Skills & Attributes Matrix Survey

1. Skills and Attributes Matrix

A skills and attributes matrix is a tool used to assess the diversity of member representation on the Board, committees and other leadership positions. The information gathered is important as it will highlight gaps that may need to be filled. That information will be used to find someone who best complements the current mix of skills and attributes on the Board or committee.

There is no particular perspective, background, experience, knowledge or skills that would be required for a position on the Board or committees. Nothing listed is required or mandatory; the information provided is used only to assist the selection committee with identifying and filling gaps.

The information gathered will be kept confidential and only shared with the selection committee.

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* Full name

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* Email address

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* Specialty

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* Practice Location

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* Payment model:

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* Contact number

Primary

Alternate

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* Stage in medical career:

Family Medicine specialist

Royal College specialist

International Medical Graduate

Early career (less than 10 years in practice)

Late career (less than 10 years until retirement)

Resident

Student

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* Perspective/Background:
(Please tick the boxes that apply).

BIPOC

Indigenous status

2SIALGBTQ+

Disability

Prefer not to disclose this information

Other/comments:

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* How do you identify?

Female

Male

Gender diverse

Other:

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* Experience/Knowledge/Skills
(Please check the number that you feel best represents your experience, knowledge or skills in the specified area).

	1 (none)	2 (low)	3 (moderate)	4 (high)
Board & Governance	Board & Governance 1 (none)	Board & Governance 2 (low)	Board & Governance 3 (moderate)	Board & Governance 4 (high)
Cultural Competence/Equity Issues	Cultural Competence/Equity Issues 1 (none)	Cultural Competence/Equity Issues 2 (low)	Cultural Competence/Equity Issues 3 (moderate)	Cultural Competence/Equity Issues 4 (high)
eHealth/Technology	eHealth/Technology 1 (none)	eHealth/Technology 2 (low)	eHealth/Technology 3 (moderate)	eHealth/Technology 4 (high)
Financial Acumen	Financial Acumen 1 (none)	Financial Acumen 2 (low)	Financial Acumen 3 (moderate)	Financial Acumen 4 (high)
Government Relations	Government Relations 1 (none)	Government Relations 2 (low)	Government Relations 3 (moderate)	Government Relations 4 (high)
Health Policy	Health Policy 1 (none)	Health Policy 2 (low)	Health Policy 3 (moderate)	Health Policy 4 (high)
Leadership	Leadership 1 (none)	Leadership 2 (low)	Leadership 3 (moderate)	Leadership 4 (high)

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* Comments

This matrix and the supporting documents (Board and Committee Diversity Policy and Guidelines for Diversifying the Board and Committees) were developed in collaboration with the Governance Committee, the internal DNS EDI Committee and physician members of equity-deserving groups.

If you have any questions or require assistance completing this form, please contact Sonia Abi-Ajab at sonia.abiajab@doctorsns.com.

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* Full name

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* Email address

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* Specialty

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* Practice Location

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* Payment model:

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* Contact number

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* Stage in medical career:

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* Perspective/Background: (Please tick the boxes that apply).

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* How do you identify?

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* Experience/Knowledge/Skills (Please check the number that you feel best represents your experience, knowledge or skills in the specified area).

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* Comments

* Perspective/Background:
(Please tick the boxes that apply).

* Experience/Knowledge/Skills
(Please check the number that you feel best represents your experience, knowledge or skills in the specified area).