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First Name
Last Name
Email
Phone
Have you ever been involved in any research or scholarly work in the past?
Yes
No
In this work, did you do any of the following? Check all that apply.
Submit an IRB protocol
Collect data
Analyze data
Write research papers
What do you see yourself doing professionally 10 years from now? (For example, in what medical specialty, type of practice, type of community/state)
Are you in a track? If so please indicate which track.
- Select -
LEADS Track
Research Track
Rural Track
CU-Unite Track
Women's Health Track
Global Health Track
What is your Medical School Graduation Year?
- Select -
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Briefly describe what brought you to medical school.
Have you completed CITI training in the last 2 years (Collaborative Institutional Training Initiative training on human subjects research ethics)?
Yes
No
What types of research or scholarly work do you expect to be involved in as part of your career? Check all that apply.
Reading Academic Journals
Attending Academic Conferences
Conducting Quality Improvement in my practice
Conducting program evaluation in my practice
Conducting research in my practice
Conducting research as faculty in an academic institution
How did you learn about the opportunity to do your MSA in the Department of Family Medicine? What attracted you to this opportunity?
What kind of an MSA project are you most interested in doing?
In which of the following types of instruction and support from DFM MSA leadership would you be interested in participating? Check all that apply.
Group workshops
Working groups with other MSA students
Summer program with stipend
Drop-in office hours
In what setting(s) are you interested in doing your MSA project?
Community
Family Practice
Laboratory
In which of the following areas would you be interested in doing your MSA project? Check all that apply.
Chronic disease
Infectious disease
Population health
Information technology
Mental health
Global health
Community center
Family Medicine outpatient clinic
Laboratory
Community based or community engagement
QI (patient care, team-based care, office flow, PCMH)
Integrated health care
Health policy and access
Advocacy
Serving the underserved
Education/curricular design
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Family Medicine (SOM)
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