Form 9 NIH NMA Feedbacl Form

OMB #0925-0748
Expiration Date 12/2019
NIH/NMA Feedback Form
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Academic Career Development Workshop

* 1. Overall impression of the following:
Poor

Fair

Good

Very Good

Excellent

N/A

The Academic Career
Development Workshop
Interaction with research
scientists and
academicians
The panel discussions
The small group
discussions with faculty
Meeting materials and
handouts
Overall communication
from NIDDK
Travel support

* 2. Additional comments regarding your overall experience with the above components of the program:

* 3. Please rate the quality of the components of the Academic Career Development Workshop.
Poor
Executive Skills in
Academic Medicine,
Speaker
Introduction to NIH
Funding Mechanisms
and Opportunities:
Support for Early Years
in Academia & the NIH
Loan Repayment
Program,
Speaker
Academic Career
Development
Opportunities at NIH: A
Panel Discussion.
Speaker(s)
Navigating the NIH
Grant Application and
Review Processes,
Speaker
Mentees, Mentors and
Mentorship,
Speaker(s)
Perspectives on Career
Development,
Speaker
Small Group
Discussions with
Extramural Faculty
Physician Wellbeing,
Speaker
Veteran's
Administration and
Funding a Research
Center,
Speaker
Women in Medicine and
Research: A Balancing
Act,
Speaker

Fair

Good

Very Good

Excellent

* 4. Listed below are the major topic areas discussed during the program. Given where you are currently in
your career, rate how important the following topic areas are to you:
Least Important

Somewhat Important

Important

Very Important

Career development
strategies
Time management
strategies
How to network
effectively
Effective communication
and negotiation skills
How to identify
appropriate NIH funding
opportunities
Components and
applying to NIH funding
opportunities
Strategies to balance
work and family

* 5. What other topic areas would be particularly useful for you that was not covered during the workshop?

* 6. What components of the Academic Career Development Workshop did you think were most helpful?

* 7. What components of the Academic Career Development Workshop did you think were least helpful?

* 8. What components of the Academic Career Development Workshop would you change and how?

* 9. Overall, did the workshop meet your expectations?
Below expectations
Met expectations
Exceeded my expectations

* 10. How likely are you to pursue a career in academic medicine?
Unlikely
Somewhat Unlikely
Undecided
Somewhat likely
Extremely likely

* 11. How would you rate the influence of the Academic Career Development Workshop on your previous
response?
Very little influence
Some Influence
Great deal of Influence
Unsure

12. Any other comments?

Research Funding & Membership

* 13. To date, have you been supported by an NIH grant or contract?
Yes
No

* 14. Have you ever applied for an NIH funding opportunity but were not awarded?
Yes
No

* 15. Are you a member of the National Medical Association?
Yes
No

* 16. Does participation in this workshop make you more likely to become a member if not a member
already?
Yes
No

Demographic Information

* 17. How would you classify your current career status?
Resident
Fellow
Instructor
Assistant Professor
Post-doctoral Researcher
Other (please specify)

* 18. What is your primary specialty?

* 19. How would you describe your gender?
Male
Female
Prefer not to answer
Other (please specify)

* 20. Which of these best describes your ethnicity (choose one)?
Hispanic or Latino
Not Hispanic or Not Latino

* 21. Which of these best describes your race (choose one or more)?
African American/Black
American Indian/Alaska Native
Asian
Native Hawaiian/Pacific Islander
White
Other (please specify)

Thank you for your feedback! Your input will help to improve future NIH-NMA Academic Career
Development Programs.