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CERA Core Survey Questions

For Residency Directors:

1) Please describe the type of residency program you direct:
  • University-Based
  • Community-Based, University-Affiliated
  • Community-Based, Non-Affiliated
  • Military
  • Other (please specify) :_______________________________________

2) In what state is your residency program located? (This information will be aggregated into regions before data is disseminated.)

3) What is the approximate size of the community in which your program is located?
  • Less than 30,000
  • 30,000 to 74,999
  • 75,000 to 149,999
  • 150,000 to 499,999
  • 500,000 to 1 million
  • More than 1 million
4) What proportion of the current residents in your program are graduates of non-US medical schools?
  • 0-24%
  • 25-49%
  • 50-74%
  • 75-100%
  • Don’t Know

5) How many years have you served as Program Director?

6) What is your gender?
  • Female
  • Male
7) How many residents (total complement) were in your program as of October 2016?
  • < 19
  • 19 - 31
  • > 31

For Clerkship Directors:

Is your medical school considered to be public or private?

  • Public
  • Private
My school is located in:
  • Canada
  • USA

For how many years have you served as Clerkship Director? (Please enter a whole number between 0 and 50)

What is your gender?
  • Female
  • Male
How do you identify yourself? (ethnicity)
  • Not Hispanic or Latino
  • Hispanic or Latino
How do you identify yourself? (race)
  • White
  • Black or African American
  • American Indian or Alaska Native
  • Asian
  • Native Hawaiian or other Pacific Islander
  • Multiracial
  • Other Race
Do you have the equivalent of a physician's degree (MD/DO)?
  • Yes
  • No

If yes, what year did you graduate from residency training?

If no, what year were you awarded your highest level of degree, such as PhD?

What percentage of your time is protected to serve as clerkship director? (Please enter a number from 0 to 100)

How many students are there typically in one CLASS at your school? (Please enter a number from 0 to 500)

Is the family medicine or primary care clerkship mandatory for all medical students?
  • Yes
  • No
In which year or years of training are medical students expected to participate in this clerkship? (Please do not count medical students who, for health or academic reasons, are out of phase with their class. Please do mark ALL years that apply.)
  • M1
  • M2
  • M3
  • M4
Please select the design of your clerkship.
  • Block only (defined as sequential weeks of full-time study)
  • Longitudinal only
  • Both block and longitudinal
How many weeks does your family medicine clerkship last?
  • Fewer than 3
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • More than 8 weeks (please specify)

How many weeks does your longitudinal family medicine clerkship last (overall duration)?

Adding together all the curricular time, how many weeks in total is your longitudinal family medicine clerkship? (for example, 1/2 day per week for 50 weeks duration = 50 half days = 25 full days = 5 weeks) (Round the calculation up from 0.5 to 1)
  • Fewer than 3
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • More than 8 weeks (please specify)

This set of questions relates to a school that has two different tracks for medical students, one with sequential weeks of full-time study (block rotation) and the other with a longitudinal format.

Please estimate the percentage of students assigned to each of the two tracks. (Must add up to 100)
  • Block________________
  • Longitudinal________________
How many weeks does the block portion of your clerkship last?
  • Fewer than 3
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • More than 8 weeks (please specify)

How many weeks does the longitudinal portion of your clerkship last? (total duration)

Adding together all the curricular time, calculate approximately how many weeks in total your longitudinal family medicine clerkship lasts. (for example, 1/2 day per week for 50 weeks duration = 50 half days = 25 full days = 5 weeks) (Round the calculation up from 0.5 to 1)
  • Fewer than 3
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • More than 8 weeks (please specify)

Recognized by organizations like the Liaison Committee for Medical Education, Regional Medical Campuses are geographically separate from the main campus, typically have students spend a block of time on site, and have an administrative structure with official ties to the Dean's Office.

How many Regional Medical Campuses does your school have? (Please write a number from 0 to 100)

What percentage of your clerkship students get sent to a Regional Medical Campus?
  • 0 %
  • 1-25 %
  • 26-50 %
  • 51-75 %
  • 76-100%

Comment

What percentage of students in your family medicine clerkship spend at least half of the rotation time in the practice of a community preceptor (defined as teachers who practice off-campus and who do not have a primary appointment in your department or institution)?
  • 0 %
  • 1-25 %
  • 26-50 %
  • 51-75 %
  • 76-100%
Please estimate the percentage of family medicine community preceptors that you pay to teach clerkship students.
  • 0 %
  • 1-25 %
  • 26-50 %
  • 51-75 %
  • 76-100 %

For those preceptors whom you pay, please estimate how much you pay PER WEEK for each clerkship student.

What percentage of your students go to clerkship sites that require overnight stays?
  • 0 %
  • 1-25 %
  • 26-50 %
  • 51-75 %
  • 76-100 %
After any centralized orientation activities at the start of the clerkship and before any end-of-clerkship assessment events, how many times are your clerkship students required to return to campus for activities and/or instruction?
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • More than 10

For Department Chairs

1) Please describe the type of residency program associated with your department
  • Medical school based
  • Community-based, medical school affiliated
  • Community-based, medical school administrated
  • Community-based, non-affiliated
  • Military
  • Don't have a residency
  • Other (please specify) :_______________________________________

2) In what year did your department begin to train residents?

3) In what state is your department located? (This information will be grouped into geographic regions before dissemination.)

4) What is the approximate size of the community in which your department is located?
  • Less than 30,000
  • 30,000 to 75,000
  • 75,001 to 150,000
  • 150,001 to 500,000
  • 500,001 to 1 million
  • More than 1 million

5) How many years have you served as Department Chair?

6) How many full-time faculty does your department have?

7) What is your gender?
  • Male
  • Female
8) How old are you?
  • 20-29 years old
  • 30-39 years old
  • 40-49 years old
  • 50-59 years old
  • 60-69 years old
  • 70+ years old

Copyright 2017 by Society of Teachers of Family Medicine