CanSAGE ECEP - EndoSURG Ottawa June 16 Course Application Form

EndoSURG Mentorship Program - June 16, 2026; Ottawa, ON

We’re excited to welcome applicants for the upcoming Ottawa course held on June 16, 2026.

To join the 2026 cohort of 12 mentees in Ottawa, applicants should meet the following criteria:

Professional Role: Must be a practicing Canadian gynecologist.
Experience Level: Ideal for non‑fellowship‑trained surgeons, within 10 years of graduating from your residency program, who are eager to expand their surgical comfort zone. Not for MIS fellowship-trained surgeons.
Surgical Privileges: You currently hold hospital privileges for the excision of superficial endometriosis.
Commitment to Education: Must attend the full pre‑conference course on June 16, 2026, including dynamic lectures and hands‑on simulation practice.
Ongoing Participation: Must commit to a 6‑month mentorship period following the conference, including:
1. Personalized pairing with a minimally invasive surgery (MIS) fellowship‑trained mentor (matched by CanSAGE).
2. Submission of surgical video footage for mentor review, with up to two one‑hour feedback sessions over six months.

Selection Process:
Space is limited to approximately 12 mentees. If there are more eligible applicants than spots available, selection will be conducted at random.

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* 1. Full Name

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* 2. Pronouns (optional)

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* 3. Email

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* 4. Address

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* 5. Phone Number

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* 6. What is the primary language used in your practice?

English

French

Other (please specify)

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* 7. When did you finish your residency program?

<2 years

2-5 years

5-10 years

>10 years

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* 8. Have you completed a fellowship in Minimally Invasive Surgery?

Yes

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* 9. At which hospital do you usually perform laparoscopic surgery?

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* 10. What describes your practice setting? Please select all that apply.

Academic

Community

Urban

Suburban

Rural

Remote

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* 11. Do you perform Laparoscopic Gynecologic Surgery on a regular basis and are interested in improving your skills in excision of superficial endometriosis?

Yes

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* 12. Will you be able to attend the entire course starting the morning of June 16, 2026?

Yes

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* 13. Are you able to commit to a 6‑month mentorship period following the conference, including: (1) Personalized pairing with a minimally invasive surgery (MIS) fellowship‑trained mentor (matched by CanSAGE), and (2) Submission of surgical video footage for mentor review, with up to two one‑hour feedback sessions over six months.

Yes

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* 14. Do you have the ability to record surgical footage in the OR for review in the future? This is usually performed with a recording device directly connected to the laparoscopic tower, exported to a USB drive. Taking a video recording with a handheld phone would not be acceptable as the footage is insufficient

Yes