4 Cep

Activity:

Clinical Electives Program Alumni

Site:

National Institutes of Health

Period:
Time Period:
Request Date:
Evaluation Type:

Clinical Electives Program Alumni Survey

Evaluator:
Participation Dates:

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No

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Clinical Electives Program Alumni Survey (OMB # 0925-0602; expires
8/31/2012)
Please take a few minutes to complete the survey below, which will ask about your
current professional experiences and other accomplishments. It will also invite you
to retrospectively evaluate your training program and serve, if you are agreeable, to
be a resource or advisor to current and future trainees in your program.
Through this survey, the NIH Office of Clinical Research Training and Medical
Education (OCRTME) is collaborating with your program to (a) identify opportunities
that will enhance the clinical research training we provide and (b) stay better
connected with you and the other graduates of our clinical training programs.
Please note that the information you share with us will only be accessible to
authorized OCRTME staff. When reported external to the office as part of our quality
improvement process, all feedback will be anonymous and reported in the
aggregate.
Thank you for helping us to improve and stay connected.
**If you are accessing this survey at the NIH or another Federal institution, Network
restrictions may prevent you from copying and pasting text directly from Office
documents into this survey via Microsoft Internet Explorer. Please use Google
Chrome or Mozilla Firefox as alternatives to enable copy and paste functions.
Burden Disclosure Statement: Public reporting burden for this collection of
information is estimated to average 20 minutes per survey, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining

the data needed, and completing and reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number.
Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974,
ATTN: PRA (0925-0602). Do not return the completed form to this address.
To review the NIH/E*Value Privacy Act Notification Statement, please click here
Are you using a different name than the one you used during training (stated at the
top of this survey)? (Question 1 of 17 )
Yes
No

If you are using a different name than the one you used during training, please state
the name you are currently using. (Question 2 of 17 )
If you are using a different name than the one you used during training, please state the
name you are currently using.

Preferred e-mail address

(Question 3 of 17 )

Preferred e-mail address

Alternate e-mail address

(Question 4 of 17 )

Alternate e-mail address

If you participated in a clinical elective(s), please select the appropriate clinical
elective(s). Please check all that apply. If you completed a research tutorial, please
mark "I participated in a research tutorial, not a clinical elective." (Question 5 of 17
- Mandatory )
Selection

Option
Alcoholism
Cardiology
Clinical Pharmacology and Therapeutics for Senior Medical Students
Critical Care Medicine

Endocrinology and Metabolism
Gynecology Consult Service
Hematology
Health Services
Hepatology
Infectious Diseases
Interdisciplinary Women's Health
Internal Medicine Consult Service
Medical Informatics
Medical Oncology
Neurology/Neuroscience Research
Neurosurgery
Nuclear Medicine
Otolaryngology—Head and Neck Surgery
Pain and Palliative Care
Pathology
Pediatric Consult Service
Pediatric Endocrinology
Pediatric Oncology
Pediatric Psychopharmacology
Radiation Oncology
Rehabilitation Medicine
Rheumatology
Sickle Cell Anemia
Surgical Oncology
Transfusion Medicine
Urologic Oncology
I participated in a research tutorial, not a clinical elective.

If you participated in a research tutorial, please let us know the name of your research
preceptor and Institute or Center. (Question 6 of 17 )

What professional degrees do you hold? Please check all that apply.
(Question 7 of 17 - Mandatory )
Selection Option
MD
MD/PhD
DO
DDS
Other

(Question 8 of 17 - Mandatory )
What is your current training status? Institution

Specialty
(if applicable)

Residency
Fellowship

What is your current professional status?

(Question 9 of 17 - Mandatory )

Trainee PGY-1
PGY-2
PGY-3
PGY-4
PGY-5 or above
NIH Fellow/Staff Clinician/Investigator
Other Government Agency
Pharmaceutical Industry
Other research
Private Practice
Other

Are you currently performing clinical and/or translational research?
(Question 10 of 17 - Mandatory )
Yes
No

(Question 11 of 17 - Mandatory )
What degree of impact did your

No

Little

Some

Much

Considerable

clinical elective or research
tutorial at NIH have on your:

Impact Impact Impact Impact

Impact

Obtaining a residency or
fellowship position through the Match
Clarifying academic goals
Clarifying professional goals
Performing successfully in an
academic or research setting
Competing successfully for
desired professional or academic
opportunities
Networking with key individuals
in field
Desire to pursue
residency/fellowship training at the
NIH

(Question 12 of 17 - Mandatory )
No
Impact

Little
Impact

Some
Impact

Much
Impact

Considerable
Impact

Because of your clinical elective
or research tutorial, how likely
are you to pursue your
interest in clinical research?

(Question 13 of 17 - Mandatory )
Unlikely

Somewhat
Likely

Likely

How likely are you to recommend NIH's Clinical Electives
Program to prospective clinical
research-oriented applicants?

What were the best parts of your clinical elective or research tutorial at the NIH?
(Question 14 of 17 )

What was missing from or could have improved your clinical elective or research
tutorial? (Question 15 of 17 )

If you could start your clinical elective or research tutorial again from the beginning,
would you choose the NIH? (Question 16 of 17 - Mandatory )
Yes
No

Please provide any additional comments about the NIH Clinical Electives Program.
(Question 17 of 17 )

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