The survey results are shared only with the Fellowship Council Accreditation Committee. However, if a problem is identified, the program may be provided with general details in order to address the issue.

* 1. Institution Name:

* 2. General Surgery Residency Program Director Name:

* 3. General Surgery Program Name:

* 5. Number of finishing Chief residents per year:

* 6. RRC status (last review date and current accreditation status): *Note: Indicate Not Applicable for Canadian Programs:

* 7. At the time of your last RRC review or GME Internal review, were any deficiencies identified which relate to the existence of institutional fellowships?

* 8. Do you feel there is sufficient clinical volume to support the training of each General Surgery resident and the fellow(s) in the fellowship currently under review in this survey?

* 9. Have any residents graduating in the last three years been deficient in (MIS, GI, HPB, Flex Endo, MIS/Colorectal, Thoracic) cases?

* 10. Do the General Surgery Chief residents and the fellow in this program ever provide care for the same patients?

* 11. Do you feel that this fellowship has had a positive, neutral, or negative impact on the General Surgery training program?

* 12. Do you have any concerns regarding this fellowship?

* 13. Would you recommend this fellowship to one of your graduating residents?

* 14. If you had any concerns or would not recommend the fellowship and would be willing to discuss this with the Accreditation Committee reviewer, please provide your contact information below.

* 15. Additional comments: