Shame in Medicine Ambassador Sign-Up Form
Alongside Shame in Medicine: The Lost Forest, The Nocturnists have developed an impact campaign to encourage audiences to use the series as a catalyst for new conversations about shame in medical culture. With the goal of supporting clinicians in using the series to reimagine our healthcare system, we are looking for series "Ambassadors" to help this work reach a wider audience. We currently have a growing base of over 80 active ambassadors who are bringing these conversations to their community, and we invite you to share any ideas you may have for how best to move this work forward!
First Name
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Last Name
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Email Address
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City/Town
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Affiliated institution, hospital, or clinic(s)
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What is your professional role? (1-2 sentences max)
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How do you see the "Shame in Medicine: The Lost Forest" series impacting your community? (1-2 sentences max)
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I'm interested in (check all that apply)
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Inviting someone from the The Nocturnists' Shame in Medicine team to give a Grand Rounds presentation, keynote talk, podcast appearance, or similar
Teaching about issues of shame in a medical education curriculum
Hosting an informal gathering of healthcare workers to discuss the series (similar to a book club, but for podcasts)
Organizing a public event at my home institution (e.g. panel discussion, fireside chat)
Submitting a written story, or recorded story, of my own shame experience, or my reactions to the shame series, to be included on The Nocturnists website
Writing an article about the series for a newsletter, listserv, blog, or journal
Attending a virtual gathering with other Shame in Medicine Ambassadors
Other (creativity is encouraged)
I'd like to hear a sneak preview of the series.
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Yes
No
Not sure
Anything else? Questions? You can also email us at shame@thenocturnists.com.
SUBMIT
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