Impact Survey for Certificate Course in Proctology Course

General Information

To understand the long term change this training course is creating, we have developed a survey form. The survey is designed to be comprehensive yet efficient, taking approximately 5 minutes to complete. Your responses will remain confidential, and the aggregated results will be used solely for analytical purposes.

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* 1. Please enter your Contact Details:

Month and Year of attending the course

Age in Years

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Mobile Number

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* 2. Gender

Male

Female

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* 3. Years of Practice

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* 4. Working with

Government Medical College

Government Non-teaching Institution

Private Medical College

Private non-teaching hospital with >/= 25 beds

Private Nursing home with <25 beds

Own Hospital

Other (please specify)

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* 5. Procedures for Hemorrhoids? (Please tick the procedures, if you are practicing it)

	Conducting before attending the course at IMMAST	Conducting after Attending the course at IMMAST
Sclerotherapy in Hemorrhoids	Sclerotherapy in Hemorrhoids Conducting before attending the course at IMMAST	Sclerotherapy in Hemorrhoids Conducting after Attending the course at IMMAST
Rubber Band Ligation	Rubber Band Ligation Conducting before attending the course at IMMAST	Rubber Band Ligation Conducting after Attending the course at IMMAST
IRC	IRC Conducting before attending the course at IMMAST	IRC Conducting after Attending the course at IMMAST
DGHAL	DGHAL Conducting before attending the course at IMMAST	DGHAL Conducting after Attending the course at IMMAST
Laser Hemorrhoidoplasty	Laser Hemorrhoidoplasty Conducting before attending the course at IMMAST	Laser Hemorrhoidoplasty Conducting after Attending the course at IMMAST
Stapler Hemorrhoidopexy	Stapler Hemorrhoidopexy Conducting before attending the course at IMMAST	Stapler Hemorrhoidopexy Conducting after Attending the course at IMMAST
Transanal Hemorrhoidopexy Chivates Procedure	Transanal Hemorrhoidopexy Chivates Procedure Conducting before attending the course at IMMAST	Transanal Hemorrhoidopexy Chivates Procedure Conducting after Attending the course at IMMAST
Closed Hemorrhoidectomy	Closed Hemorrhoidectomy Conducting before attending the course at IMMAST	Closed Hemorrhoidectomy Conducting after Attending the course at IMMAST

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* 6. Procedures for Fistula in Ano? (Please tick the procedures, if you are practicing it)

	Conducting before Attending the Course at IMMAST	Conducting after Attending the course at IMMAST
Fistulotomy	Fistulotomy Conducting before Attending the Course at IMMAST	Fistulotomy Conducting after Attending the course at IMMAST
Fistulectomy	Fistulectomy Conducting before Attending the Course at IMMAST	Fistulectomy Conducting after Attending the course at IMMAST
Fistulectomy with primary sphincter repair	Fistulectomy with primary sphincter repair Conducting before Attending the Course at IMMAST	Fistulectomy with primary sphincter repair Conducting after Attending the course at IMMAST
Coring	Coring Conducting before Attending the Course at IMMAST	Coring Conducting after Attending the course at IMMAST
Seton Cutting	Seton Cutting Conducting before Attending the Course at IMMAST	Seton Cutting Conducting after Attending the course at IMMAST
LIFT	LIFT Conducting before Attending the Course at IMMAST	LIFT Conducting after Attending the course at IMMAST
VAAFT	VAAFT Conducting before Attending the Course at IMMAST	VAAFT Conducting after Attending the course at IMMAST
FIXcision	FIXcision Conducting before Attending the Course at IMMAST	FIXcision Conducting after Attending the course at IMMAST
EXcision on internal Opening (Central Disease)	EXcision on internal Opening (Central Disease) Conducting before Attending the Course at IMMAST	EXcision on internal Opening (Central Disease) Conducting after Attending the course at IMMAST

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* 7. Procedures for Anal Fissure? (Please tick the procedures, if you are practicing it)

	Conducting before Attending the Course at IMMAST	Conducting after Attending the Course at IMMAST
Chemical Sphincterotomy Diltiazem or Nifedepin	Chemical Sphincterotomy Diltiazem or Nifedepin Conducting before Attending the Course at IMMAST	Chemical Sphincterotomy Diltiazem or Nifedepin Conducting after Attending the Course at IMMAST
BOTOX	BOTOX Conducting before Attending the Course at IMMAST	BOTOX Conducting after Attending the Course at IMMAST
Anal Dilatation	Anal Dilatation Conducting before Attending the Course at IMMAST	Anal Dilatation Conducting after Attending the Course at IMMAST
Posterior Sphincterotomy	Posterior Sphincterotomy Conducting before Attending the Course at IMMAST	Posterior Sphincterotomy Conducting after Attending the Course at IMMAST
Lateral Internal Sphincterotomy with Blade or Scissors	Lateral Internal Sphincterotomy with Blade or Scissors Conducting before Attending the Course at IMMAST	Lateral Internal Sphincterotomy with Blade or Scissors Conducting after Attending the Course at IMMAST
Lateral Internal Sphincterotomy with LASER	Lateral Internal Sphincterotomy with LASER Conducting before Attending the Course at IMMAST	Lateral Internal Sphincterotomy with LASER Conducting after Attending the Course at IMMAST
Open	Open Conducting before Attending the Course at IMMAST	Open Conducting after Attending the Course at IMMAST
Closed Lateral Internal Sphincterotomy	Closed Lateral Internal Sphincterotomy Conducting before Attending the Course at IMMAST	Closed Lateral Internal Sphincterotomy Conducting after Attending the Course at IMMAST
Open Lateral Internal Sphincterotomy	Open Lateral Internal Sphincterotomy Conducting before Attending the Course at IMMAST	Open Lateral Internal Sphincterotomy Conducting after Attending the Course at IMMAST
Fissurectomy	Fissurectomy Conducting before Attending the Course at IMMAST	Fissurectomy Conducting after Attending the Course at IMMAST
Anal Advancement Flap	Anal Advancement Flap Conducting before Attending the Course at IMMAST	Anal Advancement Flap Conducting after Attending the Course at IMMAST

