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The following questionnaire was presented to and completed by second year specialty medicine residents in Canada in 2004. Please review the questionnaire and use your cursor to click on those questions for which you wish to view results.
Demographics for Medical Residents (PGY2)
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A. Training
Please complete this questionnaire if you are in your SECOND year year of a Specialty Medicine Residency Program at a Canadian University.
If you are not a second year specialty medicine resident, please indicate your status below.
؎ First year family medicine resident
؎ Third year advanced skills family medicine training position
؎ Resident in a specialty other than family medicine
؎ Physician in practice
؎ Other
A. Training
1. Please indicate your overall sense of satisfaction with your specialty medicine program.
|
Very dissatisfied |
Dissatisfied |
Neutral |
Satisfied |
Very satisfied |
Overall satisfaction with specialty medicine program |
؎ |
؎ |
؎ |
؎ |
؎ |
2.a) For the following experiences within your residency training, please indicate:
- if the specific category of training is available to you (Please tick all that apply);
- if available and you have experienced, please rate the training using the scale provided;
- if you feel that the specific category of training should be a mandatory component of your residency curriculum
|
Available? |
Rating |
Should it be |
||||
|
|
1(poor) |
2 |
3 |
4 |
5(excellent) |
Mandatory? |
Collaborative/Interdisciplinary care |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
Communication skills |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
Critical appraisal skills/evidence-based medicine |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
End of life issues |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
Ethics and professionalism |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
Research methods |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
Working in a health care system |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
Other___________________ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
؎ |
3. Will you feel adequately prepared for the kind of practice you are planning to undertake?
B. Learning Environment
Strongly agree Agree Neutral Disagree Strongly disagree
؎ ؎ ؎ ؎ ؎
Strongly agree Agree Neutral Disagree Strongly disagree
؎ ؎ ؎ ؎ ؎
Strongly agree Agree Neutral Disagree Strongly disagree
؎ ؎ ؎ ؎ ؎
Strongly agree Agree Neutral Disagree Strongly disagree
؎ ؎ ؎ ؎ ؎
Strongly agree Agree Neutral Disagree Strongly disagree
؎ ؎ ؎ ؎ ؎
Strongly agree Agree Neutral Disagree Strongly disagree
؎ ؎ ؎ ؎ ؎
6. Considering all of the areas in medicine, what led you to select your area of specialty?
Please check ALL that apply.
| A | ؎ |
Intellectual stimulation/challenge |
G |
؎ |
Earning potential |
B |
؎ |
Doctor-patient relationship |
H |
؎ |
Research opportunities |
C |
؎ |
Workload flexibility and/or predictability |
I |
؎ |
Teaching opportunities |
D |
؎ |
Influence of a mentor |
J |
؎ |
Ability to pursue non-work related interests |
E |
؎ |
Influence of my family |
K |
؎ |
Availability of training opportunities |
F |
؎ |
Prestige |
L |
؎ |
Other _____________ |
7. When did you decide on your current residency field?
|
؎ |
Before medical school |
|
؎ |
During medical school but prior to clerkship |
|
؎ |
During clerkship |
|
؎ |
During residency |
|
؎ |
Other _____________________________________________ |
8. Does your university have a confidential mechanism in place to report incidents of sexual harassment, intimidation or other inappropriate incidents in the learning environment?
؎Yes ؎No ؎Don’t know
9. a) Have you been harassed or intimidated during your residency?
؎Yes ؎No (skip to Question 10)
If yes, by whom? ؎ Staff person
؎Medical senior/supervisor
؎Another resident (non-supervisory)
؎Other (Please specify): ________________________
9. b) If yes, when did this occur?
؎ during a family medicine experience
؎ during a specialty experience
؎ both of the above
9.c) If yes, please state the frequency: _____times per month Other (please specify):____
10. During your residency, has your level of stress been significant enough to cause you to:
Take medical leave from your residency? ؎Yes ؎No
Consult a physician for stress-related depression? ؎Yes ؎No
Take medication? ؎Yes ؎No
11. Have you encountered negative feedback when you have had to leave a specialty service outside of your program, in order to return for your own program's academic time?
