Form 1 MSRP

Activity:

MRSP/CRTP Alumni Survey

Site:

National Institutes of Health

Period:
Time Period:
Request Date:
Evaluation Type:

MRSP Alumni Survey

Evaluator:
Subject:
Participation Dates:

Participation Dates:

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MRSP/CRTP 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

Section 1 of 5: General Information
Are you using a different name than the one you used during training (stated at the
top of this survey)? (Question 1 of 44 )
No Previous Answers Recorded
Yes

No

If you are using a different name than the one you used during your MRSP/CRTP
training, please state the name you are currently using. (Question 2 of 44 )
No Previous Answers Recorded

Preferred e-mail address:

(Question 3 of 44 - Mandatory )

No Previous Answers Recorded

Alternate e-mail address:

(Question 4 of 44 - Mandatory )

No Previous Answers Recorded

What medical or dental school did you attend?
No Previous Answers Recorded

(Question 5 of 44 - Mandatory )

Please list your residency training program, location and dates of training.
(Question 6 of 44 - Mandatory )
No Previous Answers Recorded

If you completed fellowship training, please let us know the program’s name, location,
specialty/subspecialty, and dates of training (Question 7 of 44 )
No Previous Answers Recorded

Did you complete an NIH ACGME-accredited training program?
- Mandatory )

(Question 8 of 44

No Previous Answers Recorded
Yes
No

If you completed an NIH ACGME-accredited training program, in which
program below did you train?
(Question 9 of 44 )
Show Previous Answers +/If you completed an NIH ACGME-accredited training
program, in which program - Program - Institution - 1

1.

If you completed an NIH ACGME-accredited training
program, in which program - Year - 1

1.

If you completed an NIH ACGME-accredited training
program, in which program - Program - Institution - 2

2.

No Previous Answers Recorded

No Previous Answers Recorded

No Previous Answers Recorded

If you completed an NIH ACGME-accredited training
program, in which program - Year - 2

2.

Program - Institution

No Previous Answers Recorded

Year

1.
{Select}

2.
{Select}

If you trained at the NIH, but not in an ACGME-accredited training program,
which of the other clinical and translational programs did you participate in?
(Question 10 of 44 )
Show Previous Answers +/If you trained at
the NIH, but not
in an ACGMEaccredited training
program, which of
the other clinical
No Previous Answers Recorded
and translational
programs did you
attend - Program Institution - 1

1.

If you trained at
the NIH, but not
in an ACGMEaccredited training
program, which of
the other clinical No Previous Answers Recorded querying getPrePopAnswers for 1789375
and translational
programs did you
attend - Year - 1

1.

If you trained at
the NIH, but not
in an ACGMEaccredited training
program, which of
the other clinical
and translational
No Previous Answers Recorded
programs did you
attend - Program Institution - 2

2.

If you trained at
the NIH, but not
in an ACGMEaccredited training
program, which of
the other clinical
No Previous Answers Recorded
and translational
programs did you
attend - Year - 2

2.

Program - Institution

Year

1.
{Select}

2.
{Select}

If the clinical and translational training program you attended is not listed above,
please let us know its name: (Question 11 of 44 )
No Previous Answers Recorded

Which Institute/Center sponsored the clinical or translational program that was not
listed. (Question 12 of 44 )
No Previous Answers Recorded

What professional degrees do you hold?
(Question 13 of 44 )
Show Previous Answers +/MD. Area(s) of specialty:
MD. Area(s) of specialty:

No Previous Answers Recorded

PhD. Area(s) of specialty:
PhD. Area(s) of specialty:

No Previous Answers Recorded

JD. Area(s) of specialty:
JD. Area(s) of specialty:

No Previous Answers Recorded

Master’s. Area(s) of specialty:
No Previous Answers Recorded
Master’s. Area(s) of specialty:
Other:
Other:

No Previous Answers Recorded

MD. Area(s) of specialty:
PhD. Area(s) of specialty:
JD. Area(s) of specialty:
Master’s. Area(s) of specialty:
Other:

Please list your ABMS (Board) certification(s):

(Question 14 of 44 )

No Previous Answers Recorded

Section 2 of 5: Work Experience
Name of your current employer/institution
No Previous Answers Recorded

(Question 15 of 44 )

Employer/institution type

(Question 16 of 44 )

No Previous Answers Recorded
Academic
NIH
Government regulatory agency
Pharmaceutical
Other research
Private practice
Other

Employer/Institution: Notes

(Question 17 of 44 )

If you selected ‘Other,’ please explain.
No Previous Answers Recorded

What is your current status/title?

