2023 EAST Mentoring Program - Mentor & Mentee Application

Thank you for your interest in the EAST Mentoring Program.  The goal of the Mentoring Program is to promote the academic and personal growth of the young trauma and acute care surgeon by providing extramural mentorship over a 1-year period. 

The 2023 program is again implementing a multi-tiered approach to mentoring including medical professionals at various career levels to form a “Mentoring Family/Team”.   One on one mentorship opportunities are also available.  Additional information regarding the program structure can be seen here.

Please note, the EAST Mentoring Committee will only be utilizing the information via the fields addressing "Gender" and "Race/Ethnicity" if an individual indicates that it's of importance to them.

Mentee Requirements:

• You must be an EAST member (Active, Associate, Provisional, Fellow-in-Training, Medical Student) in good standing and membership dues paid in full.

• Physicians must be must be currently in training, or within five years of completion.

• Complete the below online application for matching purposes.

Mentor Requirements:

1. You must be an EAST member (Mentor (formally Senior), Active, Associate) in good standing and membership dues paid in full.

2. Complete the below online application for matching purposes.

The EAST Mentoring Committee will match and send communications regarding the Mentoring Program assignments by April 2023.

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Personal Information

Full Name*

Include first, last names and degrees/credentials

Email Address*

This is the email address that will be shared with your "Mentoring Team/Family"

Current Location/Institution *

City, State, Institution

What time zone are located in?*

Hawaii-Aleutian Time (HAT)Alaska Time (AST)Pacific Time (PT)Mountain Time (MT)Central Time (CT)Eastern Time (ET)

Current Position*

How many years have you been in practice?*

If not applicable write N/A

If not yet in practice, what is your current level?

If applicable

EAST Membership Type:*

ActiveMentor (formally Senior member)ProvisionalFellow-In-TrainingAssociateMedical StudentInternational

Please indicate your race/ethnicity:*

WhiteHispanic/LatinxBlack or African AmericanAsianNative HawaiianPrefer not to sayOther

Please indicate your gender:*

MaleFemaleNon-binaryTransgenderPrefer not to sayOther

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Areas of Mentorship: Select the TOP THREE (3) areas below you are interested in receiving/providing mentorship.

Professional / Career Development:

• Early career advice (Residency, fellowship)
• Fellowship match
• Leadership development and opportunities
• Local Administration Opportunities/Programs (trauma program, QI, PI, etc.)
• Regional/National Organizational Involvement (advocacy, policy)

Professional / Research:

• Basic science
• Clinical
• Outcomes

Professional / Clinical Practice:

• Academic
• Community
• Military
• Private

Professional / Education:

• Program or fellowship directorship
• University affiliations/positions
• Medical school education

Personal:

• Work life balance and wellness
• Safe environment (verbal abuse/bullying)
• Safe environment (domestic violence / patients and physicians)
• Minorities in the field (being a woman in surgery)
• Minorities in the field (being LGBQTIA in surgery)
• Minorities in the field (being a racial/ethnic minority in surgery)
• Fertility and infertility

Global:

• Volunteering
• Research and education

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Additional Mentorship Information

I am applying to be program as a...*

• Mentor
• Mentee

Do you prefer...*

• to be part of a 2-person mentorship relationship (Mentor/Mentee)
• to be part of a Mentoring Family/Team (between 3-5 people)

What do you hope to gain from the program?*

Additional Information*

Where do you see yourself in 5-years? Anything else that is relevant to your mentorship?

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