OGB Survey
*
Response Required
Demographic Information:
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Age:
20-29
30-39
40-49
50-59
60-69
70+
*
Sex:
Male
Female
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Surgical Specialty:
(Please check all that apply)
Burn
Cardio Thoracic
Colorectal
General
Neurosurgery
ObGyn
Ophthalmology
Orthopedics
Otolaryngology
Pediatric
Plastic
Trauma/Critical Care
Urology
Vascular
OR Nurse
Surgical PA
Other
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Practice Status:
Actively Practicing
Retired, with active license
Retired, no longer licensed
Resident
Student
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Practice Type:
Private solo practice
Private group practice
HMO
Academic
Military/Government
State and Country of Residence
State:
Country:
Did you have the opportunity to participate in any volunteer activities in medical school?
Yes
No
Did you have the opportunity to participate in any volunteer activities in residency?
Yes
No
Have you participated in a volunteer mission since residency? If No, scroll down to the last section of this survey.
Yes
No
If Yes, was it Domestic or International?
Domestic
International
Length of time:
less than 1 week
1 week
2 weeks
3 weeks
1 month
2-3 months
longer than 3 months
Was the mission sponsored by:
A religious group
A community group
A surgical society
Did any family members accompany you?
Yes
No
Did any of your hospital or office staff accompany you?
Yes
No
Was financial assistance available for participation in this mission?
Yes
No
If Yes, was it from the volunteer agency or from other sources?
Volunteer agency
Other sources
What professional activities did you engage in on this trip?
Surgery
Teaching
Other
Were you able to perform operations in your surgical specialty while you were on this mission?
Yes
No
Were you able to take any residents or medical students with you on this trip?
Yes
No
If Yes, were they able to operate?
Yes
No
Did the residents express an interest in pursing similar activities in the future?
Yes
No
If No, are you interested in volunteering?
Yes
No
Please indicate all of the applicable reasons that have kept you from volunteering:
Can’t afford time away from practice
Costs associated with volunteer missions (lost wages, transportation) are prohibitive
Concern regarding liability risk while volunteering in the US
Concern regarding liability risk while volunteering in another country
No coverage for primary practice
Length of commitment prohibitive
Unable to find information on volunteer opportunities
Unable to find opportunities that allow spouse/family to accompany you
Unable to find opportunities for your specialty
Unable to find opportunities for your practice status (retired/resident)
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