؎ Yes ؎ No
12. Do you feel that the educational and service components of your program are balanced?
Strongly agree Agree Neutral Disagree Strongly disagree
؎ ؎ ؎ ؎ ؎
C. Future Practice/ Work Setting Profile 
13. Once you complete your residency, do you plan to:
a) Practice in the field in which you are currently training? ؎ Yes ؎ No ؎ Don’t know yet
b) Practice as a locum tenens? ؎ Yes ؎ No ؎ Don’t know yet
c) Buy/ set up your own practice? ؎ Yes ؎ No ؎ Don’t know yet
d) Practice in a hospital setting?؎ Yes ؎ No ؎ Don’t know yet
e) Practice within the same province in which you are currently training?
؎ Yes ؎ No ؎ Don’t know yet
f) Practice in another province or territory in Canada?
؎ Yes ؎ Nor Don’t know yet If yes, please specify province or territory: __________
g) Leave Canada to practise in another country? ؎ Yes ؎ No ؎ Don’t know yet
h) Specialize within an area of family medicine?
؎ Yes ؎ No ؎ Don’t know yet If yes, please specify: ____________
i) Take a temporary leave of absence? ؎ Yes ؎ No ؎ Don’t know yet
j) Continue your residency by undertaking a fellowship position?
؎ Yes ؎ No ؎ Don’t know yet
k) Change disciplines/ retrain within the medical field?
؎ Yes ؎ No ؎ Don’t know yet If yes, please specify field:____________
l) Seek an administrative (non patient care) position? ؎ Yes ؎ No ؎ Don’t know yet
m) How do you intend to organize your practice setting?
؎ Solo practice
؎ Group practice
؎ Other _______________________________________
- Don’t know yet
- N/A – Do not intend to set up a practice
؎ Family physicians |
؎ Psychologists |
؎ Technicians/ technologists |
؎ Specialist physicians |
؎ Occupational therapists |
؎ Midwives |
؎ Nurse practitioners |
؎ Physiotherapists |
؎ Other ____________________ |
؎ Nurses (e.g., RN, LPN, RPN) |
؎ Social workers |
؎ N/A – Don’t intend to do patient care |
؎ Dieticians/ nutritionists |
؎ Pharmacists |
؎ Don’t know yet |
D. Future Practice/ Work Profile
A. ؎ Inner city |
F. ؎ Other _________________________ |
B. ؎ Urban/ Suburban |
G.؎ Don’t know yet |
C. ؎ Small town |
H.؎ I plan to do locum tenens |
D.؎ Rural |
I. ؎ I don’t intend to be involved in patient care |
E. ؎ Geographically isolated/ Remote |
15. Please indicate ALL of the disciplines and areas of professional activity listed below in which you intend to practice/ work. Please note: you do not have to be certified in the discipline/ area of professional activity to include it in your profile.
Please check ALL that apply to you.
