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ANZSN Mentorship Program – Expression of Interest (EOI) Survey Questions
SECTION 1 — Personal & Contact Information
*
1.
Full Name:
(Required.)
2.
ANZSN Membership ID:
*
3.
Email Address:
(Required.)
*
4.
Best Contact Number:
(Required.)
*
5.
Preferred Communication Method:
(Required.)
Email
Phone
Either
*
6.
Gender Identity:
(Required.)
Male
Female
Non-binary
Prefer not to say
Prefer to self-descirbe
*
7.
Age Range:
(Required.)
20-30
30-39
40-49
50-59
60+
*
8.
Primary Workplace (Institution & City/State):
(Required.)
*
9.
Professional Role (select one)
(Required.)
Allied Health Clinician / Allied Health Clinician in Training
Medical Clinician in Training
Medical Clinician
Nursing Clinician / Nursing Clinician in Training
Researcher (scientist/academic)
Administrator
Other (please specify)
*
10.
Career Stage (auto-branch from above)
(Required.)
If Trainee – What year of training?
If Allied Health – Years in profession
If Researcher – Years into research
List year
*
11.
Primary Workplace
(Required.)
Public
Private
City, State
*
12.
Practice / Clinical / Research Focus
Short descriptive text capturing: adult/paediatric, special interests, teaching, research etc.
(Required.)
SECTION 2 — Stream Selection (must appear early in the survey)
*
13.
Which Mentorship Stream are you applying for? (Required)
(Required.)
Quality-Driven Research Stream
"From Insight to Impact: Shaping Nephrology Through Quality Research"
(Real-world, patient-centred, QI-focused projects)
Data-Driven Research with Publishing Focus
"From Data to Discovery: Publishing the Future of Nephrology"
(Systematic reviews, registry studies, publication-focused projects)
SECTION 3 — Participation Type
*
14.
Are you applying as a:
(Required.)
Mentee
Mentor
Both (e.g., early-career clinicians who can mentor trainees but seek mentorship themselves)
If required, are you willing to participate as part of a group mentorship model (max 5 mentees & 5 mentors)? YES/NO
SECTION 4 — Project Information (for Mentees)
(
Projects are required for entry into the program: mentees must propose an idea or outline; projects are reviewed and assigned to streams
)
15.
Do you already have a project idea or outline?
Yes
No
16.
Project Title / Working Title
17.
Project Description
(
Aim, Background, Methodology
)
18.
Project Goals / Expected Outcomes
(
e.g. QI outcomes, publication aim, audit completion, patient outcomes
)
19.
Is this project part of a training requirement?
Yes
No
Unsure
20.
Do you have a preferred mentor or supervisor in mind?
No
Yes - provide name, institution and contact
SECTION 5 — Matching Criteria & Expectations
(
Used by the oversight committee to match mentors to project groups
)
21.
What skills/expertise would be most valuable in a mentor for your project?
(
E.g. audit methodology, QI design, statistical analysis, systematic review methods, publication guidance
)
22.
How do you envision a mentor supporting your project?
(
Structured meetings, review of analysis, project planning, writing support, etc.
)
23.
What level of guidance do you anticipate needing?
High
Moderate
Light
24.
Please identify any potential barriers
(
e.g., time, data access, resources
).
SECTION 6 — Mentor-Specific Questions
(
Displayed only if "Mentor" or "Both" selected
)
25.
Years of Professional Experience in Nephrology
26.
Areas in which you can offer mentorship
Quality Improvement
Audit design
Patient-centred project experience
Registry / data research
Systematic review / meta-analysis
Statistical analysis
Publication support
Leadership/career development
Other (please specify)
27.
Preferred mentoring capacity
One mentee
Small group (up to 5 mentees)
28.
Link to your institutional/professional profile
SECTION 7 — Consent, Privacy & Program Requirements
*
29.
Privacy and Information Use Acknowledgement
(Required.)
I understand that the information provided will remain under ANZSN supervision and will not be shared outside the mentorship program oversight group.
*
30.
Commitment to Participate in Structured Meetings
Acknowledges at least 4 structured meetings annually per stream
(Required.)
I confirm that the information provided is accurate, and I agree to participate in the ANZSN Mentorship Program if selected.