Survey for Physicians in Study Group

Form Approved _______

OMB No_____________

Exp. Date xx/xx/20xx___

Survey for Physicians in Study Group (EIS and PMR Alumni)

(EIS and PMR Graduates)

Public reporting burden of this collection of information varies from 20 to 40 minutes with an estimated average of 30 minutes per response, 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920- XXXX)

Question Set 1. Survey for Physicians in Study Group (EIS and PMR Alumni)

(EIS and PMR Graduates)

(Note: This will be electronic so the spaces for answers will be longer)

1. Demographics

P-Study-A1. What is your primary work affiliation? (check only one)

Government:		Medical Care Setting:
	CDC		Private Practice
	Other HHS Agency		HMO
	Other Federal Agency		Private Hospital/Clinic
	State Health Dept./Govt.
	Local Health Dept./Govt.
	International Health Agency/Govt.
Academic:		Others:
	Medical School		Foundation/Association
	School of Public Health		Industry
	Other Academic Institution		Private Business (other than patient care)
	Residency, Fellowship, Grad Study		Other
	What specialty____________________		Please specify______________

P-Study-A2. What is your primary job title (e.g., staff epidemiologist, activity chief, division director, staff physician, medical director, associate professor, agency director, chief executive officer).___________________________

P-Study-A3. How long have you worked in this position? _____ year(s) ______ month(s)

P-Study-A4. What is your primary responsibility within your organization?

a. Technical/Scientific staff

b. Clinician

b. Manager/ Leader

c. Senior Manager/Senior Leader

f. Other (Please specify)

P-Study-A5. Was this your first position since graduating from PMR/F?

1. Yes

2. No

If Yes, skip to A17

If No, go to A6

P-Study-A6. What was your previous position and work affiliation? ____________________________

P-Study-A7. How long had you worked in this position? _____ year(s) ______ month(s)

P-Study-A8. What was your primary responsibility within your organization?

a. Technical/Scientific staff

b. Clinician

b. Manager/ Leader

c. Senior Manager/Senior Leader

f. Other (Please specify)

P-Study-A9. Was this your first position since graduating from PMR/F?

1. Yes

2. No

If Yes, skip to A17

If No, go to A10

P-Study-A10. What was your previous position and work affiliation? __________________________

P-Study-A11. How long had you worked in this position? _____ year(s) ______ month(s)

P-Study-A12. What was your primary responsibility within your organization?

a. Technical/Scientific staff

b. Clinician

b. Manager/ Leader

c. Senior Manager/Senior Leader

f. Other (Please specify)

P-Study-A13. Was this your first position since graduating from PMR/F?

1. Yes

2. No

If Yes, skip to A17

If No, go to A14

P-Study-A14. What was your primary job title (e.g., staff epidemiologist, activity chief, division director, staff physician, medical director, associate professor, agency director, chief executive officer).___________________________

P-Study-A15. How long had you worked in this position? _____ year(s) ______ month(s)

P-Study-A16. What was your primary responsibility within your organization?

a. Technical/Scientific staff

b. Clinician

b. Manager/ Leader

c. Senior Manager/Senior Leader

f. Other (Please specify)

P-Study-A17. Please select the statement that best describes the function of your current position.

1. I spend more than 50% of my work time on work that contributes to the health of a population

2. I spend more than 50% of my work time taking care of patients

3. I spend more than 50% of my work time in some other role

P-Study-A18. Do you administer or manage a public health, community health, or preventive medicine program, department, or agency?

1. Yes

2. No

If Yes, go to A17

If No, skip to B1

P-Study-A19. How many staff are in the department/group that you manage?___________

P-Study-A20. How large is the budget that you administer or manage?______________

P-Study-A21. What is the size of the population served by your program?________________

B. Education

P-Study-B1. What year did you graduate from medical school? ___________

P-Study-B2. Did you complete a residency before graduating from EIS? ________________

a. Yes

b. No

If Yes, go to B3

If No, Skip to B4

P-Study-B3. What was your area of specialty during the residency you completed? _______

P-Study-B4. Did you obtain your MPH or equivalent degree prior to entering EIS?

1. Yes

2. No

If No, Go to B5

If Yes, Skip to B11

P-Study-B5. Were you provided funding from CDC for full time MPH studies?

1. Yes, from CDC’s PMR/F

2. Yes, from another CDC center

3. No

If A, Go to B6

If B or C, Skip to B11

P-StudyB6. Where did you obtain your MPH?

a. Emory

b. Other, please specify_____________

P-Study-B7. Were you offered a choice of school by the residency to obtain your MPH?

