ASMBS Surgical Mentorship Program

Need help navigating a balance between work and home? Feeling burned out in your career? Want advice on how to navigate administration or evolve your practice? Want to advance in your academic career? Or are you someone with some experience or knowledge to advise a less experienced surgeon?

On behalf of the Diversity and Inclusion committee, we present the ASMBS Surgical Mentorship Program to help promote professional success, reduce burnout, and encourage the well-being of our surgeons. Pairing an early career with mid-career surgeons (5-15 years of practice) and mid-career with senior surgeons (>15 years of experience/retired) will target the needs of the mentee over 1 year. Apply today to become a mentee or a mentor!

Testimonials

Mission

Who is eligible?

Requirements to Mentorship Program

1-year commitment, at minimum quarterly meetings (4x a year). Matches will be paired yearly. Mentees and mentors must complete surveys at the mid-year and end of the year.

Once accepted, mentees must submit a worksheet describing short- and long-term goals and a self-assessment plan to the mentor within 30 days of pairing notification. Mentors will initiate contact within 15 days to set up the first visit via telephone or videoconference. At the conclusion of each meeting, future meeting times should be scheduled, and the mentor should propose a specific action plan for the mentee to work on.

Pairings will be performed based on selected interests, with a preference for mentoring spots given to FASMBS members and ASMBS fellowship certificate holders. At any time, the mentee and/or mentor may request a change in pairings after an appropriate trial period or in rare events of severe incompatibility with follow-up from the program leadership. Pairings will be based on availability and sufficient compatibility. If new pairings are requested during the last quarter of the mentorship cycle, reapplication will be required for the next cycle.

Application

The next cycle of applications will start on February 5, 2024, and close on March 11, 2024.

If you were a previous mentor applicant, please notify Jennifer to bypass this application.

Please contact jennifer@asmbs.org for assistance.

I'm a prospective...(Required)

Mentee

Mentor

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Application

Name(Required)

First Last

ASMBS Member ID(Required)

Are you a Fellow of ASMBS (FASMBS) or have you received a Fellowship Certificate from ASMBS?(Required)

Yes

No

Preferred Email Address(Required)

Enter Email Confirm Email

Preferred Contact Phone Number(Required)

Current Institution/Hospital(Required)

Years in practice?(Required)

Less than 5 years

5-15 years

>15 years or retired

What is your current type of practice?(Required)

Select all that apply.

Academic

Academic Affiliated

Community Practice/Hospital Employed

Private Practice

Rural

Military

Government (non-military)

What best describes your gender?(Required)

Female

Male

Non-binary/third gender

Prefer not to say

Prefer to self-describe

Transgender

Which racial group do you identify with?(Required)

Select all that apply.

South Asian

East Asian

Black, African, African American, or Afro-Caribbean

Middle Eastern or North African

Native American or American Indian

Native Hawaiian/ other Pacific Islander

White

Other (describe)

Prefer not to answer

Other Race

Which ethnic group do you identify with?(Required)

Select all that apply.

Hispanic/Latinx

Non-Hispanic/Latinx

Other

Prefer not to answer

Other Ethnic Group

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Please select focused interests for the mentoring year. This will help us match you with a well-suited mentor.

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Please select areas of expertise you feel you can best support in a mentee with these particular interests.

Select your top 2 interests

Leadership Growth

Practice Growth

Research Growth

Personal Growth

Engagement, Inclusion and Diversity Support

For those interests above, please select the top 2 interests within each category.

For the interests selected above, please select the top 2 options for mentoring a mentee with these areas of development.

Leadership Growth(Required)

Select your top 2 interests.

Executive Coaching

Hospital Leadership

ASMBS Leadership Growth

Building a Cooperative Environment in OR/Practice

Conflict Resolution with Staff and/or Colleagues

Other

Other Leadership(Required)

Practice Growth(Required)

Select your top 2 interests.

Private Practice Development

Rural Practice Development

Developing an MBSAQIP Program

Contract Negotiations

Other

Other Practice Growth(Required)

Research Growth(Required)

Select your top 2 interests.

Academic Promotion

Research Guidance

Grant Writing

Other

Other Research Growth(Required)

Personal Growth(Required)

Select your top 2 interests.

Work-life Balance

Work-family Balance

Work-family Balance with Young Children

Other

Other Personal Growth(Required)

Engagement, Inclusion and Diversity Support(Required)

Select your top 2 interests.

