Thank you for sharing your information with us!  It is time to UPDATE our current HMS Home for Family Medicine (HHFM) network database, and we are looking forward to hearing from you.

The information that we collect will help us to get to know family physicians affiliated with HMS, and to connect faculty and students for clinical teaching, mentoring and research.  Because the HMS Home for Family Medicine strives for interdisciplinary education and experiences, many of our events also include students from the Chan School of Public Health, the Harvard School of Dental Medicine, MGHIHP, and the Simmons School of Social Work to name a few.  We will invite you to be included in a mentorship database for students from these other networks as well as the medical school.

We will keep the survey information private within the Center for Primary Care/HHFM, and plan to create a searchable database for our local students for clinical, research and mentoring opportunities.  You will have the opportunity to OPT OUT of this database if you wish.

Feel free to skip questions if you prefer not to answer them, although more information helps us to better understand our FM community!

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Email

Question Title

* 4. Practice address

Question Title

* 5. Practice phone number

Question Title

* 6. Practice fax

Question Title

* 7. Is your practice accessible by public transportation?

Question Title

* 8. If you answered "yes" to the above question, what is the approximate time to reach your practice on public transportation from the Longwood Medical Campus? 
For most courses in the first 2 years, practices need to be within 45 minutes of Longwood by public transportation.

Question Title

* 9. What is your usual patient care schedule (when you might be available for clinical teaching)?

Question Title

* 10. Faculty appointments currently at HMS or elsewhere, rank and department:
We ask this to know who might need support applying for a faculty position, and also how our family doctors are achieving faculty status in the absence of an FM department.

Question Title

* 11. Do you currently teach HMS students? If so, which course(s)?

Question Title

* 12. What are your current research activities, if you currently engage in research?
We hope to develop a strong network within HHFM faculty where expertise and experiences can be shared, and mentoring relationships developed.

Question Title

* 13. If you conduct research (or plan to) would you be interested in having students work with you?
All HMS students are required to complete a Scholars in Medicine project prior to graduation, which usually involves the equivalent of 4-5 months of full time work.

Question Title

* 14. What are your particular areas of clinical interest?
We would love for students to be able to find mentors who are engaged in the sorts of work to which they aspire.

Question Title

* 15. Please tell us about any work you do in advocacy and/or health equity. 
The Center for Primary Care is very involved in work to decrease health disparities, and could be a good support for faculty advocacy efforts.  Additionally, many students are seeking experience and mentoring around advocacy.

Question Title

* 16. Do you have clinical/educational/administrative leadership roles, and if so what are they?
Students are also very interested in experience and mentorship around leadership and transformation. This information could also be used to foster inter-faculty mentorship.

Question Title

* 17. Please provide a brief description of your clinical practice, including patient demographics, languages spoken commonly in your office, your scope of practice (age range, inpatient care, newborn nursery, prenatal care, SNF care etc) and any other special clinical focus.
This will help us match student interest with your clinical practice.

Question Title

* 18. TEACHING Opportunities - Please let us know if you would be interested in any of the following (if you are not doing so already).
Availability for teaching these courses is often limited, however we would love to have a pool of potential teachers when an opportunity arises.

Question Title

* 19. Other Student Contact Opportunities - HHFM would like to have a database of faculty and their educational interests/passions in order to plan regular student events that highlight the work of our local Family Physicians.  Would you be interested in:

Question Title

* 20. Mentoring: The HHFM will support mentorship not only between faculty and students, but also peer mentoring for both faculty and students. We look forward to building this community and hosting events to foster connections. Would you:

Question Title

* 21. Faculty Education: The HHFM would like to foster community among our faculty, and provide opportunities for professional growth. As we are able to resume CME planning, would you be interested in a CME course around:

Question Title

* 22. Do we have your permission to share your information in a searchable online database that is available to HMS students and faculty?

Question Title

* 23. Do we have your permission to share your information in a searchable online database that is available to students at the HSDM, HSPH, Simmons School of Social Work, and the MGH Institute of Health Professions?

Question Title

* 24. The Vision and Mission of the HMS Home for Family Medicine are:  

Mission: The HMS Home for Family Medicine is a learning community that promotes mentorship and collaboration among Harvard affiliated family physicians, residents and students, and advocates for family medicine as a specialty throughout the Harvard community.

Vision: To ensure that all HMS students have meaningful educational experiences in the specialty of family medicine, and that our unified HMS family medicine affiliates create and promote family medicine scholarship, education, and mentorship.

What would you like to see happen at the HHFM to help us succeed?  How can we better support our affiliates?

T