|
Code |
Discipline/ Area of Practice |
|
|
Academic/Research |
؎ |
501 |
Bioethics/Ethics |
؎ |
503 |
Clinical Epidemiology |
؎ |
405 |
Clinical Investigation |
؎ |
505 |
Epidemiology/Biostatistics |
؎ |
507 |
Medical Education (includes teaching and educational research) |
؎ |
509 |
Medical Science/Scientist |
؎ |
511 |
Social Sciences & Humanities in Medicine |
|
|
Acute/Critical Care |
؎ |
109 |
Critical Care Medicine/Intensive Care |
؎ |
513 |
Disaster Medicine |
؎ |
115 |
Emergency Medicine |
؎ |
515 |
Toxicology |
؎ |
517 |
Trauma |
؎ |
593 |
Addictions/substance abuse |
|
|
Anesthesiology/Anesthesia |
؎ |
101 |
Anesthesiology/Anesthesia |
؎ |
519 |
Cardiac Anesthesia |
؎ |
523 |
Administration |
؎ |
527 |
AIDS/HIV |
؎ |
529 |
Aviation/Aerospace Medicine |
؎ |
531 |
Biomedical engineering |
|
|
Cardio-Vascular/Thoracic |
؎ |
533 |
Angiography |
؎ |
301 |
Cardiac, Cardio-Thoracic Surgery |
؎ |
535 |
Cardiac Electrophysiology |
؎ |
537 |
Cardiac Rehabilitation |
؎ |
103 |
Cardiology |
؎ |
539 |
Echocardiography/ECG/ |
؎ |
619 |
Interventional Cardiology |
؎ |
319 |
Thoracic Surgery |
؎ |
105 |
Clinical Immunology & Allergy |
؎ |
401 |
Clinical Pharmacology |
؎ |
111 |
Dermatology |
|
|
Endocrinology |
؎ |
117 |
Endocrinology & Metabolism |
؎ |
541 |
Nutrition (including obesity) |
؎ |
617 |
Environmental medicine |
؎ |
119 |
Gastroenterology |
؎ |
121 |
Geriatric Medicine |
؎ |
413 |
Gynecologic Reproductive Endocrinology & Infertility |
؎ |
621 |
Hepatology |
؎ |
123 |
Hematology |
؎ |
543 |
Homecare |
؎ |
545 |
Hospitalist |
؎ |
125 |
Infectious Diseases |
؎ |
547 |
Information technology |
؎ |
127 |
Internal Medicine (general) |
|
|
Laboratory |
؎ |
201 |
Anatomical Pathology |
؎ |
549 |
Clinical Pathology |
؎ |
551 |
Cytopathology |
؎ |
211 |
Forensic Pathology |
؎ |
203 |
General Pathology |
؎ |
205 |
Hematological Pathology |
؎ |
207 |
Medical Biochemistry |
؎ |
209 |
Medical Microbiology |
؎ |
213 |
Neuropathology |
؎ |
553 |
Ocular Pathology |
؎ |
555 |
Legal/medico-legal consultations |
؎ |
129 |
Medical Genetics |
؎ |
131 |
Medical Oncology |
؎ |
633 |
Military medicine |
؎ |
133 |
Nephrology |
|
|
Neurology |
؎ |
559 |
Electromyography/EMG |
؎ |
135 |
Neurology |
؎ |
561 |
Neuro/Electrophysiology |
؎ |
137 |
Nuclear Medicine |
|
|
Obstetrics/Gynecology |
؎ |
308 |
Gynecology |
؎ |
411 |
Gynecologic Oncology |
؎ |
415 |
Maternal/fetal medicine |
؎ |
307 |
Obstetrics |
؎ |
563 |
STD/Sexual Medicine |
؎ |
139 |
Occupational Medicine |
|
|
Ophthalmology |
؎ |
567 |
Neuroophthalmology |
؎ |
309 |
Ophthalmology |
|
|
Otolaryngology |
؎ |
569 |
Head & Neck Oncology |
؎ |
571 |
Head & Neck Surgery |
؎ |
573 |
Neurootology |
؎ |
313 |
Otolaryngology |
؎ |
427 |
Palliative Care/Palliative Medicine |
؎ |
521 |
Pain Management |
|
|
Pediatrics |
؎ |
625 |
Adolescent Medicine |
؎ |
627 |
Adolescent & Pediatric Gynecology |
؎ |
417 |
Neonatal/Perinatal Medicine |
؎ |
141 |
Pediatrics |
؎ |
407 |
Developmental Pediatrics (including disabilities) |
؎ |
626 |
Pediatric Cardiac Surgery |
؎ |
143 |
Pediatric Cardiology |
؎ |
595 |
Child Psychiatry |
؎ |
145 |
Pediatric Clinical Immunology & Allergy |
؎ |
147 |
Pediatric Critical/Intensive Care |
؎ |
421 |
