UNC Medical Education Research Survey Intake Form
Please email Dr. Kurt Gilliland to be considered for the Medical Education Research Survey. Selected proposals will be asked to submit the following information before their questions can be included in the survey: (1) Survey questions, and (2) Summary of pilot testing.
- Email Address:
- Investigator name(s)- (Last, First):
- FOR STUDENTS: Faculty Mentor name and email- (Last, First):
- Problem/topic to be studied:
- Background/Significance to undergraduate medical education (please articulate the gap you are trying to bridge):
- Specific Aims and Hypotheses for your project:
- Sample population:
- Draft survey questions (Up to 15)*:
*If the instrument requires more questions, describe the rationale for inclusion of more questions.