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NASPAG Mentoring Families Sign-Up 2023-2024
The NASPAG Antiracism Committee is dedicated to fostering community, mentorship, and leadership development for providers from all racial and ethnic backgrounds. It aims to further the education of NASPAG members to strive for anti-racism within our medical and surgical fields.
The NASPAG Research Committee is committed to fostering high quality research among our members, creating opportunities for collaboration, and providing ongoing mentorship and educational opportunities for members interested in research endeavors.
The Antiracism Committee is partnering with the Research Committee Mentoring Working Group to build a community to further these goals within NASPAG. In order to promote an opportunity for better engagement and fostering ideas at all levels, Mentorship Families will be created rather than the traditional mentor-mentee dyad. In this model, each Mentorship Family will be comprised of individuals from varied levels of experience ranging from trainees to Professor.
The goal of the Mentoring Families is to connect individuals in the field of Pediatric and Adolescent Gynecology of all backgrounds, specialties, and levels of training. Our hope is that the Mentorship Family structure will provide a forum for dialogue about career development, research pursuits, and beyond.
Mentoring Families will be formed in late Spring 2023. Sign up below to be connected with your family!
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Email
Your answer
First name
Your answer
Last name
Your answer
Race (select all that apply)
Black or African American
Asian or Asian American
Middle Eastern or North African
White or Caucasian
Native Hawaiian or Pacific Islander
American Indian or Alaskan Native
Prefer not to say
Other:
Ethnicity
Not Hispanic/Latinx
Hispanic/Latinx
Prefer not to say
Other:
Clear selection
Which most closely describes your gender?
Woman
Man
Transgender woman
Transgender man
Non-binary
Agender/I don't identify with any gender
Prefer not to say
Other:
Clear selection
Current Institution Affiliation / Employer
Your answer
Current City/State
Your answer
Current time zone
Eastern Daylight Time (UTC-4)
Central Daylight Time (UTC-5)
Mountain Daylight Time (UTC-6)
Pacific Daylight Time (UTC-7)
Alaska Daylight Time (UTC-8)
Hawaii Daylight Time (UTC-9)
Other:
Clear selection
What days/times would you be interested in meeting with your family? (select all that apply)
Weekdays during the day (eg lunchtime)
Weekday evenings
Weekends
Other:
Hometown city/state
Your answer
Undergraduate institution
Your answer
Medical school/graduate school (if applicable)
Your answer
Residency institution (if applicable)
Your answer
Fellowship institution (if applicable)
Your answer
What is your role/level of training?
Medical student
Resident
Fellow
Attending physician
Nursing student
Nurse
Physician assistant or nurse practitioner assistant
Nurse practitioner
Physician assistant
Research coordinator
Administrator
Other:
Clear selection
How many years have you been in practice (years after completion of training)?
still in training
<7 years
≥7 years
N/A
Clear selection
Type of practice/clinical setting
Academic hospital-based
Community hospital-based
Private Practice
Other:
Clear selection
Academic rank (if applicable)
Instructor
Assistant professor
Associate professor
Professor
None or Non-academic position
Other:
Clear selection
What is your specialty?
Adolescent medicine
General pediatrics
Pediatric endocrinology
Other pediatrics subspecialty
Pediatric and Adolescent Gynecology
General OBGYN
Other OBGYN subspecialty
Family medicine
Other:
Clear selection
What is your OBGYN subspecialty? (
if you selected "Other OBGYN subspecialty" in previous question)
Reproductive endocrinology and infertility
Minimally invasive gynecologic surgery
Gynecologic oncology
Complex family planning
Female pelvic medicine and reconstructive surgery
Other:
Clear selection
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