4th Year Outcomes Survey

GIMSPP Outcomes Study Questionnaire

Contact / School Information

First name *

Middle name

Last name *

Street *

City *

State *

Zip *

Email *

Home Phone *

Medical school *

Graduation date *

Institution of postgraduate training, if known

Please answer the following questions based on your current preferences and plans.

1) What will you study your first postgraduate year of training? *

if Transitional, please specify:

if Other, please specify:

2) Which of the following do you intend to practice when you are finished with your postgraduate training?

if Primary Care, please specify:

if Subspecialty Care, please specify:

if Other, please specify:

3) How did the Internal Medicine preceptorship affect your interest in Internal Medicine? *

4) If you do intend to practice Internal Medicine, why did you choose this field?

if Other, please specify:

5) Where would you prefer to eventually practice medicine? *

Large city or suburb (ie, Houston, Dallas)
Medium sized city or suburb (ie, Lubbock, Austin)
Small sized city (ie, San Marcos, San Angelo)
Non-metropolitan/Rural area
Unsure/no preference

if large city, where:

if medium city, where:

if small city, where:

if rural, where:

6) Would you like to practice in a medically underserved area (MUA)* or a Health Professional Shortage Area (HPSA)**? *

7) In which state/country do you prefer to eventually practice medicine? *

if outside Texas, where:

if outside United States, where:

8) Which of these best characterizes the environment in which you grew up? *

Acknowledgement/Comments

I understand that this information will be used in confidence by the GIMSPP Office. *

Comments are appreciated.

Questions? Please e-mail us at gimspp@gimspp.org, or call us toll-free at (866) 2-GIMSPP.

* Medically Underserved Areas include areas having a shortage of personal health services for all populations. ** Health Professional Shortage Areas (HPSA) include geographic areas, population groups and facilities recognized by the Texas Department of Health as having an acute shortage of health care personnel.