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Professional Physician Coaching Questionnaire

Your insights and feedback are invaluable to my final project as a Certified Professional Diversity Coach (CPDC). More importantly, you are contributing to the vision of inclusive leadership in healthcare. After completing the questionnaire, please download my gift to you of gratitude, the MPL Your Year-In-Review-Workbook.
Thank you in advance for your response. Your efforts will mean so much to so many!  
– Dr. Teresa Dean Malcolm

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Question 1 of 12

Please select your gender

A

Male

B

Female

C

Gender Non-conforming, Gender Fluid, or Non-Binary

D

Two-Spirit

E

Intersex

F

Other not specified above

Question 2 of 12

Please select your age range

A

21-30 years

B

31-40 years

C

41-50 years

D

51-60 years

E

61-70 years

F

Greater than 70 years

Question 3 of 12

Please categorize your workplace environment

A

Academic

B

Community

C

Locums

D

Rural

E

Other not specified above

Question 4 of 12

What is your primary work setting?

A

Hospital (Inpatient or Acute Care)

B

Clinic (Outpatient, Ambulatory, or Office)

C

Corporate

D

Remote (e.g., Telemedicine, Work from home, etc.)

E

Other not specified above

Question 5 of 12

Which of the following best represents your race or ethnic heritage?

A

White

B

Black, Afro-Caribbean, or African-American

C

Latino or Hispanic

D

Asian, Asian-American, or Pacific Islander

E

Middle Eastern or Arab

F

Native American or Alaskan Native

G

Biracial/Multiracial

H

Other not specified above

Question 6 of 12

With which of the historically underrepresented groups in medicine do you identify? 

(Select all that apply)
A

Women

B

LGBTQ+

C

Racial, Ethnic, or Cultural Minority

D

Hearing, Visually, or Physically Challenged

E

Invisible or Hidden Disability

F

Veteran

G

I do not identify as being part of an underrepresented group.

Question 7 of 12

Do you have experience working with a professional physician coach? (e.g., wellness, leadership, executive, academic, life, diversity, etc.)

A

Yes

B

No

Question 8 of 12

If you answered "Yes" to the previous question, which of the factors listed, as it relates to the Coach, weighed in your selection?

(Select all that apply)
A

Gender

B

Race or Ethnic Background

C

Years of Coaching Experience

D

Price of service

E

Testimonial or Referral

F

None of the factors listed weighed in my selection.

G

I do not have experience working with a professional physician coach.

Question 9 of 12

In selecting a professional physician coach, which of the factors listed, as it relates to the Coach, would be important to you?

(Select all that apply)
A

Gender

B

Race or Ethnic Background

C

Years of coaching experience

D

Price of service

E

Testimonial or Referral

F

Coach's knowledge about topics relevant to my challenge(s)

G

I choose not to utilize professional physician coaching services.

H

Other not specified above

Question 10 of 12

Are professional physician coaching services available to you through your employer?

A

Yes

B

No

C

I am self-employed.

Question 11 of 12

Would you utilize professional physician coaching services if made available to you through your employer?

A

Yes

B

No

C

Maybe

Question 12 of 12

What suggestion would you give to a healthcare employer on how to support physicians with professional coaching? 

Confirm and Submit