Form 1 Short Course Survey for Pilot

Surveys to Support an Evaluation of the National Human Genome Research Institute (NHGRI) Summer Workshop in Genomics (Short Course)

4_Attachment 1_Short Course Survey for Pilot_4.17.15

Short Course Survey for Pilot

OMB: 0925-0732

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Attachment 1: NHGRI Short Course Survey – Students and Faculty



OMB No.: 0925-XXXX

Expiration Date: xx/xx/20xx

Collection of this information is authorized by The Public Health Service Act, Section 410 (42 USC 285). Rights of participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. The information collected in this study will be kept private to the extent provided by law. Names and other identifiers will not appear in any report of the study. Information provided will be combined for all participants and reported as summaries. You are being contacted by email to complete this survey as part of an outcome evaluation of the National Human Genome Research Institute (NHGRI) Summer Workshop in Genomics (Short Course).


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.

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Participant Information

Historical Information

This first set of questions focuses on verifying or gathering information as it stood at the time of your attendance to the Short Course; we will ask for updated information next.


Select your role during your participation in the Short Course (All Attendees)

  1. Faculty Attendee

  2. Student Attendee

  3. Nursing Faculty Attendee


[Skip logic: If Student Attendee] What degree program were you enrolled in when you attended the Short Course?

  1. Bachelor of Science (BS)

  2. Bachelor of Arts (BA)

  3. Master of Science (MS)

  4. Master of Arts (MA)

  5. Master of Public Health (MPH)

  6. Doctor of Philosophy (PhD)

  7. Doctor of Medicine (MD)

  8. Dual degree (MD & PhD)

  9. Registered Nurse (RN)

  10. Other, please specify: ____________


[Skip logic: If Faculty or Nurse Faculty Attendee] What was your primary Position or Occupation Title at the time of your attendance to the Short Course?

  1. Researcher

  2. Adjunct Instructor/Professor

  3. Assistant Professor

  4. Associate Professor

  5. Professor

  6. Distinguished and/or Endowed Professor and/or Emeritus

  7. Other, please specify: ____________


[Skip logic: If Faculty or Nurse Faculty Attendee] Was this a tenure or non-tenure track position?

        1. Tenure track

        2. Non-Tenure track


Did you hold a teaching appointment at the time of your attendance to the Short Course? (Faculty/Nursing Faculty Only)

  1. Yes

  2. No


[Skip logic: If Yes] Out of 100 percent, what best represented your teaching/research ratio at the time?

  • Teaching __________

  • Research __________

  • Other, please specify __________



Current Information

This section will capture change or updates to your professional or academic profile since your attendance to the Short Course.



Are you still with _____________________________________(prepopulate with Institutional name)? (All Attendees)

  1. Yes

  2. No


[Skip logic: If No] Please list your current institution or organizational affiliation.








Has your Position or Occupation Title changed from INSERT PIPED ANSWER since the time of your attendance in the Short Course? (Faculty/Nursing Faculty Only)

  1. Yes

  2. No


[Skip logic: If Yes] What is your current primary Position or Occupation Title?

  1. Researcher

  2. Adjunct Instructor/Professor

  3. Assistant Professor

  4. Associate Professor

  5. Professor

  6. Distinguished and/or Endowed Professor and/or Emeritus

  7. Administrator

  8. Other, please specify __________


[Skip logic: If Yes] Please specify whether this is a tenure or non-tenure track position

        1. Tenure-track

        2. Non-Tenure-track


What is your current primary Position or Occupation Title? (Student Attendee Only)

  1. Student

  2. Trainee

  3. Clinician

  4. Educator (K-12)

  5. Researcher

  6. Administrator

  7. Instructor or Professor

  8. Other, please specify __________



    1. [Skip Logic: If Student] What type of degree program are you enrolled in?

      1. MS

      2. MPH

      3. PhD

      4. MD

      5. MD/PhD

      6. RN

      7. Other, please specify __________



    1. [Skip logic: If Trainee] Please specify trainee type:

      1. Predoctoral

      2. Postdoctoral

      3. Clinical

      4. Other, please specify __________







    1. [Skip Logic: If Instructor/Professor] Please specify the type of instructor or professor position.

      1. Researcher

      2. Adjunct Instructor/Professor

      3. Assistant Professor

      4. Associate Professor

      5. Professor

      6. Distinguished and/or Endowed Professor and/or Emeritus

      7. Administrator

      8. Other, please specify __________

    2. [Skip Logic: If Instructor/Professor] Please specify whether this is a tenure or non-tenure track position.

      1. Tenure-track

      2. Non Tenure-track

Does your current position involve teaching genetics or genomics? (Student Attendee Only)

        1. Yes

        2. No


[Skip Logic: If Yes) Select the content areas you teach: (Select all that apply).