Addressing Microaggressions/Implicit Bias at Workplace

Overcoming Imposter Syndrome

Addressing Burnout

Becoming an Effective Teacher to Students/Residents/Fellows

Other

Other Engagement, Inclusion and Diversity Support(Required)

Mentor Preferences

Please select preferences for a mentor and we will do our best to match preferences.

Mentee Preferences

Please select preferences for a mentee and we will do our best to match preferences.

Preferences(Required)

Academic Medicine

Ethnicity/Race Preference

Gender Preference

LGBTQ Preference

Mentor Involved in ASMBS Leadership

Mentor Involved with Hospital Leadership

Military Background

Mindfulness Towards Balancing

Work with Families with Young Children

Private Practice

Other

No Preference

Other Preference(Required)

Enter your Other option for the selection above.

Select the Gender and Race/Ethnicity Preferences in a mentor

Select the Gender and Race/Ethnicity Preferences in a mentee

Gender Preference

Select a preference for your above ranking.

Female

Male

Non-binary

No preference

Race / Ethnicity Preference

Select all that apply for your above ranking.

Non-Hispanic White or Caucasian

Non-Hispanic Black or African American

Hispanic/Latino/a/Latinx

American Indian or Alaska Native.

Asian American and Pacific Islanders

No Preference

Other (describe)

Other Race / Ethnicity Preference(Required)

Enter a preference for your above ranking.

Please answer the following questions:

How would you describe yourself?(Required)

1-2 sentences.

What assets, skills or experiences are you most proud of?(Required)

2-3 sentences.

What are the three most important goals you hope to achieve in the next 12 months-2 years?(Required)

3-4 sentences.

Identify the key elements needed to achieve this goal in general.(Required)

2-3 sentences.

Are there weaknesses in training, skills, or experience that will impede your success?(Required)

1-2 sentences.

Are you currently facing any issues which are hindering your career development?(Required)

1-2 sentences.

What aspects of work do you find challenging that make you feel drained or stressed?(Required)

e.g teaching residents or medical students, time management, running late in the OR.
1-3 sentences.

What aspects of work are you most of proud of and gives you the most joy?(Required)

2-3 sentences.

Have you had a mentor before? If so, what has contributed to a successful or challenging mentor-mentee relationship?(Required)

1-3 sentences.

What are the top three things you need from your mentor to be successful?(Required)

What skills, knowledge and insights do you have that would be valuable sharing with your mentee?(Required)

What are you hoping to learn or achieve as a result of this mentoring experience?(Required)

2-3 sentences.

Have you been a mentor before? If so, what has contributed to a successful or challenging mentor-mentee relationship?(Required)

1-3 sentences.

What are the top three things you need from your mentee to be successful?(Required)

Are you willing to take on a second mentee?(Required)

Select...YesNo

Will you commit to initiating contact with your mentee within 2 weeks of application pairing?(Required)

Select...YesNo

Will you commit to meeting (at minimum) quarterly with your mentor/mentee, completing a mid-year and end of the year short survey, and submitting an action plan?(Required)

Failure to do so may result in early termination from the mentoring program.

Select...YesNo

What methods of communication best fit your style to communicate with your mentor/mentee?(Required)

Select all that apply.

Phone Calls

Text Messaging

Video Conferencing/Video Chat (e.g Zoom, FaceTime, Skype, Microsoft Teams)

Email

Chats via Messenger (Whatsapp, Facebook Messenger)

Upload your resume or CV.(Required)

PDF only. Upload limit: 4MB.

Accepted file types: pdf, Max. file size: 4 MB.

Statement of Diversity and Inclusion: Our mentorship program is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all participants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. By agreeing to participate in our mentorship program you are therefore agreeing to our principles of diversity, equity, and inclusion.

Confidentiality Agreement: Mentorship is built on a solid foundation of trust and respect. Unless directed by the mentee or mentor, conversations are to remain confidential. Any concerns regarding mentor and mentee behavior should be reported to the program. If concerns arise regarding safety of the mentor or mentee, potential reporting to the medical board may occur. Applications are to remain confidential and only selected members to the Diversity and Inclusion committee and assigned liaisons will have access to applications for pairing purposes. Advice and recommendations regarding patient clinical scenarios should not be used as official consultations for patient care and absolve medical legal responsibilities by mentee/mentor. Mentor and mentee may request a different pairing at any time during the program and will be rematched if available pairing is deemed a good fit. By entering the mentorship program, you agree to abide by these confidentiality rules.

Consent(Required)

I agree to abide by Diversity & Inclusion and Confidentiality Statements.

Agree

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