Survey
RequiredRequired Question(s)

By completing our survey you will be entered into our monthly drawing for a free tuition for the conference of your choice.  By entering your personal information, you consent to receive e-mail communications from Symposia Medicus.  Incomplete forms are ineligible for the drawing.

 

About You

 
Required 1.

Please enter the information indicated below.


First Name:
Last Name:
State/Province
(US/Canada):
Country:

Required 2.

Degree:

MD
DO
CNM
FNP
WHNP
PNP
ARNP
PA
PA-C
MSN
MS
BSN
RN
RNC
MBBS
PhD
Other  
Required 3.

E-mail Address:

 

50 characters left.
4.
What is your gender?
Female
Male

 About Your Practice

 
Required 5.

Practice/Specialty:

OB/GYN
Obstetrics
Gynecology
Women's Health
Emergency Medicine
Pediatrics
Pediatric Emergency Medicine
Neonatology
Family Practice
General Practice
Internal Medicine
Hospital Medicine
Other  
Required 6.

Practice Setting:

Private Practice
HMO
Single Specialty Group Practice
Multi-Specialty Group Practice
Community Health Center
Hospital
Academic
Research
Industry (Pharm, etc)
Other  
7.

How long have you been in practice?

Less than five years
Between six and ten years
Between eleven and twenty years
More than twenty years

Educational Needs

 
Required 8.

In which of the areas stated below, could your clinical practice be improved if you had additional knowledge and/or skills?  Check all that apply.

Communication between care providers and patients
Interdisciplinary team collaboration and cooperation
Quality improvement ideas for health care systems & patient safety
Infomatics - using information technology to support decision making
Required 9.

Please list clinical topics that would assist you in more effectively providing better patient care:

 

350 characters left.
10.

Please list non-clinical topics that would assist you in more effectively providing better patient care:

 

350 characters left.
11.

What else could we do to meet your CE needs?

 

350 characters left.

Where You Want To Go

 
12.

Please rate the following destinations in the USA by how likely you would attend a conference there:
(if you select maybe, tell us what would change your answer to a yes)

 No Maybe Yes   
Lake Tahoe, California (Summer)   
Jackson Hole, Wyoming (Summer)   
Chicago, Illinois   
Whitefish, Montana   
Santa Monica, California   
Orlando, Florida (Universal Studios)   
Monterey, California   
Las Vegas, Nevada   
St. Thomas, US Virgin Islands   
Tucson, Arizona   
  • Comment:

  • 500 characters left.
13.

Please rate the following destinations outside the USA by how likely you would attend a conference there:
(if you select maybe, tell us what would change your answer to a yes)
   

 No Maybe Yes   
Grand Cayman Island   
St. Kitts Island   
Havana, Cuba   
Atlantis Resort, Bahamas   
Montreal, Canada (Summer)   
Los Cabos, Mexico   
Barcelona, Spain   
Florence, Italy   
Vienna, Austria   
Paris, France   
  • Comment:

  • 500 characters left.
14.

Please rate the following cruise ship destinations  by how likely you would attend a conference there:
(if you select maybe, tell us what would change your answer to a yes)

 No Maybe Yes   
Danube River Cruise (Budapest to Germany)   
Seine River Cruise (Paris to La Havre)   
Mediterranean Cruise (Rome, Athens, Greek Islands)   
Baltic Cruise (Copenhagen, Stockholm, St. Petersburg)   
Caribbean Islands   
Galapagos Islands   
Alaska Inside Passage   
Hawaiian Island Cruise   
New England Cruise (Autumn)   
  • Comment:

  • 500 characters left.
15.

List other conference destinations where you would go.

 

350 characters left.

Other Things We Would Like To Know

 
16.
How do you prefer earning your CE credits?
Online webinars or videos
In-person lectures or discussions
Audio recordings
Hands-on workshops, labs, and simulations
Abstract submission
Other  
17.
What social media platforms are you active on?  Check all that apply.
Facebook
LinkedIn
Twitter
Instragram
Google+
I am not active on social media
Other  
18.

When you are browsing social media pages, what device do you mostly use? 

Desktop/laptop
Smartphone (iPhone, Android, etc.)
Tablet (iPad, Kindle Fire, etc.)
I am not active on social media
19.

How many Symposia Medicus conferences have you attended?

0
1-2
3-4
5-6
7-9
10+
20.

How can we improve our website to better meet your educational needs?

 

350 characters left.