2019 St. Claire Family Medicine Residency Program Graduate Survey

I. GENERAL INFORMATION

1. Please provide your name and current mailing address:

First NameLast Name

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone number:

Area CodePhone Number

Email:

Email

2. Where did you graduate high school?

High School Name

Residency graduation year

city/county/state/zip

City

Street Address Line 2

CountyState / Country

Postal / Zip Code

3.Did you complete any of the following?

If yes please identify:

Type/year

4. Do you have specialty board certification?

Please specify:

Specialty/Year

II. CURRENT PRACTICE INFORMATION

5. Are you now in Practice?

If not, what year did you leave practice?

Year

Are you practicing family medicine?

If no, specify

6. Please provide the name and address of your primary practice site:

Name of practice

Address:

7. For your most recent week of typical practice, how many hours did you spend?

Seeing patients in office or clinic

Seeing patients in hospital (not ER)

Seeing patients in ER or urgent care facility

Seeing patients in NH or extend care facility

Administration

Teaching (in & out clinic)

Other

Total

Total hours

8. For your present primary practice site?

a. What is the county?

County

b. How many years have you been in practice there?

Years

c. What percent of your current professional activity is there?

%

How many patients do you see in their homes in a typical week?

9. Which of the following best describes your primary practice site?

A. Check one:

B. Check one:

10. What is the approximate demographic makeup of patient visits to your PRIMARY practice site?

White

%

Black or African American

%

Hispanic

%

Other

%

Total =

11. Do you have OTHER practice sites?

If yes, what is the county?

If you answered no please skip to question 13.

12. Which of the following best describes your other practice sites (if you answered yes to question 11)? Check all that apply

13. Describe the PRIMARY hospital at which you practice (check all that apply):

14. In the past, have you ever provided medical care for which your service were volunteered or free? (e.g. missionary work, free clinic, etc)

III. RESIDENCY PREPARATION FOR PRACTICE

Instructions: For each of the subject areas listed below, please indicate whether or not the item is currently a part of your practice (yes or no). Then regardless of whether or not this is part of your practice, circle the response 1, 2, or 3, which indicate how well your FM residency training prepared you for this part of practice.

Patient care & Medical Knowledge

Rows	YES! Currently part of my practice	No! Not part of my practice	Under-prepared for practice (1)	Adequately Prepared for practice (2)	Well Prepared for practice (3)
15. Care of newborn & infants	1	2	3	4	5
16. Care of children & adolescents	6	7	8	9	10
17. Woman's health including gynecology	11	12	13	14	15
18. Men's Health	16	17	18	19	20
19. Maternity Care	21	22	23	24	25
20. Care of older adults	26	27	28	29	30
21. Ambulatory medicine	31	32	33	34	35
22. Inpatient medicine	36	37	38	39	40
23. Urgent & emergent care	41	42	43	44	45
24. Intensive/critical care	46	47	48	49	50
25. Mental Health	51	52	53	54	55
26. X-ray interpretation	56	57	58	59	60
27. Conditions of the musculoskeletal system	61	62	63	64	65
28. Care of the surgical patient	66	67	68	69	70
29. Oral Health	71	72	73	74	75

Interpersonal & Communication Skills

Rows	YES! Currently part of my practice	No! Not part of my practice	Under-prepared for practice (1)	Adequately Prepared for practice (2)	Well Prepared for practice (3)
30. Human Behavior	76	77	78	79	80
31. Family structure & function	81	82	83	84	85
32. Psycho-social components	86	87	88	89	90
33. The doctor-patient relationship	91	92	93	94	95

Professionalism

Rows	YES! Currently part of my practice	No! Not part of my practice	Under-prepared for practice (1)	Adequately Prepared for practice (2)	Well Prepared for practice (3)
34. Medical Ethics	96	97	98	99	100
35. Personal and professional growth	101	102	103	104	105
36. Culturally competent	106	107	108	109	110

Practice-based Learning & Improvement

Rows	YES! Currently part of my practice	No! Not part of my practice	Under-prepared for practice (1)	Adequately Prepared for practice (2)	Well Prepared for practice (3)
37. Health maintenance/disease prevention	111	112	113	114	115
38. Evidence-based medicine	116	117	118	119	120
39. Patient centered care	121	122	123	124	125
40. Continuous quality assessment & improvement	126	127	128	129	130

Systems-based Practice

Rows	YES! Currently part of my practice	No! Not part of my practice	Under-prepared for practice (1)	Adequately Prepared for practice (2)	Well Prepared for practice (3)
41. Practice management	131	132	133	134	135
42. Medical informatics	136	137	138	139	140
43. Accessing community resources	141	142	143	144	145
44. Oral health consultation	146	147	148	149	150
45. Community oriented primary care	151	152	153	154	155

46. Overall, my residency training prepared me effectively for the type of practice I am in.

Please comment:

47. In preparing me for practice, the volume of patients seen during my residency was:

48. In preparing me for practice, the variety of patients seen during my residency was:

49. We welcome your suggestions for improving residency training and ideas. Please write these or other comments in the space below.

IV. Federal funding agencies request this information about our training programs (confidential)

Do your currently work (i.e. clinical service or training efforts) 50% or more of your time in any of the following medically undeserved setting?

If yes, please check all that apply:

51. Which of the following describes your ethnic background? (check all applicable)

According to Health Resources and Services Administartion (HRSA), an individual from a disadvantaged backgroun is defined as someone who:

Do you think you met the definition for "disadvantage background" on entering residency?

Thank you very much!!!