4 Rep

Activity:

Resident Electives Program Survey

Site:

National Institutes of Health

Period:
Time Period:
Request Date:
Evaluation Type:

Resident Electives Program Participant Survey

Evaluator:
Participation Dates:

Do you want to use auto-scrolling on this evaluation?

Yes

No

Click this link to mark this evaluation as not applicable: Suspend

Resident Electives Program Participant 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 16 )
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 16 )
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 16 )

Preferred e-mail address

Alternate e-mail address

(Question 4 of 16 )

Alternate e-mail address

Please select the clinical elective(s) in which you participated. Please check all that
apply. (Question 5 of 16 - Mandatory )
Selection

Option
Allergy and Immunology
Cardiology
Critical Care Medicine
Endocrinology and Metabolism
Endocrine Oncology (Surgical)

Hematology
Hematopathology
Infectious Diseases
Medical Oncology
Neurology
Pain and Palliative Care Medicine
Pathology
Pediatric Oncology
Reproductive Endocrinology and Infertility
Rheumatology
Transfusion Medicine

What professional degrees do you hold? Please check all that apply.
(Question 6 of 16 - Mandatory )
Selection Option
MD
MD/PhD
DO
DDS
Other

(Question 7 of 16 - Mandatory )
Specialty

What is your current training status? Institution (if applicable)
Residency
Fellowship

What is your current professional status?
PGY-2
PGY-3
PGY-4
PGY-5 or above
NIH Fellow/Staff Clinician/Investigator

(Question 8 of 16 - Mandatory )

Other Government Agency
Pharmaceutical Industry
Other research
Private Practice
Other

Are you currently performing clinical and/or translational research?
of 16 - Mandatory )

(Question 9

Yes
No

(Question 10 of 16 - Mandatory )
What degree of impact did
your elective rotation at NIH
have on your:

No
Impact

Little
Impact

Some
Impact

Much
Impact

Considerable
Impact

Little
Impact

Some
Impact

Much
Impact

Considerable
Impact

Obtaining a fellowship position
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

(Question 11 of 16 - Mandatory )
No
Impact
What effect did your elective
rotation have on your interest to
pursue clinical research?

(Question 12 of 16 - Mandatory )
Unlikely

Somewhat
Likely

How likely are you to recommend NIH's Resident
Electives Program to other colleagues?

What were the best parts of your rotation at the NIH?

(Question 13 of 16 )

Likely

What was missing from or could have improved your rotation?

(Question 14 of 16 )

If you could start your rotation again from the beginning, would you choose the NIH?
(Question 15 of 16 - Mandatory )
Yes
No

Please provide any additional comments about the NIH Resident Electives Program.
(Question 16 of 16)

If you are satisfied with the evaluation, click the Submit button. Once submitted, you will no
longer be able to make changes to this evaluation.
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