00-1:00 pm. It is open to the first 25 people who complete this survey. You will receive a confirmation email with more details in the coming weeks.

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Please provide your contact information.

Name

Organization

Email address

Phone number

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* Please select the title that is closest to yours:

Instructor

Assistant professor

Associate professor

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* How many years have you been in your current role?

Less than 1

1-2

2-3

More than 3 years

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* Please mark your area(s) of interest:

Education - skill development

Education - research and scholarship

Research - clinical

Research - health services

Research - basic science

Research - translational

Administration - leadership

Quality improvement and patient safety

Question Title

* Please provide 2 specific questions that you would like to have addressed through this session. This will greatly enhance the value of your conversation with your mentor. If you are a researcher seeking mentorship on a research project, please include a statement of research aims or goals.

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* Please provide your contact information.

Question Title

* Please select the title that is closest to yours:

Question Title

* How many years have you been in your current role?

Question Title

* Please mark your area(s) of interest:

Question Title

* Please provide 2 specific questions that you would like to have addressed through this session. This will greatly enhance the value of your conversation with your mentor. If you are a researcher seeking mentorship on a research project, please include a statement of research aims or goals.

Question Title

* Please copy and paste a brief bio or CV in the space below.

*
Please provide your contact information.