Modern Heroes of Science and Medicine

Featured Participant Survey

Thank you for agreeing to participate in Modern Heroes of Science and Medicine, an educational coloring-book series introducing children and families to physicians, scientists, researchers, clinicians, health educators, and other individuals whose work has contributed to better health, medicine, scientific understanding, patient care, or public-health policy.

Our goal is to present your work accurately, positively, and in language young readers can understand. Please answer as much or as little as you wish. We may edit responses for length, clarity, and age appropriateness, but we will use your answers to help ensure that your entry accurately reflects the work you consider most important. Items marked * are required.

New to IPAK-EDU? Featured participants are warmly invited to join our community at https://ipakedu.online/membership/ — optional, and not required to take part.

Section 1 — About You

1. Full name *

Exactly as you would like it to appear in the book.

2. Professional credentials

Examples: MD, DO, PhD, MPH, DC, RN, JD.

3. Preferred professional description

Examples: Pediatrician, Epidemiologist, Cardiologist, Research Scientist, Neuroscientist, Health Educator.

4. Current or principal professional affiliation

Optional.

5. Website or professional biography

A link we can use to verify basic biographical information.

Section 2 — Your Work

6. In your own words, what area or areas of science, medicine, or health have been the primary focus of your work?

7. What do you consider your three most important contributions to science, medicine, health, or public policy?

Please do not limit yourself to the work for which you are best known publicly.

8. If we could teach children only ONE thing about your life's work, what would you want it to be?

9. What problem, question, observation, patient experience, or scientific puzzle first drew you into this work?

10. Was there a discovery, clinical observation, study, or experience that significantly changed the way you thought about health or medicine?

If so, please describe it.

Section 3 — Science in Practice

11. What have you investigated, discovered, developed, treated, improved, or helped bring greater attention to?

Research findings, treatment approaches, diagnostic methods, technologies, nutritional approaches, public-health improvements, scientific methods, educational work, or other contributions.

12. Are there particular scientific papers, books, clinical programs, inventions, treatments, organizations, or initiatives that should be mentioned in your profile?

Please include links or citations when convenient.

13. What contribution of yours do you think has been overlooked or insufficiently recognized?

14. Have you helped change a medical practice, scientific assumption, public-health policy, or way of thinking?

Yes No

15. Please describe what you sought to change and why.

Section 4 — Asking Difficult Questions

Science advances when people are willing to investigate questions whose answers may be uncertain, unpopular, unexpected, or contrary to prevailing assumptions.

16. Have you ever pursued a scientific or medical question because you believed an important issue was being overlooked?

Yes No

17. What was the question, and why did you believe it mattered?

18. Did your research, clinical experience, or analysis ever lead you to disagree with an established medical or public-health policy?

Yes No Prefer not to answer

19. What evidence or experience led you to that position?

20. Did speaking publicly about your conclusions carry professional, institutional, financial, legal, reputational, or personal consequences?

Yes No Prefer not to answer

21. If you wish, please describe what happened.

22. Looking back, would you make the same decision to speak up?

Yes No It depends Prefer not to answer

22b. Optional explanation

Section 5 — Health-Preserving Medicine

23. Which of the following have been important themes in your work? (Select all that apply)

Prevention Nutrition Metabolic health Exercise or physical activity Sleep Mental and emotional wellness Environmental health Toxicology Infectious disease Immunology Vaccine science or safety Pediatric health Maternal or reproductive health Cardiovascular health Cancer Neurology Neurodevelopment Gastrointestinal health Microbiome Endocrinology Chronic illness Integrative medicine Functional medicine Critical care Emergency medicine Drug safety Pharmacology Medical-device safety Diagnostic innovation Clinical research Epidemiology Biostatistics Research integrity Evidence-based medicine Informed consent Patient autonomy Physician autonomy Medical ethics Public-health policy Health education Other

23b. If "Other", please specify

24. What do you believe medicine or public health should do MORE of to preserve human health?

25. What do you believe medicine or public health should do LESS of?

Section 6 — For Young Readers

26. What were you curious about as a child?

27. Did you know when you were young that you wanted to become a physician, scientist, researcher, or health professional?

Yes No Not sure My career developed in an unexpected way

27b. Optional explanation

28. Was there a teacher, physician, scientist, parent, book, experience, or historical figure who inspired you?

29. What qualities do you think make a good scientist or physician?

30. What advice would you give a child who wants to become a scientist, physician, researcher, or healer?

31. Complete this sentence: "Never be afraid to ______."

32. Complete this sentence: "Science works best when ______."

33. Complete this sentence: "Good medicine begins with ______."

Section 7 — A Little About You

These questions help us make each profile memorable and human.

34. What is something about you that children might find surprising?

35. Do you have a hobby, favorite activity, sport, musical interest, artistic interest, animal, or unusual skill we might mention?

36. What is your favorite scientific fact, medical fact, or fact about the human body?

37. If you could meet any scientist, physician, inventor, or thinker from history, who would it be?

38. Why?

Section 8 — Your Illustration

39. Please upload a photograph of yourself to use as the reference for your coloring-book portrait.

A clear photograph showing your face is best; one in your professional environment is also welcome. JPG, PNG, WEBP or HEIC. Large photos are automatically resized before upload.

40. Is there anything you would particularly like included in the illustration?

Examples: laboratory equipment, microscope, stethoscope, books, research papers, plants, foods, brain waves, human cells, heart, DNA, computer, patients, outdoor setting, teaching setting.

41. Is there anything you do NOT want depicted?

42. May we use the photograph you provide as a visual reference for creating an original illustrated coloring-book portrait of you? *

Yes No

43. Do you own the photograph or otherwise have authority to permit us to use it as an artistic reference? *

Yes No Unsure

43b. If unsure, please tell us who owns the photograph

Section 9 — Accuracy and Permissions

44. May we use information you provide in this survey to prepare your biographical entry for Modern Heroes of Science and Medicine? *

Yes No

45. May we quote short portions of your responses in your entry? *

Yes No Please contact me before quoting directly

46. May we identify and describe your published research, books, public testimony, clinical work, educational work, and other publicly documented contributions? *

Yes No Please contact me first

47. Would you like the opportunity to review the factual text of your entry before publication? *

Yes No

48. If we have a factual question while preparing your entry, may we contact you?

Yes No

49. Best email address for project correspondence *

50. Is there someone on your staff or team whom we should copy on correspondence?

Optional — name and email.

Section 10 — Help Us Find the Next Heroes

51. Who else should be included in Modern Heroes of Science and Medicine?

Physicians, scientists, researchers, clinicians, health educators, or others whose work since approximately 2015 has helped advance health, medicine, scientific understanding, patient care, or public-health policy.

52. Why should we feature them?

53. Are there younger or less publicly recognized scientists or physicians whose contributions deserve greater attention?

54. Would you be willing to introduce us to any of the people you nominated?

Yes Possibly No

Final Question

55. Is there anything important about your life, scientific work, clinical work, or contribution to human health that we failed to ask?

Join the IPAK-EDU Community (optional)

Featured participants are warmly invited to join ipakedu.online — a social learning platform for independent science, courses, webinars and research groups. Joining is entirely optional and has no bearing on your inclusion in the book.

J. Are you on ipakedu.online?

I am already a member Not yet — please include the link to join in my confirmation email Not right now

Permission Acknowledgment

By submitting this survey, I understand that the information I voluntarily provide may be used to develop an educational biographical profile for the Modern Heroes of Science and Medicine book series, subject to the permissions I selected above. I understand that submission of this survey does not obligate either party to publication and that the editors may independently verify factual information before publication.

A1. Name (electronic signature) *

A2. Electronic acknowledgment *

I agree.