Form 1 Feedback Form

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NIH/NMA Feedback Form
OMB #0925-0748
Expiration Date: 08/2023

 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 (0925-0748). Do not return the completed form to this address.

Please provide your overall impression of the following:
The Academic Career Development Workshop

Very Poor
Poor
Fair
Good
Very Good

Interaction with research scientists and academicians

Very Poor
Poor
Fair
Good
Very Good

The panel discussions

Very Poor
Poor
Fair
Good
Very Good

The small group discussions with faculty

Very Poor
Poor
Fair
Good
Very Good

Meeting materials and handouts

Very Poor
Poor
Fair
Good
Very Good

Overall communication from NIDDK

Very Poor
Poor
Fair
Good
Very Good

Travel support

Very Poor
Poor
Fair
Good
Very Good

Additional comments regarding your overall experience
with the above components of the program:

03/10/2023 9:26am

__________________________________________

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Please rate the quality of the following components of the Academic Career Development Workshop:
Executive Skills in Academic Medicine, Speaker

Very Poor
Poor
Fair
Good
Very Good

Introduction to NIH Funding Mechanisms and
Opportunities: Support for Early Years in Academia &
the NIH Loan Repayment Program, Speaker

Very Poor
Poor
Fair
Good
Very Good

Academic Career Development Opportunities at NIH: A
Panel Discussion. Speaker(s)

Very Poor
Poor
Fair
Good
Very Good

Navigating the NIH Grant Application and Review
Processes, Speaker

Very Poor
Poor
Fair
Good
Very Good

Perspectives on Mentorship, Speakers

Very Poor
Poor
Fair
Good
Very Good

Small Group Discussions with Extramural Faculty

Very Poor
Poor
Fair
Good
Very Good

Women in Medicine and Research: A Balancing Act,
Speaker

Very Poor
Poor
Fair
Good
Very Good

Other talk TBD, Speaker

Very Poor
Poor
Fair
Good
Very Good

Listed below are the major topic areas discussed during the program. Given where you are currently in your career,
rate how important the following topic areas are to you:
Career development strategies

03/10/2023 9:26am

Not Important
Slightly Important
Moderately Important
Important
Very Important

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Time management strategies

Not Important
Slightly Important
Moderately Important
Important
Very Important

How to network effectively

Not Important
Slightly Important
Moderately Important
Important
Very Important

Effective communication and negotiation skills

Not Important
Slightly Important
Moderately Important
Important
Very Important

How to identify appropriate NIH funding opportunities

Not Important
Slightly Important
Moderately Important
Important
Very Important

Components of and applying to NIH funding
opportunities

Not Important
Slightly Important
Moderately Important
Important
Very Important

Strategies to balance work and family

Not Important
Slightly Important
Moderately Important
Important
Very Important

What other topic areas would be particularly useful
for you that was not covered during the workshop?

What components of the Academic Career Development
Workshop did you think were most helpful?

What components of the Academic Career Development
Workshop did you think were least helpful?

What components of the Academic Career Development
Workshop would you change and how?

Overall, how satisfied were you with the workshop?

03/10/2023 9:26am

__________________________________________

__________________________________________

__________________________________________

__________________________________________
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

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How likely are you to pursue a career in academic
medicine?

Very unlikely
Unlikely
Undecided
Likely
Very likely

How influential was the Academic Career Development
Workshop on your previous response?

Not at all influential
Slightly influential
Somewhat influential
Very influential
Extremely influential

Any other comments?
__________________________________________
To date, have you been supported by an NIH grant or
contract?

Yes
No

Have you ever applied for an NIH funding opportunity?

Yes
No

If you applied for an NIH funding opportunity, were
you awarded?

Yes
No

Are you a member of the National Medical Association?

Yes
No

Does participation in this workshop make you more
likely to become a member if not a member already?

Yes
No
N/A

How would you classify your current career status?

Resident
Fellow
Instructor
Assistant Professor
Post-doctoral Researcher
Other

Please specify other career status:

What is your primary specialty?

How would you describe your gender?

Please specify other gender:

Which of these best describes your ethnicity (choose
one)?

03/10/2023 9:26am

__________________________________

__________________________________
Male
Female
Prefer not to answer
Other

__________________________________
Hispanic or Latino
Not Hispanic or Not Latino

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Which of these best describes your race (choose one or
more)?

Please specify other race:

03/10/2023 9:26am

African American/Black
American Indian/Alaska Native
Asian
Native Hawaiian/Pacific Islander
White
Other

__________________________________

projectredcap.org