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.

Institution Name:

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* 1. Institution Name:

General Surgery Residency Program Director Name:

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* 2. General Surgery Residency Program Director Name:

General Surgery Program Name:

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* 3. General Surgery Program Name:

Number of finishing Chief residents per year:

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* 5. Number of finishing Chief residents per year:

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

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

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

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* 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?

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?

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* 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?

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

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

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

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

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

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

Do you have any concerns regarding this fellowship?

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

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

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

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.

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* 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.

Additional comments:

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* 15. Additional comments:

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