(Question 18 of 44 )

No Previous Answers Recorded
Dean
Chair
Non-academic
Associate Professor
Professor
Instructor
Assistant Professor
Fellow
Resident
Intern
Medical/Dental Student
Other

Academic Status/Title: Notes

(Question 19 of 44 )

If you selected ‘Other,’ please explain.
No Previous Answers Recorded

Is your current academic appointment a tenure track position?

(Question 20 of 44 )

No Previous Answers Recorded
Yes
No
Not applicable (do not have an academic appointment)

If your current academic appointment is a tenure track position, do you currently
have tenure? (Question 21 of 44 )
No Previous Answers Recorded
Yes
No, not yet eligible
Not applicable (do not have an academic appointment)

Are you currently performing clinical and/or translational research?
(Question 22 of 44 )
No Previous Answers Recorded
Yes
No

(Question 23 of 44 - Mandatory )
Show Previous Answers +/K01 Mentored Research Scientist Development

No Previous Answers Recorded

K01 Mentored Research Scientist Development

K08 Mentored Clinical Scientist Development

No Previous Answers Recorded

K08 Mentored Clinical Scientist Development

K12 Mentored Clinical Scientist Development
K12 Mentored Clinical Scientist Development

No Previous Answers Recorded

No Previous Answers Recorded

K22 Career Transition Award
K22 Career Transition Award

K23 Mentored Patient Oriented Research

No Previous Answers Recorded

K23 Mentored Patient Oriented Research

K24 Midcareer Investigator Award in Patient Oriented
Research

No Previous Answers Recorded

K24 Midcareer Investigator Award in Patient Oriented Research

K30 Clinical Research Curriculum Award

No Previous Answers Recorded

K30 Clinical Research Curriculum Award

K99/R00 Pathway to Independence Award

No Previous Answers Recorded

K99/R00 Pathway to Independence Award

No Previous Answers Recorded

R01 Research Project Grant Program
R01 Research Project Grant Program

No Previous Answers Recorded

R03 Small Group Program
R03 Small Group Program

R21 Exploratory Developmental Research Grant Award

No Previous Answers Recorded

R21 Exploratory Developmental Research Grant Award

Intramural NIH Research

No Previous Answers Recorded

Intramural NIH Research

Other Federal Funding

No Previous Answers Recorded

Other Federal Funding

Private

No Previous Answers Recorded

Private

University

No Previous Answers Recorded

University

Pharmaceutical

No Previous Answers Recorded

Pharmaceutical

Other
Other

What are your
current funding

No Previous Answers Recorded

What is the dollar amount of your grant(s)?

sources?
ALL FIELDS
REQUIRE
RESPONSE

None

Less
than
$50K

$51K to $101K to $251K to $501K
$100K
$250K
$500K to $1M

Greater
than $1M

K01 Mentored Research
Scientist Development

K08 Mentored Clinical Scientist
Development

K12 Mentored Clinical Scientist
Development

K22 Career Transition Award

K23 Mentored Patient Oriented
Research

K24 Midcareer Investigator
Award in Patient Oriented
Research

K30 Clinical Research
Curriculum Award

K99/R00 Pathway to
Independence Award

R01 Research Project Grant
Program

R03 Small Group Program

R21 Exploratory
Developmental Research
Grant Award

Intramural NIH Research

Other Federal Funding

Private

University

Pharmaceutical

Other

Funding Sources: Notes

(Question 24 of 44 )

If you selected ‘other federal funding,’ ‘private funding,’ or ‘other funding,’ please explain.

No Previous Answers Recorded

When you completed medical or dental school what was your debt burden?
(Question 25 of 44 )
No Previous Answers Recorded
none
<$50,000
$50,000-$99,999
$100,000-$150,000
>$150,000
I prefer not to answer

What are the most important clinical research challenges facing you in your career
currently? (Optional) (Question 26 of 44 )
No Previous Answers Recorded

(Question 27 of 44 )
Show Previous Answers +/What is your professional title?
What is your professional title?

No Previous Answers Recorded

What are your clinical and/or research interests?
What are your clinical and/or research interests?