1. Yes

2. No

3. Not applicable. Comment:___________

P-Study-B8. Would you have chosen another school if you had the option?

1. Yes

2. No

If Yes, go to B9

If No, Skip to B11

P-Study –B9. Why? ___________

P-Study-B10. What school would you have preferred to attend? ___________________

P-Study-B11. What years were you in EIS?

1. 1990-1992

2. 1991-1993

3. 1992-1994

4. 1993-1995

5. 1994-1996

6. 1995-1997

7. 1996-1998

8. 1997-1999

9. 1998-2000

10. 1999-2001

11. 2000-2002

12. 2001-2003

13. 2002-2004

14. 2003-2005

15. 2004-2006

P-Study-B12. What was your assignment site during EIS?

a. CDC or other Federal Agency

b. State, County, or Local Health Department

P-Study-B13. What was your motivation for applying to CDC’s PMR/F?

Motivation to Apply to PMR/F	SA	A	Neutral	D	SD	NA
Leadership training
Develop public health policy
Opportunity to learn public health practice in different settings
Learn program management and evaluation
Train in the specialty of preventive medicine
Support for MPH
Other (Please specify)_____________

KEY: Strongly Agree (SA), Agree (A), Neutral (N), Disagree (D), and Strongly Disagree (SD),

(N/A) - Did not take this component of the practicum

P-Study-B14. What years were you in your PMR/F Practicum year?

1. 1996-1997

2. 1997-1998

3. 1998-1999

4. 1999-2000

5. 2000-2001

6. 2001-2002

7. 2002-2003

8. 2003-2004

9. 2004-2005

10. 2005-2006

11. 2006-2007

P-Study-B15. What was your assignment site during your PMR/F Practicum year?

a. CDC or Other Federal Agency

b. State, County, or Local Health Department

P-Study-B16. Did you take the American Board of Preventive Medicine (ABPM) Board exam?

a. Yes

b. No

If Yes, go to B17

If no, skip to B20

P-Study-B17. When did you sit for the board exam that you passed?

1. 1996

2. 1997

3. 1998

4. 1999

5. 2000

6. 2001

7. 2002

8. 2003

9. 2004

10. 2005

11. 2006

12. 2007

13. Other, Please specify_______________

P-Study-B18. What influenced your decision to take the board exam? ___________________

P-Study-B19. To what degree did the educational focus of PMR/F contribute to your preparation for taking the board exam?

1. Strongly agree

2. Agree

3. Neutral

4. Disagree

5. Strongly disagree

Skip to C1

P-Study-B20. What influenced your decision to NOT take the board exam? _______________

C. Leadership

P-Study-C1. Does PMR/F fulfill its mission of developing Public Health Leaders? SA-A-N-D-SD

P-Study-C2. Please indicate whether and in what capacity you perform these leadership skills and how well your CDC training prepared you to perform these skills?

Leadership Skills and Functions	C2.1. Did EIS provide you with the foundation to develop this skill? SA-A-N-D-SD	C2.2. Did PMR/F provide you with the foundation to develop this skill? SA-A-N-D-SD	C2.3. Do you perform this function in your current position? Yes/No If yes, go toC.2.4 --> If no, go to C.3 (below)	C2.4. If Yes, What is your most senior role in this capacity: Participant Lead Executive Oversight
a. Identifying public health priorities and setting goals and objectives for an organizational unit
b. Identifying capacity and responsibilities and implementing strategies to achieve public health goals and priorities for an organizational unit
c. Building strategic alliances with internal and external partners to address public health priorities
d. Building and maintaining the organization’s capacity to achieve goals and objectives
e. Providing leadership and direction for the development  and evaluation of policies, procedures, and performance standards within an organization and among collaborating agencies
f. Planning, implementing and evaluating PH/PM programs
g. Setting mission and direction for your organizational unit

KEY: Strongly Agree (SA), Agree (A), Neutral (N), Disagree (D), and Strongly Disagree (SD),

(N/A) - Did not take this component of the practicum

P-Study-C3. What recommendations do you have for the PMR/F curriculum for developing PH/PM leadership skills for now and for the future? _______________________________

D. Relevancy and Preparation

P-Study-D1. Select the responses that best represent PMR/F’s relevancy to your current professional activities.