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* 8. Procedures for Pilonidal Sinus? (Please tick the procedures, if you are practicing it)

	Conducting before Attending the course at IMMAST	Conducting after attending the course at IMMAST
Shaving the back	Shaving the back Conducting before Attending the course at IMMAST	Shaving the back Conducting after attending the course at IMMAST
Pit picking	Pit picking Conducting before Attending the course at IMMAST	Pit picking Conducting after attending the course at IMMAST
Trephining	Trephining Conducting before Attending the course at IMMAST	Trephining Conducting after attending the course at IMMAST
EPSiT	EPSiT Conducting before Attending the course at IMMAST	EPSiT Conducting after attending the course at IMMAST
LASER	LASER Conducting before Attending the course at IMMAST	LASER Conducting after attending the course at IMMAST
Rhomboid Flap	Rhomboid Flap Conducting before Attending the course at IMMAST	Rhomboid Flap Conducting after attending the course at IMMAST
Multiple Z Plasty	Multiple Z Plasty Conducting before Attending the course at IMMAST	Multiple Z Plasty Conducting after attending the course at IMMAST

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* 9. On an average, How many above mentioned procedures you conduct, in a month?

Before Attending the course at IMMAST

After attending the course at IMMAST

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* 10. Is the learning at IMMAST making the difference in the following?

	Yes	No
Improving the skill in conducting the procedures	Improving the skill in conducting the procedures Yes	Improving the skill in conducting the procedures No
Reduction in Complication	Reduction in Complication Yes	Reduction in Complication No
Improving the skill in effectively managing the complication	Improving the skill in effectively managing the complication Yes	Improving the skill in effectively managing the complication No
Increase in confidence in conducting the procedure	Increase in confidence in conducting the procedure Yes	Increase in confidence in conducting the procedure No
Improved Practice	Improved Practice Yes	Improved Practice No
Improved Income	Improved Income Yes	Improved Income No
Patient satisfaction	Patient satisfaction Yes	Patient satisfaction No

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* 11. Please mention the barriers to not start the procedures. (Please select as many as applicable)

Lack of Knowledge

Lack of sufficient skill

Lack of Confidence

Financial constraints

Lack of Instrument / Equipment

Lesser patient load

Other (please specify)

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* 12. Please rate how useful is the IMMAST Alumni connect initiative, with respect to

	Please rate it from 5-Most useful to 1- Least useful
Addressing Queries	Addressing Queries Please rate it from 5-Most useful to 1- Least useful menu
Networking opportunities	Networking opportunities Please rate it from 5-Most useful to 1- Least useful menu
Receiving updates	Receiving updates Please rate it from 5-Most useful to 1- Least useful menu

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* 13. Other procedures being conducted by you, after attending training at IMMAST?

Pudendal Block

Injection of Methylene blue for anal pain or pruritus ani

Overlapping Sphincteroplasty

Rectovaginal Fistula

Hybrid Procedures

Other (please specify)

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* 14. After attending the course at IMMAST, Please state your progress in other fields

Started presenting in your city IMA group, GP group

Talks in city and state conferences

Lecture in National conference

Presentation in international conference

Picture and video demo of your own work

Making slides / Power point presentations

Making videos

Other (please specify)

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* 15. Have you attended other Similar courses?

Yes

Impact Survey for Certificate Course in Proctology Course

General Information

Question Title

* 1. Please enter your Contact Details:

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* 2. Gender

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* 3. Years of Practice

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* 4. Working with

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* 5. Procedures for Hemorrhoids? (Please tick the procedures, if you are practicing it)

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* 6. Procedures for Fistula in Ano? (Please tick the procedures, if you are practicing it)

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* 7. Procedures for Anal Fissure? (Please tick the procedures, if you are practicing it)

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* 8. Procedures for Pilonidal Sinus? (Please tick the procedures, if you are practicing it)

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* 9. On an average, How many above mentioned procedures you conduct, in a month?

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* 10. Is the learning at IMMAST making the difference in the following?

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* 11. Please mention the barriers to not start the procedures. (Please select as many as applicable)

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* 12. Please rate how useful is the IMMAST Alumni connect initiative, with respect to

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* 13. Other procedures being conducted by you, after attending training at IMMAST?

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* 14. After attending the course at IMMAST, Please state your progress in other fields

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* 15. Have you attended other Similar courses?

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* 16. Please write when and where you have attended similar course?

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* 17. Any Other Comment