Attachment 1_SGI-SurveyQuestions_v2

OMB#0925-XXX Exp: XX-XXXX

Attachment 1: Summer Genetics Institute Alumni Survey Questions

Purpose of Survey and Consent

The National Institute for Nursing Research (NINR) at the National Institutes for Health is conducting this important survey to examine the extent to which the Summer Genetics Institute is achieving its long-term goals in research and clinical practice, so that changes to the program can be made as needed. All Summer Genetics Institute alumni are being asked to complete the survey.

Public reporting burden for this collection of information is estimated to average 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX). Do not return the completed form to this address. NINR will use the survey results to determine the extent to which the Summer Genetics Institute program is achieving its goals, and to make improvements to the program, as necessary. We will share the survey results with Summer Genetics Institute alumni in the future.

Your responses to this survey will be kept private to the extent permitted by law. Your personal identity will be protected. Data files will be stored securely so that outsiders cannot see them. Your answers will be collated with the responses of other participants and analyzed. No one will be identified in study reports or publications resulting from this survey which may be published or presented publicly.

NINR is authorized to conduct this survey under section 42USC 285q of U.S. Law.

Your participation is voluntary. You can choose to not answer questions and stop your participation at any time without consequence to you. We believe that your participation in the survey has very low risk of harm to you.

If you have questions about this survey or your participation, please contact Dr. Amanda Greene by email at [email protected] or by phone at (301) 496-9601.

By checking the Yes box, I acknowledge that I have read this statement and agree to participate in this survey. *

Yes, I accept

No, end the survey

Survey Instructions

* IMPORTANT *: The browser BACK button cannot be used while taking the survey. Because of the logical branching of the survey, it must be answered in sequence.

You will have an opportunity after completing the survey to edit your response.

If you cancel the survey at any time, you will be prompted to save your responses to edit at a later time or delete your responses.

Summer Genetics Institute Survey Questions:

1. What year did you attend the NINR Summer Genetics Program? ______________

Demographics

2. What is your current age?

30 years or less

31- 35

36 - 40

41 - 45

46 - 50

51- 55

56 - 60

61 - 65

66 years or more

3. What is your sex?

Male

Female

4. Are you Hispanic or Latino?

Yes

No

5. Please select the racial category(s) with which you most closely identify (select all that apply):

White

Black or African American

Native Hawaiian or other Pacific Islander

Asian

American Indian or Alaska Native

Decline to Respond

Education and Certifications

6. Please enter the date range (start and finish year) next to each degree completed (Leave blank if N/A):

Example: 1987-1991

Example: 1987-1991, 2001-2005

BA/BS: _________________

Masters: _________________

PhD: _________________

DrPH: _________________

DNP: _________________

MD: _________________

DDS: _________________

JD: _________________

Other (Please include degree name, Example: DVM 1979-1983): _________________

7. Please enter the year for each certificate you have obtained (Leave blank N/A):

Certified Genetic Counselor ______________

NP ______________

PA ______________

CNS ______________

Other (Please specify certificate and year) ____________________________

8. Are you an RN?

Yes

No

Work/position History

9. What is your current employment or educational position (select all that apply)?

Unemployed

Scientist at research institute

Scientist for federal, state or local government

US military or Commissioned Corps

Faculty appointment

Clinician (provide direct patient care such as RN, NP, CNS, MD, DDS, Psychologist)

Pre-doctoral position

Post-doctoral position

Self-employed

Student

Other (Please specify) ____________________________

10. Is your principal employer a:

(Unemployed)

Dental school
Engineering school
Medical school
Nursing school
School of public health
Other university school or department
University-affiliated research center or research institute
Non-profit research center or institute not affiliated with a university

For-profit research center/institute or organization not affiliated with a university

Other employer (Please specify type) ____________________________

11. What percent of your current time at work is spent on research? ___________%

12. What percent of your current time at work is spent on teaching in an academic program? ___________%

13. What percent of your current time at work is spent on direct patient care including counseling? ___________%

14. What percent of your current time at work is spent as a health care manager / administrator? ___________%

15. After attending the Summer Genetics Institute, were you accepted into a fellowship, postdoctoral, or traineeship program?