PMR/F Major Training Activities	D1.1. This component of the PMR/F curriculum prepared me for my current professional activities. (SA-A-N-D-SD-NA)	D1.2. This component of PMR/F curriculum is relevant to general, current PH/PM practice. (SA-A-N-D-SD-NA)	D1.3. I frequently use the skills achieved through this component of training. (SA-A-N-D-SD-NA)	D1.2.3 This component of the curriculum helped me to develop leadership skills. (SA-A-N-D-SD-NA)
Classroom leadership and management training
On-the Job leadership training
Policy development
Program evaluation
Project management
Community interventions
Grant proposal development or review
Occupational and environmental medicine training
Week-long congressional visit to Washington
Train-the-Trainer course and teaching in the EIS course
Attending a national PH/PM conference
Mentoring received at a practicum site
Working at a different type of public health agency from the assignment in EIS (either local, state, or federal level)

KEY: Strongly Agree (SA), Agree (A), Neutral (N), Disagree (D), and Strongly Disagree (SD),

(N/A) - Did not take this component of the practicum

P-Study-D2. What topics or activities could be improved, and how? ____________________

P-Study-D3. What areas or topics should be de-emphasized? _____________

P-Study-D4. What additional topics or training should be included in the curriculum, and why?____

P-Study-D5. What topics or training should be removed from the curriculum, and why? _________

P-Study-D6. What suggestions do you have for improving the curriculum overall?______

E. Contributions to PH/PM

P-Study-E1. Since you graduated from PMR/F, how many of the following have you written and published in the field of public health and/or preventive medicine?

1. Books ____

2. Book-chapters ____

3. Papers in peer-reviewed journals ____

4. Abstracts in peer-reviewed journals ____

5. Publications for lay audiences ____

P-Study-E2. Have you held an office in a professional association since graduating from PMR/F?

a. Yes

b. No

If Yes, go to E3

If no, skip to E4

P-Study-D3. In which professional associations have you held office since graduating from PMR/F?

E3.1 Professional Association	E3.2 Office(s) held	E3.3 Year(s)
a.
b.
c.

P-Study-E4. What would you describe as your most important contribution(s) or accomplishment(s) to the field of public health and/or preventive medicine? _________________________________

P-Study-E5. Have you served as a subject matter expert on public health/ preventive medicine issues? (Example: before legislative bodies, senior leadership in organizations, and lay groups/audiences)

a. Yes

b. No

If Yes, go to E6

If no, skip to F1

P-Study-E6. Please Specify: _____________________

F. Added Value

P-Study-F1. Did the PMR/F add value in preparing you for your job(s) post PMR/F compared to your preparation before PMR/F?

a. Yes

b. No

If Yes, go to .F.1.a

If no, skip to F2

F.1.a-i check all that apply:

1. Made me more competitive as an applicant due to having field and headquarters experience.

2. Allowed me to assume leadership responsibilities sooner than if I had not completed PMR/F.

3. Made me more confident that I could perform the job duties because of the knowledge, skills, and behaviors I learned during PMR/F.

4. Increased my understanding of the larger systems and skills, beyond epidemiology, involved in planning PH/PM interventions.

5. Made me more knowledgeable about programmatic and policy issues and factors that influence them.

6. Made me more knowledgeable of public health practice skills.

7. Made me more knowledgeable about my leadership and management style.

8. Made me a better leader.

9. Other (please specify)__________________________

P-Study-F2. Would you recommend the CDC PMR/F to others?

1. Yes

2. No

3. Not sure

P-Study-F3. If you could do it over again, would you apply to PMR/F?

1. Yes

2. No

3. Not sure

P-Study-F4. Why or why not? ___________________

P-Study-F5. Are their any gaps between the PMR/F curriculum and the knowledge and skills required to practice public health and preventive medicine now and in the future?

G. Optional Questions

P-Study-G1. What is your sex?

a. Male

b. Female

P-Study-G2. What is your ethnicity?

a. Hispanic or Latino

b. Not Hispanic or Latino

P-Study-G3. What is your race? (Select one or more)

a. American Indian or Alaska Native

b. Asian

c. Black or African-American

d. Native Hawaiian or other Pacific Islanders

e. White

EXTRA Questions for physicians and veterinarians in Reference Groups only. Will not be asked of anyone else

P-Study -X1. This question is N/A for this group.

P-Study -X2. This question is N/A for this group.

P-Study -X3. This question is N/A for this group.

P-Study -X4. This question is N/A for this group.

P-Study-X5. This question is N/A for this group.

P-Study-X6. This question is N/A for this group.

P-Study –X7. This question is N/A for this group.

P-Study-X8. This question is N/A for this group.

P-Study-X9. This question is N/A for this group.

P-Study-X10. This question is N/A for this group.

END