Mentor Program Interest Survey
The American Academy of Pain Medicine (AAPM) is launching a new Pipeline Mentorship Program to connect trainees with faculty mentors. To build a strong foundation, we’re gauging interest from attendings and faculty who are willing to share their experience, wisdom, and guidance with the next generation. Please take a few minutes to complete this short survey, your input will shape the future of mentorship at AAPM.
Name
*
First Name
Last Name
Email
*
example@example.com
Institution/Practice Affiliation
*
Title/Position
*
How many years have you been in practice?
*
1-5
6-10
11+
Areas of Expertise (check all that apply)
*
Clinical practice
Research
Academic advancement
Leadership/administration
Advocacy/policy
Innovation/entrepreneurship
Work-life integration
Other
If other:
Preferred mentorship focus areas
Preferred level of involvement
*
One-time or short-term mentoring (e.g., “speed dating” style event)
Ongoing 1:1 mentorship relationship
Both
Availability for mentee meetings (choose preferred cadence)
*
Monthly
Bi-monthly
Quarterly
May 7th Only
What motivates you to serve as a mentor within AAPM?
Would you be interested in participating in the Virtual Mentorship Speed Dating Webinar on Thursday, May 7th?
*
Yes
Not at this time
Any additional comments or suggestions for shaping the mentorship program?
Submit
Should be Empty: