Pre-Course Questionnaire 2019 MIS Laparoscopic Colectomy - Pre-course questionnaire * Denotes required field Name* First Last Province*Email* Gender*FemaleMaleOtherAge*The following questions are designed to understand your clinical practice setting and experience.Practice Demographics*Rural (<20,000)Small Urban (20,000 to 100,000)Large Urban (>100,000)Practice Setting*Community PracticeCommunity Practice with Academic AppointmentAcademic PracticeYears in practice (since residency / fellowship)*Fellowship*NoneMISColorectalOtherPlease SpecifyLocation of fellowship(s) as applicablePercentage of general surgery cases approached laparoscopically* 0-25% 26-50% 51-75% 76-100% Number of colectomies per year* 0-10 11-20 More than 20 Procedure Frequency and EffectivenessFor each type of procedure, please include the number performed over the last year and select the letter corresponding to the level of expertise at which you are confident that you can currently perform the procedure.Right hemicolectomy*Right hemicolectomy*A- Definitely NOT EffectiveBCDE- Definitely EffectiveLeft hemicolectomy*Left hemicolectomy*A- Definitely NOT EffectiveBCDE- Definitely EffectiveSigmoidectomy*Sigmoidectomy*A- Definitely NOT EffectiveBCDE- Definitely EffectiveProcedure & Task ConfidenceFor each item, please use the scale given to choose the answer best representing your level of confidence.Formulate an operative plan for the performance of laparoscopic right hemicolectomy*A- Not confident at allBCDE- Completely confidentFormulate an operative plan for the performance of laparoscopic left hemicolectomy*A- Not confident at allBCDE- Completely confidentIdentify proper anatomical planes and isolate anatomic structures for the performance of laparoscopic right colectomy*A- Not confident at allBCDE- Completely confidentIdentify proper anatomical planes and isolate anatomic structures for the performance of laparoscopic left colectomy*A- Not confident at allBCDE- Completely confidentCompetently conduct the technical steps of laparoscopic right colectomy*A- Not confident at allBCDE- Completely confidentCompetently conduct the technical steps of laparoscopic left colectomy*A- Not confident at allBCDE- Completely confidentAdditional Information To Be Shared with MentorsWhat are your goals for this program?*What do you believe may help you the most?I would be disappointed if this program included:What will be the most challenging part of this program?
