Form 1 OITE Resilience Training Program survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

OITE-ResilienceTrainingProgram-Form

Resilience Training Program: Building a Resilient Scientist (OITE/OD)

OMB: 0925-0648

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Resilience Training Program: Building a Resilient Scientist
NIH Office of Intramural Training & Education

OMB Number: 0925-0648
Expiration Date: 31 May 2021
Office of Intramural Training & Education
National Institutes of Health
https://www.training.nih.gov
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Public reporting burden for this collection of information is estimated to average 15-minutes per submission. 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 0925-0648. Do not return the completed form to this address.
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.
1. Before we start with the survey, we need to create a unique identifier, so we can match up your data with the
later questionnaires. The following questions are used only to generate a unique identifier and will not be used
for any other purposes.
Write the DAY of the month on which you are born as a two digit number.
For example, if you were born on March 7th, you would put 07.

First initial of your middle name (if no middle name, write X).
For example, if your name is Jane Doe Miller, you would put D.

What is the last 4 digits of your phone number?(If you don't have a phone number, write 0000.)
For example, if your phone number is (202) 123-4567, you would put 4567.

2. Do you currently describe yourself as female, male, or transgender?
Female
Male
Transgender
None of These

3. What is your race?
(select all that apply)
American Indian or Alaska Native
Asian or Asian American
Black or African American
Native Hawaiian or other Pacific Islander
White or Caucasian

4. What is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino
None of the Above

5. Which university/institution are you affiliated with? (Drop down list of institutions)

6. What is your university/institute department or university/institute program name?

7. What is your current educational status?
Undergraduate student
Masters student (MS/MA)
Professional degree student (e.g., Med, Dental, Law)
Ph.D. or doctoral student
Postdoctoral trainee
Other, Please specify

8. Indicate the extent to which the following statements are true for you.
True
Nearly
All the
Time

Often
True

Sometimes Rarely
True
True

Not
True at
All

I am able to adapt when changes occur.
I can deal with whatever comes my way.
I try to see the humorous side of things when I am faced with
problems.
Having to cope with stress can make me stronger.
I tend to bounce back after illness, injury or other hardships.
I believe I can achieve my goals, even if there are obstacles.
Under pressure, I stay focused and think clearly.
I am not easily discouraged by failure.
I think of myself as a strong person when dealing with life’s
challenges and difficulties.
I am able to handle unpleasant or painful feelings like sadness, fear,
and anger.

9. Indicate how often the following statements are true for you at work/school. In completing this section, focus
on stress that’s a result of your work/school, not on stress from elsewhere (e.g., home).
All the
Time
I’m unable to concentrate on my job because of work-related stress
I spend a significant proportion of my workday coping with work
stress
Work stress distracts my attention away from my job tasks
Mental energy I’d otherwise devote to my work is squandered on
work stressors
I delay starting on new projects at work because of stress
I spend time talking to co-workers about stressful work situations

Often

Sometimes Rarely

Never

10. The questions below ask you about your feelings and thoughts during the last month. In each case, indicate
how often you felt or thought a certain way.
Very
Often

Fairly
Often

Sometimes

Almost
Never

Neverr

In the last month, how often have you felt that you were unable to
control the important things in your life?
In the last month, how often have you felt confident about your
ability to handle your personal problems?
In the last month, how often have you felt that things were going
your way?
In the last month, how often have you felt difficulties were piling up
so high that you could not overcome them?

11. Indicate the extent to which you agree with the statements below.
Mixed or
Neither
Agree
Strongly
Slightly
nor
Slightly
Strongly
Agree Agree Agree Disagree Disagree Disagree Disagree
I am engaged and interested in my daily activities
I am optimistic about my future

12. On an average week, how often do you feel bothered by the following problems?
Nearly
Over Half
Every Day the Days
Feeling anxious
Not being able to stop or control worrying
Becoming easily annoyed or irritable
Feeling down, depressed, or hopeless
Little interest or pleasure in doing things
Trouble falling or staying asleep or sleeping too much
Poor appetite or overeating

A Day or
Two

Not at All

13. General Resilience Questions
Very
High

High

Neither
High
Nor Low

Very
Low

Low

How high is your current Stress-load (i.e., Current work demands,
work/home-front stressors, challenges).
How is your morale at work/school?
Being as honest as possible, how would you rate your job/work
performance (i.e., Meeting demands on time, accomplishing tasks)?