Yes

No

Yes – Answer question 15a-c

No – Skip to question 16

15a. Please specify the focus of your fellowship, postdoctoral, or traineeship program: _______

15b. Please specify the year you began the fellowship, postdoctoral, or traineeship program: _______

15c. Please specify the year you completed or expect to complete the fellowship, postdoctoral, or traineeship program: ________

Accomplishments - Research

16. How many research grants have you applied for since attending the Summer Genetics Institute?

0 (Skip to Question 18)

1

2

3

4

5 or more

If answer is not zero - Answer question 16a

16a. Did any of these research grant applications have a genetics component?

Yes, all the grants had a genetics component

Yes, some of the grants had a genetics component

No, none of the grants had a genetics component

17. Since attending the Summer Genetics Institute, how many research grants have you been awarded as the Principal Investigator (PI)?

0 (Skip to question 18)

1

2

3

4

5 or more

If answer is not zero - Answer question 17a

17a. In the box below, please provide the following information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

17b. In the box below, please provide the following information for each grant awarded:

Grant title

Grant number

Funding agency/organization name

Award amount?

Year study began

Length (number of years) of grant

Example: “Genetics of Recovery After Brain Injury,” National Institute on Nursing Research, RO1, 2005-2010 ($1,578,470)

18. Since attending the Summer Genetics Institute on how many funded research grants have you participated as a co-PI?

0

1

2

3

4

5 or more

19. Since attending the Summer Genetics Institute on how many funded research grants have you participated as a project manager?

0

1

2

3

4

5 or more

20. Since attending the Summer Genetics Institute on how many funded research grants have you participated as a research assistant?

0

1

2

3

4

5 or more

21. Since attending the Summer Genetics Institute on how many funded research grants have you been a clinical research nurse?

0

1

2

3

4

5 or more

Accomplishments: Publications, Presentations, Posters

22. Since attending the Summer Genetics Institute, have you authored or co-authored any peer-reviewed research publications?

Yes (Answer question 22a)

No (Skip to question 23)

22a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

22b.In the box below, please provide the peer-reviewed research publication citation(s):

Example: Spiegelhalter, D., M. Pearson, et al. (2011). Visualizing Uncertainty About the Future. Science 333(6048): 1393-1400

23. Since attending the Summer Genetics Institute, have you authored or co-authored any non-peer reviewed publications (e.g., opinion pieces, editorials)?

Yes (Answer question 23a)

No (Skip to question 24)

23a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

23b. In the box below, please provide the non-peer reviewed publication citation(s):

Example: Donald G McNeil, Jr. (2010). Palliative Care Extends Life, Study Finds. The New York Times. New York

24. Since attending Summer Genetics Institute, have you authored or co-authored any published books or monographs?

Yes (Answer question 24a)

No (Skip to question 25)

24a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

24b. In the box below, please provide the publication citation(s):

Example: Book/Monograph: Khandker, S. R., G. B. Koolwal, et al. (2010). Handbook on impact evaluation: quantitative methods and practices. Washington, DC, World Bank

Example: Book Chapter: Maciejewski, M. (1997). Generic Measures in Understanding Health Care Outcomes Research. R. L. Kane. Gaithersburg, MD, Aspen Publishers, Inc: 19-52

25. Since attending the Summer Genetics Institute, have you presented any research papers or posters at conferences?

Yes (Answer question 25a)

No (Skip to question 26)

25a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

25b. In the box below, please provide the presentation or poster citation(s):

Example: Leydesdorff, L. (2011). An Evaluation of Impacts in “Nanoscience & nanotechnology:” Steps towards standards for citation analysis. 2011 Atlanta Conference on Science, Technology, and Innovation Policy. Atlanta, GA

Accomplishments: Patents & Products

26. Since attending the Summer Genetics Institute, have you received any patents that are a result of your research?

Yes (Answer question 26a)

No (Skip to question 27)

26a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

26b. In In the box below, please provide:

-Patent name(s)

-Patent year(s)

-Patent number(s)

Example: Williams, Dave. (2005). Screw less clip mounted computer drive. U.S. Patent 6,885,550, filed August 24, 2000, and issued April 26, 2005

27. Since attending the Summer Genetics Institute, have you released any copyrighted products (e.g., educational videos, teaching tools) as a result of your research?

