Form 3 Graduate Medical Education

Graduate Medical Education Graduate Survey
Graduate Medical Education Alumni Survey

(OMB # 0925-0602 expires 8/31/2019)
Please take a few minutes to complete the survey below, which will ask about your current
professional experiences and other accomplishments.
Through this survey, the NIH Office of Clinical Research Training and Medical Education (OCRTME)
intends 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.
**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.
* 1. Please enter your name below:
If you are using a different name than the one you used during training please enter it on the 2nd line:
Full name during time at
NIH
Current name if changed:

* 2. In what year did you graduate from your NIH GME Program?

* 3. What is your preferred email address?

* 4. In which of the ACGME-accredited training Programs below did you train, if applicable? (See next
question for Non-Accredited Programs and following question for ADA Programs)
Allergy and Immunology- NIAID
Anatomic Pathology- NCI
Combined Medical Oncology & Hematology- NCI
Critical Care- CC
Cytopathology- NCI
Endocrinology and Metabolism- NIDDK
Epilepsy (NCC sponsored program)
Gastroenterology (U. Maryland sponsored program
Hematology- NHLBI
Hematopathology- NCI
Hospice & Palliative Care- CC/ODDCC
Infectious Diseases- NIAID
Medical Biochemical Genetics- NHGRI
Medical Genetics- NHGRI
Medical Oncology- NCI
Neurological Surgery- NINDS
Neurophysiology (NCC sponsored program)
Pediatric Endocrinology- NICHD
Psychiatry- NIMH
Reproductive Endocrinology-NICHD
Rheumatology- NIAMS
Transfusion Medicine/Blood Banking- CC
Vascular Neurology- NINDS
Non-Accredited Fellowship Program

* 5. If you did not train in an ACGME-accredited training Program, please select which non-accredited
programs did you train in?
Alcoholism

Autonomic Disorders
Brain Imaging
Cardiac/Cardiovascular Imaging
Child Psychiatry
Clinical Chemistry
Clinical Trial Methodology
Deafness & Communication Disorders
Endocrine Clinical & Research Surgery Fellowship
Epilepsy
Gastroenterology
Hepatology
HIV and AIDS Malignancy Research
Image-Guided Cardiovascular Intervention
Immunotherapy
Medical Retinal Fellowship
Motor Neuron Disease
Movement Disorders
Muscle Disorder
NIMH Clinical Fellowship
Nephrology Clinical Research Training
Neurogenetics
Neuroimmunology and Neurovirology
Neuro-Oncology
Neurorehabilitation
Clinical Neurosciences (Research)
Ophthalmic Genetics & Visual Function
Surgical Neurology Fellowship (Non-Accredited)
Surgical Oncology
Urologic Oncology Fellowship
Uveitis & Ocular Immunology
Other (please specify)

6. If you trained in an ADA Program please indicate which program below:
NIDCR Clinical Research Fellowship
Dental Public Health
Oral Health Informatics
Other (please specify)

* 7. What professional degrees do you hold?
MD.
PhD.
J.D.
Master’s
Other:

* 8. Please list your ABMS (Board) certification(s):

* 9. Name of your current employer/institution:

* 10. Employer/Institution type:
Academic
NIH
Government Regulatory Agency
Pharmaceutical/Industry
Other research
Private practice
Other (please explain)

* 11. What is your current academic status/title?
Dean
Chair
Professor
Associate Professor
Assistant Professor
Instructor
Non-Academic Appointment
Other (please explain)

* 12. Is your current academic appointment a tenure track position?
Yes
No
Not applicable (do not have an academic appointment or tenure not offered)

* 13. If you selected yes for tenure track, do you currently have tenure?
Yes
No, not yet eligible
No

* 14. Are you currently performing clinical and/or translation research?
Yes
No

* 15. If you are receiving NIH research grants; What are your current funding sources and the dollar amount
of your grant(s):
None

Less than
$50K

$51K to
$100K

$101K to
$250K

$251K to
$500K

$501K to $1M

K01 Mentored Research
Scientist Development
K08 Mentored Research
Scientist Development
K12 Mentored Research
Scientist Development
K22 Career Transition
Award
K23 Mentored Patient
Oriented Research
K24 Midcareer
Investigator Award in
Patient Oriented
Research
K99/R00 Pathway
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

16. What are the most important clinical research challenges facing you in your career this year?

* 17. What is your professional title?

18. What organization and/or department do you work for?

Greater than
$1M

19. What are your current clinical and/or research interests?

* 20. Please note any professional honors or awards you have received below:

21. Please list your publications: Feel free to copy and paste from your resume or other document.

22. What were the best parts of your GME training at NIH?

* 23. What was missing from or could be improved about your training program?

24. Please provide any additional comments about GME or research training at the NIH:

* 25. Would you be willing to serve as a resource for current NIH GME trainees who seek to learn from your
professional experiences?
Yes
No