Pediatric Diagnostic Radiology |
؎ |
149 |
Pediatric Endocrinology & Metabolism |
؎ |
423 |
Pediatric Emergency Medicine |
؎ |
315 |
Pediatric General Surgery |
؎ |
151 |
Pediatric Gastroenterology |
؎ |
153 |
Pediatric Hematology/Oncology |
؎ |
155 |
Pediatric Infectious Diseases |
؎ |
159 |
Pediatric Nephrology |
؎ |
575 |
Pediatric Neurology |
؎ |
577 |
Pediatric Neurosurgery |
؎ |
579 |
Pediatric Otolaryngology |
؎ |
581 |
Pediatric Orthopedic Surgery |
؎ |
583 |
Pediatric Pathology |
؎ |
585 |
Pediatric Plastic Surgery |
؎ |
161 |
Pediatric Respiratory Medicine/Respirology |
؎ |
163 |
Pediatric Rheumatology |
؎ |
623 |
Pediatric Urology |
؎ |
165 |
Physical Medicine & Rehabilitation |
؎ |
587 |
Primary Care/General Practice/Family Practice |
|
|
Psychiatry |
؎ |
597 |
Family/Marital Therapy |
؎ |
599 |
Geriatric Psychiatry |
؎ |
167 |
Psychiatry |
|
601 |
Forensic Psychiatry (Psychiatry and the Law) |
؎ |
603 |
Psychogeriatrics |
؎ |
605 |
Psychopharmacology |
؎ |
|
Public Health |
؎ |
107 |
Community Medicine/Public Health |
؎ |
589 |
International Medicine |
؎ |
591 |
Travel/Tropical Medicine |
؎ |
169 |
Radiation Oncology |
|
|
Radiology |
؎ |
113 |
Diagnostic Radiology |
؎ |
607 |
Interventional Radiology |
؎ |
419 |
Neuroradiology |
؎ |
171 |
Respiratory Medicine/Respirology |
؎ |
173 |
Rheumatology |
؎ |
611 |
Sleep disorders |
؎ |
613 |
Spinal Cord Injury |
؎ |
615 |
Sports medicine |
|
|
Surgery |
؎ |
403 |
Colorectal Surgery |
؎ |
628 |
Cosmetic Surgery |
؎ |
303 |
General Surgery |
؎ |
409 |
General Surgical Oncology |
؎ |
629 |
Hand Surgery |
؎ |
305 |
Neurosurgery |
؎ |
311 |
Orthopedic Surgery |
؎ |
317 |
Plastic Surgery |
؎ |
631 |
Transplantation |
؎ |
321 |
Urology |
؎ |
323 |
Vascular Surgery |
؎ |
425 |
Transfusion Medicine |
؎ |
609 |
Ultrasound |
؎ |
565 |
Women’s Health |
؎ |
|
Please specify (others) below |
؎ |
801 | Q15S801_X |
؎ |
802 |
Q15S802_X |
؎ |
803 |
Q15S803_X |
؎ |
804 |
Q15S804_X |
؎ |
805 |
Q15S805_X |
؎ |
806 |
Q15S806_X |
؎ |
807 |
Q15S807_X |
16. Do you have a PDA (personal digital assistant/ wireless device)? ؎ Yes ؎ No
E. Time Allocation
i) Direct patient care without a teaching component, regardless of setting |
؎ |
ii) Direct patient care with a teaching component, regardless of setting |
؎ |
iii) Teaching/ Education without direct patient care (contact with students/residents, |
؎ |
iv) Indirect patient care (charting, reports, phone calls, meeting patients’ family, etc.) |
؎ |
v) Health facility committees |
؎ |
vi) Managing your practice (staff, facility, equipment, etc.) |
؎ |
vii) Research (including management of research and publications) |
؎ |
viii) Administration (i.e. management of university program, chief of staff, department head, |
؎ |
ix) Continuing medical education/ professional development (courses, reading, videos, |
؎ |
x) Other (participation in professional or specialty organizations, medico-legal activities, |
؎ |
F. Professional Income 
؎ |
Unsure |
؎ |
Fee-for-service only |
؎ |
Salary only |
؎ |
Capitation only |
؎ |
Sessional/ per diem/ hourly payments only |
؎ |
Service contract only |
؎ |
Blended payment |
![]()
IF BLENDED, what components would you want included? Check ALL that apply.