No Previous Answers Recorded

Address Line 1
Address Line 1

No Previous Answers Recorded

Address Line 2 (optional)
Address Line 2 (optional)

No Previous Answers Recorded

City/Town
City/Town

No Previous Answers Recorded

State
State

No Previous Answers Recorded

Zip Code
Zip Code

No Previous Answers Recorded

Country
Country

No Previous Answers Recorded

Phone Number
Phone Number

No Previous Answers Recorded

What is your professional title?
What are your clinical and/or research interests?
Address Line 1
Address Line 2 (optional)
City/Town
State
Zip Code
Country
Phone Number

(Question 28 of 44 )
Show Previous Answers +/Direct patient care ( ___ %):
If you have completed your residency and fellowship training, what
proportion of your time is devoted to the following:
Direct patient care ( ___ %):

No Previous Answers Recorded

Research ( ___ %):
Research ( ___ %):

No Previous Answers Recorded

Teaching ( ___ %):
Teaching ( ___ %):

No Previous Answers Recorded

Administration ( ___ %):
Administration ( ___ %):

No Previous Answers Recorded

Total %:
Total %:

No Previous Answers Recorded

If you have completed your residency and fellowship training, what
proportion of your time is devoted to the following:
Direct patient care ( ___ %):

Research ( ___ %):

Teaching ( ___ %):

Administration ( ___ %):

Total %:

Please note any professional honors or awards you have received.

(Question 29 of 44 )

Feel free to copy and paste from your resume or other document.
**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.
No Previous Answers Recorded

Section 3 of 5: Publications
If you published during or after participating in the MRSP/CRTP, please share with
us the total number of peer-reviewed publications. (Question 30 of 44 )
No Previous Answers Recorded
1-3
4-6

7-10
11-15
16-20
21-25
>25
None

Please list your publications, and add an asterisk in front of your publications that are
based on research performed during your MRSP/CRTP year. Feel free to copy and
paste from your resume or other document. (Question 31 of 44 )
**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.
No Previous Answers Recorded

Section 4 of 5: Training Experience
What is the overall degree of impact MRSP/CRTP has had on your professional
career? (Question 32 of 44 )
No Previous Answers Recorded
N/A

No
Impact

Little
Impact

Some
Impact

Much
Impact

Considerable
Impact

(Question 33 of 44 )
Show Previous Answers +/Successfully complete your Board Exam(s)
Successfully complete your Board Exam(s)

No Previous Answers Recorded

Perform typical procedures for specialty
Perform typical procedures for specialty

No Previous Answers Recorded

Perform successfully in an academic or research setting
Perform successfully in an academic or research setting
Perform successfully in a non-academic or non-research
setting
Perform successfully in a non-academic or non-research
setting

No Previous Answers Recorded

No Previous Answers Recorded

Teach (medical students, residents, fellows, and/or patients)
Teach (medical students, residents, fellows, and/or patients)

No Previous Answers Recorded

Compete successfully for grants
Compete successfully for grants

No Previous Answers Recorded

Compete successfully for desired professional opportunities
Compete successfully for desired professional opportunities

No Previous Answers Recorded

Work well with other members of a healthcare team
Work well with other members of a healthcare team

No Previous Answers Recorded

Manage and lead others
Manage and lead others

No Previous Answers Recorded

Stay current in specialty
Stay current in specialty

No Previous Answers Recorded

Network with other key individuals in field
Network with other key individuals in field

No Previous Answers Recorded

Achieve work-life balance
Achieve work-life balance

No Previous Answers Recorded

Become a life-long learner
Become a life-long learner

No Previous Answers Recorded

Be knowledgeable of established and evolving biomedical,
clinical, epidemiological and social-behavioral sciences,
when applying this knowledge to patient care (Medical
Knowledge)
Be knowledgeable of established and evolving biomedical,
clinical, epidemiological and social-behavioral sciences,
when applying this knowledge to patient care (Medical
Knowledge)
Provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the