Yes (Answer question 27a)

No (Skip to question 28)

27a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

27b. In In the box below, please provide:

In the box below, for each product please provide:

-Type of product(s)

-Copyright year(s)

-Copyright number(s)

Example: Green, Paul (1986). Behavioral interviewing kit. U.S. Copyright # TX0002080524

Accomplishments: Science Leadership

28. Since attending the Summer Genetics Institute, have you received any science, teaching or health care awards or honors?

Yes (Answer question 28a)

No (Skip to question 29)

28a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

28b. Please enter the title(s) and year(s) of any science award(s) or honor(s) received:

28c. Please enter the title(s) and year(s) of any teaching award(s) or honor(s) received:

28d. Please enter the title(s) and year(s) of any health care award(s) or honor(s) received:

Accomplishments: Clinical

29. Since attending the Summer Genetics Institute, have you been elected to any science, teaching or healthcare leadership position?

Yes (Answer question 29a)

No (Skip to question 30)

29a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

29b. Please enter the title(s) and year(s) of any science leadership position(s) to which you were elected:

29c. Please enter the title(s) and year(s) of any teaching leadership position(s) to which you were elected:

29d. Please enter the title(s) and year(s) of any health care leadership position(s) to which you were elected:

Influence of Summer Genetics Institute

30. Since attending the Summer Genetics Institute, have you been appointed to any science, teaching or health care leadership position?

Yes (Answer question 30a)

No (Skip to question 31)

30a. In the question(s) below, please provide the information as requested.

Please note: If this information is included in your CV, you have an option of emailing your CV to [email protected]

I chose to email my CV to NINR. Skip the next question

30b. Please enter the title(s) and year(s) of any science leadership position(s) to which you were appointed:

30c. Please enter the title(s) and year(s) of any teaching leadership position(s) to which you were appointed:

30d. Please enter the title(s) and year(s) of any health care leadership position(s) to which you were appointed:

31. Since attending the Summer Genetics Institute, have you intentionally incorporated knowledge of genetic testing and/or genetic diseases into your clinical practice?

Yes

No

Not sure

I do not have a clinical practice

32. How have you used knowledge gained from the Summer Genetics Institute in your clinical practice (Please select all that apply)?

(I do not have a clinical practice)

Patient/family education

Patient/family counseling

Ordering genetic tests

Interpreting genetic tests

Treating genetic diseases

I have not used the training received at the Summer Genetics Institute in my clinical practice

Referring patient(s)/family(s) for genetic counseling, testing, or treatment

Other (please specify): ________________________________________________

Please indicate the extent to which you agree or disagree with each of the following statements pertaining to your participation in the Summer Genetics Institute.

33. The Summer Genetics Institute has been valuable to my career.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Not applicable

34. The Summer Genetics Institute has made me more likely to engage in genetics research activities.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Not applicable

35. The Summer Genetics Institute has made me more likely to incorporate genetics into my clinical activities.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Not applicable

36. The Summer Genetics Institute has made me more likely to incorporate genetics into my teaching activities.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Not applicable

37. I have received a good return on investment by attending the Summer Genetics Institute. Institute.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Not applicable

FINAL THOUGHTS

38. What are the 1 or 2 biggest strengths of the Summer Genetics Institute?

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

39. What are 1 or 2 aspects of the Summer Genetics Institute that could be improved?

If you have any other comments about the Summer Genetics Institute that you would like to share, please use the box below:

*IMPORTANT* By clicking on the Finish button, you are submitting your responses to the NINR team.

You will have a chance to review and edit your responses after clicking Finish. Please do not use the browser BACK button.

Survey Closing

NINR would appreciate the opportunity to follow-up with you next year as we are interested in changes in employment and your research activities over time.

In the event your contact information changes, please email NINR at [email protected] with your new contact information.

Thank you for taking the time to complete this important survey.

Version 13, 5/21/2012 Page 22 of 22