Clone of ASPN AI and Medical Technology Member Survey

ASPN Mentee Application Survey
Thank you for your interest in the ASPN Invasive Pain Medicine Mentorship Program.
This program is focused on helping the top professionals in pain medicine cultivate their growth with mentorship from leaders within our field. This application is designed to understand your experiences, goals, and motivations as you navigate your early career in chronic pain medicine. ASPN mentees must be selected by our mentors. A committee will review your application and final decisions will be made by your mentor. We encourage you to apply for mentors who can support your professional growth and provide guidance as you establish your career in this important field through similar interests and backgrounds. Please answer the following questions as honestly and thoughtfully as possible.
Section 1

Personal & Professional Background
Name

First NameLast Name
Email
example@example.com
Current Position
Institution/Organization
Attending Physician (>5 years)Early Career Attending (1-5 years)Pain Medicine Fellow
What drew you to the field of interventional pain? (Please describe your motivations, experiences, or any turning points that influenced your decision to pursue this specialty)
2. Clinical Interests & Goals

Interested Areas of Mentorship
Contract NegotiationsPractice StructureMarketingBilling/ReimbursementIndustry RelationsPolicy & Advocacy in Pain MedicineEndoscopic Spinal ProceduresSpinal Fusion/SpacerSacroiliac FusionIntra-Discal ProceduresVertebral AugmentationBVN AblationDorsal Column/Epidural StimulationDorsal Root Ganglion StimulationTargeted Drug DeliveryOther
As a provider, what are your goals in the next 2-5 years in terms of your clinical practice and career? (This could include specific skills you want to develop, clinical outcomes you wish to impact, research, or the types of patient populations you hope to serve.)
3. Mentorship Needs & Expectations
What are the primary reasons you are seeking mentorship at this stage in your career? ((Please explain what you hope to gain from the mentorship relationship, whether it is clinical advice, career guidance, and research opportunities. It is important to be specific such as detailing specific research like industry vs. academic or clinical trials vs. education)
What kind of mentorship relationships or experiences have you had in the past, and how have they shaped your approach to learning and professional development? (This could include positive or negative mentorship experiences and how they influenced your growth.)
How do you hope to contribute to ASPN and the field of interventional pain in the future? If you have worked with ASPN, please mention that here as well. (Consider what kind of impact you hope to have on patient care, research, education, policy in chronic pain medicine.)
Additional Thoughts?
Is there anything else you would like to share about your career journey, current challenges, or mentorship needs?
Confidentiality & Agreement

By submitting this application, you acknowledge your commitment to engaging with a mentor in a respectful, professional manner and understand that the mentorship program is designed to support your career development within chronic pain medicine.
YesNo
Thank you for taking the time to complete this application! We look forward to connecting you with an ASPN mentor who can help you achieve your goals!
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ASPN Mentee Application Survey

Section 1

2. Clinical Interests & Goals

3. Mentorship Needs & Expectations

Confidentiality & Agreement