Pediatric Coaching and Mentoring Program 1:1 Meeting Documentation Form

Pediatric Coaching and Mentoring Program

1:1 Meeting Documentation Form

Date of Meeting:

Spring/Fall Meeting

Spring Meeting (January - June)

Fall Meeting (July - December)

Other

Mentee Name:

Mentor Name:

End of Mentee's Appointment:

Mentee's Primary/Academic Mentor

As discussed during our November meeting, please ask your mentee who their primary (academic) mentor is.

Broad Topics of Discussion:

(select all that apply)

Academic

Leadership Development

Research

Clinical Teaching

Work/Life Balance

(select all that apply)

Appointment/Promotion Criteria

Review CV

Compensation

Relationship with Mentor/Division Chief

Goals and Achievements

Review CE Evaluations (1x/year) - by Nov.1

Other

(please enter below)

Notes:

Action Items: Mentee

Action Items: Mentor

Send me a copy of my responses