Subject Matter Expert EnrollmentSubject Matter Expert Enrollment FormSubject Matter Expert Enrollment FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Program *Road to Success in Residency- 2025Which aspect of the program are you interested in participating in? You can choose more than one (find about each aspect in the post above) *Virtual sessionsMentorshipObservershipFirst Name *This is how it will appear on the announcementsLast Name *This is how it will appear on the announcementsEmail Address *WhatsApp *Preferred Mode of Communication *EmailWhatsAppBoth Email or WhatsAppLinkedin Link or work webpage *type “no” if not availableTwitter handle *type “no” if not availableAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeName of Institution/Hospital/University *Choose one affiliation to be included in the announcementsPosition/Academic Rank *Choose one rank (e.g. Professor or consultant—not both)Speciality/Subspeciality *City/State *Country *Biosketch *In less than 250 words Professional Photo * Click or drag a file to this area to upload. .png, .jpg, .jpeg format; shows the face and shoulders; shows the face and shoulders, square shape, professional background; this picture will be posted on the website CV * Click or drag a file to this area to upload. .pdf, .doc, .docx format; Mentorship programPreferred Mentorship Duration *3 months6 months12 monthsHow many mentees are you willing to accept at a time (up to three) *Preferred Mentorship Type *1:1 MentorshipGroup Mentorship (up to 5 mentees)Both works for meDo you have any criteria or preferences for mentees (e.g., level, gender preference)? *Observership programPreferred Observership Duration (as minimum as half a day) *When is the start date for accepting observers? *When is the end date for accepting observers? *Do you have any criteria or preferences for observers (e.g., level, gender preference)? *Please indicate your preference regarding the background check for observers *Background check is not required.My institution will conduct the background check.I request SAMA to conduct the background check on my behalf.Are you currently involved in any other mentorship/observership program? *YesNoVirtual sessionsTopics/dates (you can choose more than one) *Writing CV- Saturday, February 1, 2025Personal statement-Saturday, Saturday, February 15, 2025Letter of Recommendation, March 1, 2025Choosing the right residency program -Saturday, March 29, 2025Internal medicine match application- Saturday, April 12, 2025Surgery match application- Saturday, April 26, 2025Neurology match application-Saturday, May 10, 2025Understanding Match and Application Timelines: Step-by-step guidance on ERAS, NRMP-Saturday, June 21, 2025Thriving in Your Intern Year: Maintaining Work-Life Balance During Residency, Understanding your paycheck, getting you finances right- Saturday, July 5, 2025Visa application process: Maintaining visa status during residency. Understanding immigration pathways (e.g., J1 waiver, H1B, green card).-Saturday, July 19, 2025Interview preparation-Saturday, August 2, 2025Ranking of programs- Saturday, August 16, 2025Residency Bootcamp (Training first year residents on notes writing and case presentation) *May, 24, 2025May, 31, 2025June, 7, 2025June, 14, 2025I can not participateSAMA Values and non-discrimination policy. *I agree to abide by the SAMA Values and the program’s non-discrimination policy.probono *I understand that I am volunteering my time and will not be paid for this learning activityAttestation of SME Responsibilities *I attest to reading the SME Responsibilities outlined by the Facilitator and will abide with themSlide Preparation Use the slide template provided by the facilitator (that contains the relevant logos) Do not include any patient personal information (e.g. name, date of birth, medical record number) Day of Session Join 15 minutes before the session starts to confirm everything is in working order Use a quiet location with stable, high-speed internet Please use a computer that has a camera Position the webcam so the whole face is visibleIn the event of unforeseen unavailability, i.e. unable to present with less than one month notice *I give permission to a colleague to present my slides on my behalfConsent to record presentation and share with learners *I gave permission to record my talk and share with learnersConsent to share pdf of presentation with learners *I gave permission to share the pdf of my talk with the learnersConsent to include content of my presentation in SAMA Learning Management System (Moodle) *I gave permission to content of my presentation in SAMA Learning Management System (Moodle)Responsiveness Commitment *I understand that I have to respond within one week to select a mentee/observer once their information is made available.I understand that I have to contact the selected mentee/observer within one month of their selection to initiate the observership/mentorship process.Submit form
