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Medical Resident (PGY2) Results

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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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:

 

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?

                           ؎ Yes            ؎ No                 ؎ Don’t know yet

 

B.          Learning Environment

4.a) Do you feel that your training experience within your oun specialty program has taken place in an open learning environment?

Strongly agree             Agree               Neutral             Disagree                    Strongly disagree
            ؎                    ؎                    ؎                    ؎                                ؎

4.b) Do you feel that your training experience within your oun specialty program has taken place in an supportive learning environment?

Strongly agree             Agree               Neutral             Disagree                    Strongly disagree
            ؎                    ؎                    ؎                    ؎                                ؎

4.c) Do you feel that your training experience within your oun specialty program has taken place in an collegial learning environment?

Strongly agree             Agree               Neutral             Disagree                    Strongly disagree
             ؎                    ؎                    ؎                    ؎                                ؎

5.a) Do you feel that your training experience outside your oun specialty program have taken place in an open learning environment?

Strongly agree             Agree               Neutral             Disagree                    Strongly disagree
           ؎                    ؎                    ؎                    ؎                                ؎

5.b) Do you feel that your training experience outside your oun specialty program have taken place in an supportive learning environment?

Strongly agree             Agree               Neutral             Disagree                    Strongly disagree
          ؎                    ؎                    ؎                    ؎                                ؎

5.c) Do you feel that your training experience outside your oun specialty program have taken place in an collegial learning environment?

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

    n) Which of the following types of health care providers do you plan to collaborate with in providing patient care? Please check ALL that apply

    ؎ 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

    14.       Please describe the population PRIMARILY served by the practice you intend to undertake after completion of residency. Please check ONLY ONE

    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/
          Cardiac Stress Testing

    ؎

    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

    17. Please indicate in which of the following areas you intend to spend time or participate upon completion of your residency training. Please check ALL that apply.

    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,
            preparation, marking, evaluations, etc.)

    ؎

    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,
            Ministry of Health, etc.)

    ؎

    ix)    Continuing medical education/ professional development (courses, reading, videos,
             tapes, seminars, etc.)

    ؎

    x)     Other (participation in professional or specialty organizations, medico-legal activities,
             etc.)

    ؎

    F.    Professional Income

    18. If you had a choice, how would you prefer to be paid for your services as a physician? 
    Please check ONLY ONE.

    ؎

    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:

    _

    _

    _

    _

    _

    _

    20. How many years of POST-SECONDARY education did you complete before entering medical school? (If you were a Quebec student, please do not include CEGEP)

    0 1 2 3 4 5 6 7 8 9 10 >10

    21. Beyond secondary school, what degrees/ diplomas did you complete prior to entering medical school?     Please check ALL that apply.

    ؎ 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

    23.b) Please indicate the percentage of time spent during your residency in the following clinical settings:

    Rural hospital                            _________%

    Small/community hospital                     _____%

    Large teaching hospital            _________%  

    Community office practice                    _____%

    Office practice in hospital            _________%

    Other   ____________________%

    24. Are you presently enrolled in a ‘return of service’ program, that is, a program where you have committed yourself to certain practice restrictions [location, specialty, employer, military service, armed forces, etc.] in return for financial compensation during medical school or residency?

                ؎ Yes  ؎ No

    25. Please indicate the amount of debt you had and/or expect to have at various times in your medical education, as indicated below. Please separate these into 1) debt directly related to being in a medical residency program (tuition, books, accommodations, etc.), and 2) other debt (personal, mortgage, car loan, etc.)

    a) Debt upon entering your medical residency training                                  
    Debt directly related to being               Other
    in a medical residency program          Debt
    ؎ no debt                                                         ؎ no debt                                
    ؎ less than $1,000                                          ؎ less than $1,000                    
    ؎ $1,001 to $5,000                                          ؎ $1,001 to $5,000                   
    ؎ $5,001 to $10,000                                        ؎ $5,001 to $10,000                 
    ؎ $10,001 to $20,000                                      ؎ $10,001 to $20,000                
    ؎ $20,001 to $40,000                                      ؎ $20,001 to $40,000                
    ؎ $40,001 to $60,000                                      ؎ $40,001 to $60,000                
    ؎ $60,001 to $80,000                                      ؎ $60,001 to $80,000                
    ؎ $80,001 to $100,000                                    ؎ $80,001 to $100,000              
    ؎ $100,001 to $120,000                                  ؎ $100,001 to $120,000          
    ؎ $120,001 to $140,000                                  ؎ $120,001 to $140,000          
    ؎ $140,001 to $160,000                                  ؎ $140,001 to $160,000          
    ؎ Over $160,000                                             ؎ Over $160,000
    ؎ I prefer not to provide this information         ؎ I prefer not to provide this information

    b) Current Debt                                   
    Debt directly related to being               Other
    in a medical residency program          Debt
    ؎ no debt                                                         ؎ no debt                                
    ؎ less than $1,000                                          ؎ less than $1,000                    
    ؎ $1,001 to $5,000                                          ؎ $1,001 to $5,000                   
    ؎ $5,001 to $10,000                                        ؎ $5,001 to $10,000                 
    ؎ $10,001 to $20,000                                      ؎ $10,001 to $20,000                
    ؎ $20,001 to $40,000                                      ؎ $20,001 to $40,000                
    ؎ $40,001 to $60,000                                      ؎ $40,001 to $60,000                
    ؎ $60,001 to $80,000                                      ؎ $60,001 to $80,000                
    ؎ $80,001 to $100,000                                    ؎ $80,001 to $100,000              
    ؎ $100,001 to $120,000                                  ؎ $100,001 to $120,000          
    ؎ $120,001 to $140,000                                  ؎ $120,001 to $140,000          
    ؎ $140,001 to $160,000                                  ؎ $140,001 to $160,000          
    ؎ Over $160,000                                             ؎ Over $160,000
    ؎ I prefer not to provide this information         ؎ I prefer not to provide this information

    c) Debt upon completion of your medical residency training                                  
    Debt directly related to being               Other
    in a medical residency program          Debt
    ؎ no debt                                                         ؎ no debt                                
    ؎ less than $1,000                                          ؎ less than $1,000                    
    ؎ $1,001 to $5,000                                          ؎ $1,001 to $5,000                   
    ؎ $5,001 to $10,000                                        ؎ $5,001 to $10,000                 
    ؎ $10,001 to $20,000                                      ؎ $10,001 to $20,000                
    ؎ $20,001 to $40,000                                      ؎ $20,001 to $40,000                
    ؎ $40,001 to $60,000                                      ؎ $40,001 to $60,000                
    ؎ $60,001 to $80,000                                      ؎ $60,001 to $80,000                
    ؎ $80,001 to $100,000                                    ؎ $80,001 to $100,000              
    ؎ $100,001 to $120,000                                  ؎ $100,001 to $120,000          
    ؎ $120,001 to $140,000                                  ؎ $120,001 to $140,000          
    ؎ $140,001 to $160,000                                  ؎ $140,001 to $160,000                                  
    ؎ Over $160,000                                             ؎ Over $160,000
    ؎ I prefer not to provide this information         ؎ I prefer not to provide this information

    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

    30. Which of the following describe your family members? If your parents or siblings are retired or deceased, please provide their main occupation while working. 
    Please check ALL that apply.

     

    Father

    Mother

    Sibling(s)

    Medical doctor

    O

    O

    O

    Nurse

    O

    O

    O

    Pharmacist

    O

    O

    O

    Other healthcare professional

    O

    O

    O

    31. Select the ONE statement which best describes the environment in which you grew up prior to university.

     

    ؎

    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