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LteAsdxpL78EgBUW9RF53XrKngrVE2b3pNAMUrwTEoq2KBCWLyU9

CATCH mentee match survey

CATCH, developed and co-led by two URiMs for URiMs, is a low time commitment and high-impact mentoring program where self-identified URiM trainees, regardless of career interest, are paired one-on-one with a faculty member for the purpose of increasing the trainee's professional development and sense of belonging in the Harvard medical community.

Your responses to this survey may be included as part of aggregate data in presentations or publications.

First name:

* must provide value

Last name:

* must provide value

Email address:

* must provide value

What year did you or will you graduate from medical school?

What is your gender identity?

Female (including transgender female)

Male (including transgender male)

Non-binary

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With which of these traditional race / ethnicity categories do you most identify?

* must provide value

Asian, non-Hispanic

Black, non-Hispanic

Hispanic (regardless of race)

White, non-Hispanic

Another race, non-Hispanic (includes American Indian / Alaska Native, Native Hawaiian / Other Pacific Islander)

Multiracial, non-Hispanic

Other race / ethnicity

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Please describe other race / ethnicity:

* must provide value

Which aspects of your ancestry inform your identity?

* must provide value

African

African-American

Afrocaribbean

Asian

European or White

Latinx

Indian subcontinent

Jewish

Middle Eastern

Native American or Indigenous

Pacific Islander

Other ancestry

Please describe other ancestry:

* must provide value

Do you have children for whom you are a primary caregiver?

* must provide value

Yes

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What is your current role?

* must provide value

Medical student

Resident

Other role

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Please describe other current role:

* must provide value

Which type of program are you in?

* must provide value

MD / PhD

Other combined MD degree

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Please describe other combined MD degree:

* must provide value

In which year of medical school are you?

* must provide value

MS 1

MS 2

MS 3

MS 4

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Please state your field and year of residency training:

* must provide value

Which of the following do you envision as major elements of your future career?

* must provide value

Clinical practice

Clinical / epidemiological research

Basic / translational research

Bioinformatics

Public health / policy

Medical education

Administration

Industry / private sector

Uncertain at this time

Other major element

Please describe other major element of your future career:

* must provide value

Do you have a defined area of clinical interest (e.g. "adult cardiology", "some pediatric subspecialty", "surgery", "public health in Asia")"?

* must provide value

Yes

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Please describe your defined area of clinical interest:

* must provide value

Which characteristics of your mentor would you regard as of great importance to provide you with suitable guidance?

* must provide value

Similar gender identity

Similar ancestry

Mentor is also a parent

Similar broad career direction

None of the above - I am flexible as to who my mentor is

Other characteristic

Please describe other characteristic of your mentor that you regard of great importance:

* must provide value

Are you currently in another formal mentoring program?

* must provide value

Yes

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Please provide name of mentoring program:

* must provide value

I would like to participate in the program evaluation study. The study entails filling out short, anonymous surveys every 6 months during my participation in the program and every year afterwards for 10 years. I may opt out at any time by emailing jbc@bwh.harvard.edu, subject line: CATCH.

* must provide value

Yes

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Please provide an email that is not affiliated with your institution to ensure that you continue to receive surveys after you are done with this program (e.g., gmail, yahoo).

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.