Initial Survey

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

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

3. Are you a:

4. (Checked resident or fellow) What year of training in current program are you in?

5. What is your primary clinical setting (if checked faculty physician above)?

6. What is your age in years?

7. Check all that apply:

8. Right now, I have so much at work to be thankful for.

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

10. At the present time, life has been good to me at work.

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

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

13. 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.

14. Right now, I feel deeply appreciative for the things others have done for me at work.

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

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

17. Right now, I think it’s important to enjoy the simple things that pertain to my work.

18. I have a chance to use my strengths every day at work

19. I feel like I am thriving at my job

20. I feel like I am making a meaningful difference at my job

21. I am often pleasantly fascinated by things that happen at my job

22. I always bounce back quickly after difficulties:

23. I always find a solution when something unforeseen happens:

24. I can adapt to events in my life that I cannot influence:

25. My mood reliably recovers after frustrations & setbacks:

26. Events from this work setting affect my life in an emotionally unhealthy way:

27. I feel burned out from my work

28. I feel fatigued when I get up in the morning & have to and to face another day on the job

29. I feel frustrated by my job

30. I feel I am working too hard

31. How likely are you to recommend this as a good place to work to a colleague?

32. If you didn’t rate a 10, why not?

33. Have you completed an individual or group wellness plan?

34. I obtain a sense of sense of joy/mutual delight through connection with my colleagues at work

35. I find that through my present work, I am able to connect to the meaning in medicine.

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

37. Do you currently make a conscientious habit of reflecting on your mental health as a vital sign?

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

39. I have become more callous toward people since I took this job

40. Engagement: I believe that engaging in improving workplace systems/activities supports my well-being.

41. Over the last two weeks, how often have you been bothered by feeling nervous, anxious or on edge

42. Over the last two weeks, how often have you been bothered by not being able to stop or control worrying

43. Over the last two weeks, how often have you been bothered by feeling down, depressed, or hopeless

44. Over the last two weeks, how often have you been bothered by little interest or pleasure in doing things

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

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

47. In the last month, how often have you felt that things were going your way?

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