Is your medical school considered to be public or private?

• Public
• Private

In what state/province is your school located? (This information will be aggregated into regions before data is disseminated.)

How long have you been in your current clerkship director role?

How many total years have you served as a clerkship director?

What is your current gender identity? Select all that apply

• Female/Woman
• Male/Man
• Genderqueer/Gender non-conforming
• Non-binary
• Choose not to Disclose
• Prefer to self-describe (please specify)

Which of the following best defines your race or ethnicity? Select all that apply:

• Hispanic/Latino/a/Spanish Origin
• American Indian/Alaska Native/Indigenous
• Asian
• Black/African American
• Native Hawaiian/Pacific Islander
• White
• Middle Eastern/North African

For URM Questions we used the following definition from AAMC:
“Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population (Black/African-American, Hispanic/Latino/of Spanish Origin, American Indian/ Alaska Native/Indigenous, Native Hawaiian/other Pacific Islander, and certain Asian ethnicities).”

I self-identify as underrepresented in medicine.

• No
• Yes

Do you have a physician's degree (e.g. 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?

How many students are there typically in one CLASS at your school?

What percent of your medical school graduates matched into family medicine in 2019? 

• 5% or less 
• 6 - 10% 
• 11 - 15% 
• 16 - 20%
• 21 - 25%
• More than 25%

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? 

What percentage of your clerkship students get sent to a Regional Medical Campus?

• 0 %
• 1-25 %
• 26-50 %
• 51-75 %
• 76-100%

Comments:

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

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)

In what year did your department begin to train residents?

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

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

How many years have you been in your current department chair role?

How many total years have you served as a department chair?

How many full-time FTEs (MD, DO, PhD, PharmD, and other types of faculty) does your department have?

What is your current gender identity? Select all that apply

• Female/Woman
• Male/Man
• Genderqueer/Gender non-conforming
• Non-binary
• Choose not to Disclose
• Prefer to self-describe (please specify)

Which of the following best defines your race or ethnicity? Select all that apply:

• Hispanic/Latino/a/Spanish Origin
• American Indian/Alaska Native/Indigenous
• Asian
• Black/African American
• Native Hawaiian/Pacific Islander
• White
• Middle Eastern/North African

For URM Questions we used the following definition from AAMC:
“Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population (Black/African-American, Hispanic/Latino/of Spanish Origin, American Indian/ Alaska Native/Indigenous, Native Hawaiian/other Pacific Islander, and certain Asian ethnicities).”

I self-identify as underrepresented in medicine.

• No
• Yes

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

Because the CERA General Member Survey may have either a general or targeted audience, these are only example questions. Final core questions will be determined by the accepted researchers.

What is your highest degree earned?

• EdD
• DNP
• DO
• MD
• MD/PhD or DO/PhD
• PhD
• Other doctoral level
• Other nursing level
• Master’s level
• Bachelor’s level

In what year did you earn your highest degree? [text box whole number yyyy]

In what state or province is your practice/program located? (This information will be aggregated into regions before data is disseminated.)

Please estimate the size of the community in which your workplace 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

Is your institution a(n)…?

• Allopathic medical school
• Osteopathic medical school
• Not at a medical school

Does your institution have…?

• Multiple residencies including family medicine
• Multiple residencies not including family medicine
• Only a family medicine residency
• No residency education

How old are you?

• Drop-down list 18-90 years old

What is your current gender identity? Select all that apply

• Female/Woman
• Male/Man
• Genderqueer/Gender non-conforming
• Non-binary
• Choose not to Disclose
• Prefer to self-describe (please specify)

Which of the following best defines your race or ethnicity? Select all that apply:

• Hispanic/Latino/a/Spanish Origin
• American Indian/Alaska Native/Indigenous
• Asian
• Black/African American
• Native Hawaiian/Pacific Islander
• White
• Middle Eastern/North African

For URM Questions we used the following definition from AAMC:
“Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population (Black/African-American, Hispanic/Latino/of Spanish Origin, American Indian/ Alaska Native/Indigenous, Native Hawaiian/other Pacific Islander, and certain Asian ethnicities).”

I self-identify as underrepresented in medicine.

• No
• Yes