ADFM New Chair Advising Application

1. Program Structure & Collecting Demographics

Paired Relationships of an early career chair advisee (1 to 3 years) with a more experienced chair advisor (5 or more years, preferred, but earlier in some cases). The advisor may also serve as a facilitator for relationships with others for specific expertise or input, if needed.
ADFM tries to match new chairs with an advisor who will be a good fit for their department structure or individual interests, however the pairing may not always be ideal. We consider it “no fault,” so both parties are welcome to let ADFM know if the match is not working for any reason at any point.
Plan for 2-year time period for the formal advising relationship, with a specified approach. The relationship can continue “indefinitely” but the pair are encouraged to set specific goals for the 2-year period.
For the pair, we suggest:
1. Committing to “check-ins” and communication at least quarterly (every 3 months).
2. Identifying specific goals/objectives. Minimum of two objectives.
  1. Choose at least one from the following list of topics: managing up and down; leading change; financial issues; HR issues; faculty development; research program development; or another topic that the pair agrees to focus on.
  2. And one “general goal” of providing/receiving advice and approaches to problem solving/management dilemmas.
3. And we recommend “sit-downs” in person, at least twice yearly, at national meetings where both parties are present (ADFM, STFM, NAPCRG, and/or AAMC), at least 30 to 60 minutes
  1. Review goals/objectives/progress
  2. General or new issues

Please start by answering the following demographic questions to help us pair you with the most suitable mentor or mentee.

Question Title

* 1. Name:

Question Title

* 2. Current Job Title:

Question Title

* 3. Department Name:

Question Title

* 4. E-Mail Address:

Question Title

* 5. How long have you been in your role?

Under 3 years

3 to 5 years

5 to 10 years

More than 10 years

Question Title

* 6. Describe your department setting.

Allopathic Medical School (MD)

Osteopathic Medical School (DO)

Regional Medical Center (e.g., stand-alone programs)

Other (please specify)

Question Title

* 7. Is your institution public or private?

Public

Private

Question Title

* 8. How many students were in the
most recent entering class at
your school of medicine?

<75

75-149

>149

N/A

Question Title

* 9. Do you consider your department to be:

Small

Medium

Large

Don't know

Question Title

* 10. Are you interested in:

Becoming an advisor

Being an advisee

ADFM New Chair Advising Application

1. Program Structure & Collecting Demographics

Question Title

* 1. Name:

Question Title

* 2. Current Job Title:

Question Title

* 3. Department Name:

Question Title

* 4. E-Mail Address:

Question Title

* 5. How long have you been in your role?

Question Title

* 6. Describe your department setting.

Question Title

* 7. Is your institution public or private?

Question Title

* 8. How many students were in themost recent entering class atyour school of medicine?

Question Title

* 9. Do you consider your department to be:

Question Title

* 10. Are you interested in:

* 8. How many students were in the
most recent entering class at
your school of medicine?