Pre-Stream Survey

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Username

Professional Degree 1(Required)

Professional Degree 2

Professional Degree 3

Institution(Required)

1. How do you gender-identify at this point in time?(Required)

2. How do you identify (check all that apply)?(Required)

African or Afro-Caribbean or Black

Arab or Middle Eastern

Asian or Pacific Islander

Caucasian or European or White

Latino or Latina or Hispanic

Native American or Alaskan Native

Multi-ethnic

I do not identify as any of the above

Prefer not to answer

3. Are you a:(Required)

Resident

Fellow

Faculty (Physician)

APP

Other

Prefer not to answer

4. If Faculty or APP: What is your primary clinical setting:

5. If a resident or fellow what year of training in current program are you in?

6. What is your primary clinical setting?(Required)

7. Age in years:(Required)

8. Check all that apply:(Required)

I come from a rural residential background

I come from a disadvantaged background

I practice in a rural residential area

I practice in a disadvantaged area

9. Right now, I have so much at work to be thankful for.(Required)

10. At this present time, if I had to list everything that I felt grateful for at work, it would be a very long list.(Required)

11. At the present time, life has been good to me at work.(Required)

12. Currently, I couldn’t have gotten where I am today at work without the help of many people.(Required)

13. Although I think it’s important to feel good about my current work accomplishments, I think that it’s also important to remember how others have contributed to my accomplishments.(Required)

14. Although I’m basically in control of my work at the present time, I can’t help but think about all those who have supported me and helped me along the way.(Required)

15. Right now, I feel deeply appreciative for the things others have done for me at work.(Required)

16. Currently, I think that it’s important to “Stop and smell the roses” as it pertains to my work.(Required)

17. Currently, I believe that it’s important to pause often to “count my blessings” at work.(Required)

18. Right now, I think it’s important to enjoy the simple things that pertain to my work.(Required)

19. I have a chance to use my strengths every day at work(Required)

20. I feel like I am thriving at my job(Required)

21. I feel like I am making a meaningful difference at my job(Required)

22. I am often pleasantly fascinated by things that happen at my job(Required)

23. I always bounce back quickly after difficulties:(Required)

24. I always find a solution when something unforeseen happens:(Required)

25. I can adapt to events in my life that I cannot influence:(Required)

26. My mood reliably recovers after frustrations & setbacks:(Required)

27. Events from this work setting affect my life in an emotionally unhealthy way:(Required)

28. I feel burned out from my work(Required)

29. I feel fatigued when I get up in the morning & have to and to face another day on the job(Required)

30. I feel frustrated by my job(Required)

31. I feel I am working too hard(Required)

32. How likely are you to recommend this as a good place to work to a colleague?(Required)

33. If you didn’t rate a 10, why not?

34. Right now, I have so much at work to be thankful for(Required)

35. Currently, I believe that it’s important to pause and “count my blessings” at work.(Required)

36. Right now, I feel deeply appreciative for the things others have done for me at work.(Required)

37. Have you completed an individual or group wellness plan?(Required)

Yes

38. I obtain a sense of sense of joy/mutual delight through connection with my colleagues at work(Required)

39. I find that through my present work, I am able to connect to the meaning in medicine.(Required)

40. I am currently engaged in a project to improve my workplace (QI, process improvement, etc)(Required)

Yes

41. Do you currently make a conscientious habit of reflecting on your mental health as a vital sign?(Required)

Yes

42. (if yes to above) What are the elements of your plan?

43. I have become more callous toward people since I took this job(Required)

44. Engagement: I believe that engaging in improving workplace systems/activities supports my well-being.(Required)

45. Feeling nervous, anxious or on edge(Required)

Not at all	Several days	More than half the days	Neary every day

46. Not being able to stop or control worrying(Required)

Not at all	Several days	More than half the days	Neary every day

47. Feeling down, depressed, or hopeless(Required)

Not at all	Several days	More than half the days	Neary every day

48. Little interest or pleasure in doing things(Required)

Not at all	Several days	More than half the days	Neary every day

49. In the last month, how often have you felt that you were unable to control the important things in your life?(Required)

50. In the last month, how often have you felt confident about your ability to handle your personal problems?(Required)

52. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?(Required)

49. In the last month, how often have you felt that you were unable to control the important things in your life?(Required)