14. How often do you engage in the following behaviors as a stress coping strategy? (Select all that apply)
Frequently Occasionally
Work out/exercise
Journal
Seek out resources available on my campus
Professional therapy
Read articles or watching talks on coping with stress
Reach out to a friend
Mindfulness activities (e.g., meditation)
Eating a healthy diet
7 or more hours of sleep
Setting boundaries
Cognitively reframing
Only worrying about what I can control
Practicing gratitude
Asserting myself when appropriate
Reaching out mentors
Increasing helpful self-talk

Rarely

Never

15. Post Series Question.
Did the following behaviors help as a stress coping strategy?

Helped
Helped
Helped
a Lot Moderately a Liittle

Didn't
Help at
All

Don't
Use /
Didn't
Use

Work out/exercise
Journal
Seek out resources available on my campus
Professional therapy
Read articles or watching talks on coping with stress
Reach out to a friend
Mindfulness activities (e.g., meditation)
Eating a healthy diet
7 or more hours of sleep
Setting boundaries
Cognitively reframing
Only worrying about what I can control
Practicing gratitude
Asserting myself when appropriate
Reaching out to mentors
Increasing helpful self-talk

16. Rate how well the following statements describe you:
A Lot
I feel my life has a sense of purpose
My life feels worthwhile
I believe that there is a larger reason or purpose for my life
I feel my life is going nowhere

Some

A Little

Not at All

17. Next you will see a list of things that people sometimes do, think, or feel when something stressful happens.
Everybody deals with problems in their own way. Rate how much you do each of the following things when
something stressful happens in your life.
When something stressful happens in my life…
A Lot

Some

A Little

Not at All

I think about what I can learn from the situation
I work to change or fix the problem
I try not to think about it, to forget about it
I think about the positive aspects, or the good that can come from the
situation
I start to act without thinking
In life, things don’t always go the way that we want.

18. Everyone has different preferences for how they deal with situations in which something doesn’t turn out the
way that they want, and they are not able to change it. Rate how much you do each of the following.
When something doesn’t turn out the way that I want…
A Lot
Little things upset me easily
I think about what good things could come from the situation
I find it hard to stop thinking about what happened
I start working on other new goals
I think about what I can learn from the situation

Some

A little

Not at all

19. Below is a list of statements about your general experiences. Indicate how frequently you experience or
engage in each of them.
There is no “right” or “wrong” answer as everyone is different, so simply answer according to your own
experience. Think about school as work, if needed.
Almost
Always Frequently Occasionally Rarely
I "observe" myself
I have insight into myself
I look at why people act the way they do
I have learnt about myself and how I see the world
I am continuing to work on and develop myself
I focus on ways of amending my behavior that would be useful
I feel generally positive about self-awareness
I reassess my own and others' responsibilities
I'm aware of my abilities and limitations
I am reflective.
I am realistic about myself
I see my work life as something I have power to affect*
I recognize the stress and worry in my current work.*
I can “take a step back” from situations to understand them
better*
I think about how as colleagues or peers we interact with each
other*
I have changed the way I work*

Never

20. Rate the degree to which you agree or disagree with each of the following statements

Strongly
Agree

Agree

Neither
Agree
Nor
Strongly
Disagree Disagree Disagree

I will be able to achieve most of the goals that I set for myself.
When facing difficult tasks, I am certain that I will accomplish them.
In general, I think that I can obtain outcomes that are important to me.
I believe I can succeed at most any endeavor to which I set my mind.
I will be able to successfully overcome many challenges.
I am confident that I can perform effectively on many different tasks.
Compared to other people, I can do most tasks very well.
Even when things are tough, I can perform quite well.

21. (Post-series only) Which session(s) did you participate in either live or viewing the posted recordings?
Part I. An Introduction to Resilience and Wellness
Part II. Exploring our Self-Talk: Cognitive Distortions and Imposter Fears
Part III. Emotions and Emotional Intelligence in the Workplace
Part IV. Self-Advocacy and Assertiveness for Scientists
Part V. Developing Feedback Resilience
Part VI. Managing Up to Maximize Mentoring Relationships

22. (Post-series only) Overall, how would you rate this series?
Excellent

Very good

Good

Fair

Poor

23. (Post-series only) How likely are you to recommend this series to a friend or a colleague?
Very likely

Somewhat likely

Neither likely or
unlikely

Somewhat unlikely

Very unlikely

24. (Post-series only) Rate the extent to you agree or disagree with the following statements:

Strongly
Agree
This series was valuable to me.
How well did you understand topics covered in Becoming a Resilient
Scientist Series BEFORE participating in the summer?
How well did you understand topics covered in Becoming a Resilient
Scientist Series AFTER participating in the summer?
Since participating in the resilience series, I have become more
resilient in my work and/or life.
Since participating in the resilience series, I have become a better
scientist.
Since participating in the resilience series, I have learned to manage
conflict better.
Since participating in the resilience series, I have learned to manage
my stress better.
Since participating in the resilience series, I have gained important
skills that will help my work/life.

25. How can we make the series better?

Agree

Neither
Agree or
Strongly
Disagree Disagree Disagree


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File Created2021-01-14

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