ESCP Robotic Surgery Fellowship Application

Name

Email

Work Address

Contact Number

Do you have access to robotic platform at your current job/training position?

Yes

No

Will you have access to robotic surgery platform following completion of ESCP robotic surgery fellowship?

Yes

No

Is your department or training programme lead aware of your application for this fellowship?

Yes

No

Have you looked at Work Visa and local medical council registration requirements for your potential host centres for the fellowship?

Yes

No

Are you currently in a formal robotic surgery training programme or have applied for one?

Yes

No

Do you hold medical licence for practice or registration to work in any other country in addition to your current country of practice?

Yes

No

How many hours of robotic simulated training you have completed?

How old are you?

< 35 years

35-40 years

> 40 years

For how long you have been ESCP member?

for 12 months

12-24 months

24-36 months

36-48 months

> 48 months

Are you member of ESCP committees or young ESCP?

Yes

No

How long ago you graduated from medical school?

8 years

8-12 years

12-15 years

>15 years

Which country you studied in for your medical degree?

Eastern Europe

Western Europe

Central Europe

Outside EU

Which country you are practising in currently?

Eastern Europe

Western Europe

Central Europe

Outside EU

Have to passed ESBQ examination?

Yes

No

Which year you have attended ESCP annual conference? (Can select all 5)

2013

2014

2015

2016

2017

2018

2019

2020

2021

How much time you have spent in colorectal surgery practice during and after completion of residency training?

< 6 years

6-10 years

10-15 years

> 15 years

How many publications you had in the past 5 years in peer reviewed journals (exclude case reports and abstracts)?

0

1

2

3

4

5

How many publications you had in the past 5 years in peer reviewed journals in the field of coloproctology (exclude case reports and abstracts)?

0

1

2

3

4

5

How many national/international poster presentations you had in the past 5 years?

0

1

2

3

4

5

>5

How many national/international oral presentations you had in the past 5 years?

0

1

2

3

4

5

>5

Have you participated in ESCP snapshot audit ? (Select all options if applicable)

None

2015

2016

2017

2018

2019

2020

2021

Have you been awarded a fellowship by ESCP in the past? (Select all options if applicable)

Pre-conference placement

KSCP travelling fellowship

JSCP travelling fellowship

ASCRS travelling fellowship

Observership

3 months fellowship

6 months fellowship

Open right hemicolectomy:

Assisted

< 10

10-20

>20

Supervised trainer scrubbed

< 10

10-20

>20

Independent

< 10

10-20

>20

Open segmental resection:

Assisted

< 10

>10, 20

>20

Supervised trainer scrubbed

< 10

>10, 20

>20

Independent

< 10

>10, 20

>20

Open anterior resection:

Assisted

< 10

>10, 20

>20

Supervised trainer scrubbed

< 10

>10, 20

>20

Independent

< 10

>10, 20

>20

Emergency laparotomy:

Supervised trainer scrubbed

< 20

>20, 100

>100

Independent

< 50

>50, 100

>100

Laparoscopic appendicectomy:

Supervised trainer scrubbed

< 20

>20, 50

>50

Independent

< 50

>50, 100

>100

Laparoscopic cholecystectomy:

Supervised trainer scrubbed

< 20

>20, 50

>50

Independent

< 50

>50, 100

>100

Laparscopic right hemicolectomy:

Assisted

< 10

>10, 20

>20

Supervised trainer scrubbed

< 10

>10, 20

>20

Independent

< 10

>10, 20

>20

Laparoscopic anterior resection/ left colonic resection:

Assisted

< 10

>10, 20

>20

Supervised trainer scrubbed

< 10

>10, 20

>20

Independent

< 10

>10, 20

>20

Haemorrhoid Surgery:

Supervised trainer scrubbed

< 10

>10, 20

>20

Independent

< 10

>10, 20

>20

Fistula surgery:

Supervised trainer scrubbed

< 10

>10, 20

>20

Independent

< 10

>10, 20

>20

Robotic assisted laparoscopic anterior resection/ left colonic resection:

Assisted

None

< 10

>10, 20

Supervised trainer scrubbed

None

< 10

>10, 20

Independent

None

< 10

>10, 20

>20

Do you have any formal Research Qualifications?

None

PhD

Doctorate in Medicine (MD)

Number of research grants secured in the past 5 years as main applicant and co-applicant?

0

1

2

3

4

5

Have you won any international awards for your work, presentations or research?

Yes

No

Have you attended any courses / workshops for the robotic surgery in coloproctology?

Yes

No

Have you completed a required simulated training on the robotic surgery console?

Yes

No

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ESCP Robotic Surgery Fellowship Application

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ESCP Robotic Surgery Fellowship Application

About ESCP

News & Events

Education

Research

Members

Useful

Get in touch