  1. Biology of genetics and genomics

  2. Biology of human genetics

  3. Molecular/cellular genetics

  4. Genetics and genomics of common diseases

  5. Genetic and genomic technology

  6. Pharmacogenetics and genomics

  7. Ethical, legal and social implications of genetics/genomics

  8. Resources for genetic/genomic education

  9. Career resources (e.g., grant writing)

  10. Other, please specify: __________

[Skip Logic: If Yes) Out of 100 percent, what percentage of your time is dedicated to teaching? (Student Attendee Only) ______


Which of the following best describes your primary field of work? (All Attendees)

  1. Academia

  2. Government

  3. Clinical

  4. Clinical/Government

  5. Industry

  6. Non-profit

  7. Other, please specify: __________


Please identify any additional credentials or degrees you have received or pursued since the Short Course. (Select all that apply). (All Attendees)

  1. None received or pursued

  2. BS/BA

  3. MS/MA

  4. MPH

  5. PhD

  6. MD/PhD

  7. MD

  8. RN

  9. Other, please specify: _____________


[Skip logic: If received or pursuing] Have you completed the credential or degree(s)?

  1. Yes

  2. No

  3. Other, please specify: ______________


[Skip logic: If received or pursuing] What discipline(s) is your credential or degree associated with?





The Short Course Program

The next set of questions focuses on your professional activities since the Short Course.


Teaching Appointment

Out of 100 percent, what best represents your current teaching/research ratio? (Faculty/Nursing Faculty Only)

  • Teaching __________

  • Research __________

  • Other __________


[Skip logic: If Yes] To what degree did your experience at the Short Course influence your teaching to research ratio? (Faculty/Nursing Faculty Only)

  1. No influence

  2. Some influence

  3. Moderate influence

  4. Great influence


How many year(s) have you been engaged in teaching? (Faculty/Nursing Faculty Only)




Integration of Short Course Knowledge


Please indicate whether you agree or disagree with the following statement: I was able to update my curriculum as a result of my participation in the Short Course. (Faculty/Nursing Faculty Only)

Yes, I made substantial changes

Yes, I made some changes

Yes, I made minor changes

No, I did not make any changes


[Skip logic: If Yes or variant of Yes] I was able to update my genetics or genomics curriculum and teaching materials in the following ways: (Select all that apply)

  1. Informal/unplanned integration (e.g., anecdotal narratives, spontaneous examples)

  2. Added content to my lecture materials

  3. Added assignments to my courses

  4. Removed other content to make way for new information

  5. Developed new teaching objectives for my existing courses

  6. Created new lab experiments

  7. Developed a new course

  8. Shared teaching material with other faculty

  9. Other, please specify: __________


[Skip logic: If Yes or variant of Yes] I was able to update my curriculum and teaching materials in the following content areas: (Select all that apply)

  1. Biology of genetics and genomics

  2. Biology of human genetics

  3. Molecular/cellular genetics

  4. Genetics and genomics of common diseases

  5. Genetic and genomic technology

  6. Pharmacogenetics and genomics

  7. Ethical, legal and social implications of genetics/genomics

  8. Resources for genetic/genomic education

  9. Career resources (e.g., grant writing)

  10. Other, please specify: __________


[Skip logic: If Yes or variant of Yes] How much time was required to update your curriculum and teaching materials after participating in the Short Course?

  1. Less than 3 months

  2. Between 3 and 6 months

  3. Between 6 months and 1 year

  4. Between 1 and 2 years

  5. Between 2 and 5 years

  6. More than 5 years


Beyond curriculum integration, in what other ways did you disseminate information from the Short Course to students? If you did not disseminate information beyond curriculum integration, please write “Did not disseminate further.” (Faculty/Nursing Faculty Only)







Please rate how much you think the following institutional factors influenced your ability to transfer your knowledge to students following participation in the Short Course. (Faculty/Nursing Faculty Only)



No Influence

Minor Influence

Moderate Influence

Great Influence

Not Applicable

Time and space to accommodate or integrate new information into existing curriculum

Relevant course(s) not available

Process for changing curriculum

Support of colleagues

Support by supervisor or leadership

Institutional awareness about the importance of genetic and genomic content

Curriculum committee support

Incentive (financial or recognition/praise)

Institutional funding or resources

Ability to secure external funding or resources

Protected time to develop content


Please rate how much you think the following student-related factors influenced your efforts to transfer your knowledge to students. (Faculty/Nursing Faculty Only)



No Influence

Some influence

Moderate influence

Great influence

Not applicable

Student preparedness (e.g., students’ prerequisite knowledge)

Student perception around applicability of information to their career

Student awareness about the importance of genetic and genomic content

Students’ interest

Students’ self-confidence



Did the Short Course influence your research? (All Attendees)

  1. Yes

  2. No



[Skip logic: If Yes] Please describe how your experience at the Short Course influenced your research.








To what degree did your experience at the Short Course influence your decision to engage in the following activities? (All Attendees)



No Influence

Some influence

Moderate influence

Great influence

Not applicable

Presentations at scientific meeting

Attendance at scientific meeting

Involvement in professional organizations

Took additional classes on genetics/genomics

Attended seminars/events on genetics/genomics

Informal genetics/genomics chats

Engaged a mentor in the genetics/genomics field

Became involved in a research group related to genetics/genomics

Conducted research in genetics/genomics

Attended professional meetings related to genetics/genomics

Presented material at various events related to genetics/genomics

Published findings related to genetics/genomics



To what degree did your experience at the Short Course influence your decision to pursue new career or educational options? (All Attendees)

  1. No influence

  2. Some influence

  3. Moderate influence

  4. Great influence

  5. Not applicable – I did not pursue new career or educational options


[Skip logic: If Yes or variant of Yes] Please describe how the Short Course influenced your decision to pursue new career or educational options.








Since the Short Course, have you been involved with Short Course attendees, NIH or NHGRI? (All Attendees)

  1. Yes

  2. No


[Skip logic: If Yes] Please indicate the ways you have been involved with Short Course attendees, NIH or NHGRI since attending the program. (Select all that apply)

  1. Communications with fellow attendees

  2. Additional contact with presenter(s)

  3. Additional contact with NIH or NHGRI staff

  4. Pursued other training or educational opportunities at NIH

  5. Pursued other training opportunities at NHGRI

  6. Used NHGRI online resources

  7. Involved in writing NIH grant-application

  8. Awarded NIH grant

  9. Joined NIH Listserv(s) or other forms of communication

  10. Other, please specify: _____________


Background Information

This section is focused on demographic information.


What year were you born? (All Attendees)

  1. 1999

  2. 1998

  3. 1997

  4. 1996

  5. 1995

  6. 1994

  7. 1993

  8. 1992

  9. 1991

  10. 1990

  11. 1989

  12. 1988

  13. 1987

  14. 1986

  15. 1985

  16. 1984

  17. 1983

  18. 1982

  19. 1981

  20. 1980

  21. 1979

  22. 1978

  23. 1977

  24. 1976

  25. 1975

  26. 1974

  27. 1973

  28. 1972

  29. 1971

  30. 1970

  31. 1969

  32. 1968

  33. 1967

  34. 1966

  35. 1965

  36. 1964

  37. 1963

  38. 1962

  39. 1961

  40. 1960

  41. 1959

  42. 1958

  43. 1957

  44. 1956

  45. 1955

  46. 1954

  47. 1953

  48. 1952

  49. 1951

  50. 1950

  51. 1949

  52. 1948

  53. 1947

  54. 1946

  55. 1945

  56. 1944

  57. 1943

  58. 1942

  59. 1941

  60. 1940

  61. 1939

  62. 1938

  63. 1937

  64. 1936

  65. 1935

  66. 1934

  67. 1933

  68. 1932

  69. 1931

  70. 1930

  71. 1929

  72. 1928

  73. 1927

  74. 1926

  75. 1925

  76. 1924

  77. 1923

  78. 1922

  79. 1921

  80. 1920

  81. 1919

  82. 1918

  83. 1917

  84. 1916

  85. 1915

  86. 1914

  87. 1913

  88. 1912

  89. 1911

  90. 1910

  91. 1909

  92. 1908

  93. 1907

  94. 1906

  95. 1905

  96. 1904

  97. 1903

  98. 1902

  99. 1901

  100. Do not wish to provide



What is your sex? (All Attendees)

  1. Male

  2. Female

  3. Do not wish to provide


What is your ethnicity? (All Attendees)

  1. Hispanic or Latino

  2. Not Hispanic or Latino

  3. Do not wish to provide


What race do you consider yourself? (Select all that apply) (All Attendees)

  1. White or Caucasian

  2. Black or African American

  3. Asian

  4. American Indian/Alaska Native

  5. Native Hawaiian or other Pacific Islander

  6. Do not wish to answer


Do/did you have a disadvantaged background, which can be defined either as coming from a family with an annual income below established low-income thresholds, or coming from an educational environment such as that found in certain rural or inner-city environments that have demonstrably and directly inhibited you from obtaining the knowledge, skills, and abilities necessary to develop and participate in a research career? (All Attendees)

  1. Yes

  2. No

  3. Do not wish to answer


Please enter any other comments you would like to share with us about the Short Course and your experiences since attending the program. If you have no additional comments, please hit the next button. (All Attendees)








This is the end of the survey, thank you for your time, we appreciate your input.


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