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University name

Address

How many years is medical education program at your university?

What year was the mentoring program established?

Is the mentoring program group based?

Is the mentoring program One To One?

Is the mentoring program mandatory or voluntary?

How long does the mentoring program last? (longitudinal or for a limited time period)

What is the mentoring program’s main objective?

What was the background for establishing a mentoring program?

Student assessment?

LCME requirements?

If other, please specify

How would you describe the faculty leaderships support for the mentoring program?

Who has the role of being a mentor?

Physicians?

Faculty members?

Senior students?

Peer students?

If other, please specify

How are mentors recruited?

Voluntary?

Snowballing?

Mandatory?

If other, please specify

Are there any incentives for being a mentor?

Financial compensation?

CME credits?

If other, please specify

Has the mentoring program been assessed?

Has the mentor program been described or assessed in a written publication?

Group based

What is the average group size?

How are groups formed?

Randomly?

By alphabetic order?

Matching tools?

Students form their own groups?

If other, please specify

Are the groups fixed in terms of mentee members?

How many mentors per group?

Does the mentor follow one group for the entire duration of the mentoring program?

How many group meetings per semester?

Where does the group meet?

On campus/in the hospital?

In a mentor’s home?

In a mentee’s home?

If other, please specify

What are the main topics for discussion or training in the mentoring groups?

One to one

How are mentor-mentee pairs composed?

Randomly?

Matching tools?

If other, please specify

How many times per semester does the mentor-mentee pair (intend to) meet?

In a mentee’s home?

Where does the mentor-mentee pair meet?

In the mentor’s office?

In the mentor’s home?

In the mentee’s home?

If other, please specify

What are the main topics for discussion or training in the mentor-mentee meetings?

Finally, if we would like to know more about your medical school’s mentoring program, who may we contact (information will NOT be posted on this homepage unless you tick the consent box below)?

Name

Phone

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