No Previous Answers Recorded

No Previous Answers Recorded

promotion of health (Patient Care)
Provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the
promotion of health (Patient Care)
Effectively exchange information and collaborate with
patients, their families, and health professionals
(Interpersonal & Communication Skills)
Effectively exchange information and collaborate with
patients, their families, and health professionals
(Interpersonal & Communication Skills)
Carry out professional responsibilities and demonstrate an
adherence to ethical principles (Professionalism & Ethics)
Carry out professional responsibilities and demonstrate an
adherence to ethical principles (Professionalism & Ethics)
Investigate and evaluate one’s care to patients, to appraise
and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and
life-long learning (Practice-based Learning and
Improvement)
Investigate and evaluate one’s care to patients, to appraise
and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and
life-long learning (Practice-based Learning and
Improvement)

No Previous Answers Recorded

No Previous Answers Recorded

No Previous Answers Recorded

Be aware of and responsive to the larger context and system
of healthcare, as well as the ability to call effectively on
other resources in the system to provide optimal healthcare
(Systems-based Practice)
Be aware of and responsive to the larger context and system No Previous Answers Recorded
of healthcare, as well as the ability to call effectively on
other resources in the system to provide optimal healthcare
(Systems-based Practice)

No
Little Some Much Considerable
What degree of impact did MRSP
N/A
or CRTP have on your ability to: Impact Impact Impact Impact
Impact
Successfully complete your Board
Exam(s)
Perform typical procedures for
specialty
Perform successfully in an
academic or research setting

Perform successfully in a nonacademic or non-research setting
Teach (medical students, residents,
fellows, and/or patients)
Compete successfully for grants
Compete successfully for desired
professional opportunities
Work well with other members of a
healthcare team
Manage and lead others
Stay current in specialty
Network with other key individuals
in field
Achieve work-life balance
Become a life-long learner
Be knowledgeable of established
and evolving biomedical, clinical,
epidemiological and socialbehavioral sciences, when applying
this knowledge to patient care
(Medical Knowledge)
Provide patient care that is
compassionate, appropriate, and
effective for the treatment of health
problems and the promotion of
health (Patient Care)
Effectively exchange information
and collaborate with patients, their
families, and health professionals
(Interpersonal & Communication
Skills)

Carry out professional
responsibilities and demonstrate an
adherence to ethical principles
(Professionalism & Ethics)
Investigate and evaluate one’s care
to patients, to appraise and
assimilate scientific evidence, and
to continuously improve patient
care based on constant selfevaluation and life-long learning
(Practice-based Learning and
Improvement)
Be aware of and responsive to the
larger context and system of
healthcare, as well as the ability to
call effectively on other resources in
the system to provide optimal
healthcare (Systems-based Practice)

Were you able to find and begin employment (or additional training) of your choice
within your specialty/subspecialty upon completing your MRSP/CRTP training at
NIH? (if applicable) (Question 34 of 44 )

No Previous Answers Recorded
Yes

No

Employment/Additional Training: Notes

(Question 35 of 44 )

If ‘no,’ please explain.
No Previous Answers Recorded

What were the best parts of your MRSP/CRTP training at NIH?
No Previous Answers Recorded

(Question 36 of 44 )

What was missing from or could be improved about your MRSP/CRTP training (if
applicable)? (Question 37 of 44 )
No Previous Answers Recorded

If you could start your year-out enrichment program again from the beginning, would
you choose NIH for some or all of this training? (Question 38 of 44 )

No Previous Answers Recorded
Yes

Maybe

No

MRSP/CRTP Program Selection: Notes

(Question 39 of 44 )

If ‘Unlikely’ please explain.
No Previous Answers Recorded

How likely are you to recommend NIH for a year-out enrichment program to
medical/dental students. (Question 40 of 44 )
No Previous Answers Recorded
Unlikely

Somewhat Likely

Likely

How likely are you to recommend NIH for clinical or translational research training to
prospective research-oriented medical/dental students and physicians?
(Question 41 of 44 )

No Previous Answers Recorded
Unlikely

Somewhat Likely

Likely

Likelihood to Recommend NIH for medical/dental student programs and GME
training: Notes (Question 42 of 44 )
If 'Unlikely’ please explain
No Previous Answers Recorded

Please provide any additional comments about MRSP, CRTP, GME or clinicalresearch training at NIH. (optional) (Question 43 of 44 )
No Previous Answers Recorded

Section 5 of 5: Alumni Network
Would you be willing to serve as a resource for current MRSP/CRTP trainees who
seek to learn from your professional experiences? (Question 44 of 44 )
No Previous Answers Recorded
Yes

No

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