؎ |
Fee-for-service |
؎ |
Salary |
؎ |
Capitation |
؎ |
Sessional/ per diem/ hourly payments |
؎ |
Service contract |
؎ |
Benefits/ pension |
؎ |
On-call remuneration beyond fee-for-service |
؎ |
Other _______________________ |
؎ |
Unsure |
G. Education & Demographics
19. Please provide the 6-digit postal code of your current main residence: |
_ |
_ |
_ |
_ |
_ |
_ |
0 1 2 3 4 5 6 7 8 9 10 >10
؎ None
؎ Diplome d’étude collegial (CEGEP)
؎ Bachelor’s
؎ Master’s Please specify field/discipline: __________________________
؎ Doctorate Please specify field/discipline: __________________________
؎ Other ________________________________________
22. When and where did you complete your undergraduate MEDICAL training?
Country |
||
23a). At which university are you currently doing your medical training?
؎ University of British Columbia
؎ University of Calgary
؎ University of Alberta
؎ University of Saskatchewan
؎ University of Manitoba
؎ University of Western Ontario
؎ McMaster University
؎ University of Toronto
؎ University of Ottawa
؎ Queen’s University
؎ Université de Sherbrooke
؎ Université de Montréal
؎ McGill University
؎ Université Laval
؎ Dalhousie University
؎ Memorial University
Rural hospital _________% |
Small/community hospital _____% |
Large teaching hospital _________% |
Community office practice _____% |
Office practice in hospital _________% |
Other ____________________% |
؎ Yes ؎ No
a) Debt upon entering your medical residency training |
b) Current Debt |
c) Debt upon completion of your medical residency training |
26.How much did the amount of debt that you may have had when you graduated from medical school affect your choice of specialty?
Not at all Most important factor
O O O O O
27. How much will the amount of debt that you may have once you complete your residency program affect your choice of practice location?
Not at all Most important factor
O O O O O OUnsure
28. Marital status. Please check ONE only.
؎ single, seperated, divorced or widowed
؎ married, living with partner
Is your spouse/partner a: ؎ physician ؎ other health care provider ؎ neither
29. Do you have children or other dependents for whom you personally provide care/ supervision?
|
؎ |
No |
|
|
|
؎ |
Yes |
If yes, do you have major responsibility for the care of these individuals? |
|
|
؎ Yes |
؎ No |
||
|
If these are children, what is the age of the youngest? _____ years old |
|||
|
Father |
Mother |
Sibling(s) |
Medical doctor |
O |
O |
O |
Nurse |
O |
O |
O |
Pharmacist |
O |
O |
O |
Other healthcare professional |
O |
O |
O |
|
؎ |
Exclusively/ predominantly rural |
|
؎ |
Exclusively/ predominantly small town |
|
؎ |
Exclusively/ predominantly urban |
|
؎ |
Mixture of environments |
32. In which province(s) or territories did you grow up prior to going to university?
Indicate ALL that apply.
BC AB SK MB ON QC NB NS PE NL NT YT NU Outside of Canada
33. Please enter the first three digits of the postal code where you lived in your final year of high school. If you lived at a boarding school, please enter the postal code of where your family lived during that year. If you did not live in Canada, please indicate the country where you lived.
If in Canada, first three digits of postal code: ___ ___ ___
If not in Canada, type in the country: _______________________________
34. What is your ethnic/ cultural background? Please check ALL that apply.
؎ White
؎ Aboriginal (e.g., status, non-status, Métis, Inuit)
؎ Chinese
؎ South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
؎ Black
؎ Filipino
؎ Latin American
؎ Southeast Asian (e.g., Cambodian, Indonesian, Laotian, Vietnamese, etc.)
؎ Arab
؎ West Asian (e.g., Afghan, Iranian, etc.)
؎ Japanese
؎ Korean
؎ Other ____________
؎ I prefer not to provide this information
35. Please indicate the languages that you could comfortably speak with your future patients.
|
؎ |
English |
؎ |
French |
؎ |
Other(s) ____________________ |
36. Were you born in Canada?
O Yes
O No. Please indicate your status in Canada.
O Canadian citizen
O Permanent resident (landed immigrant)
O Other _____________
37. Your year of birth: 19 |
_ |
_ |
38. Sex: ؎ Male ؎ Female
39. Comments
