CANADIAN TATME PROCTORSHIP NETWORK (Participant)

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* 1. Participant Information

First Name, Last Name

Credentials

Appointments (Institution)

Full mailing address

e mail

phone number

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* 2. How many rectal surgeries do you do a year?

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* 3. How many laparoscopic rectal cancer surgeries do you do a year?

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* 4. How many TAMIS local excision do you do a year?

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* 5. What is your comfort level of laparoscopic suturing
(please create a scale from 1-4)

1 not comfortable

2 neutral

3 comfortable

4 very comfortable

1 not comfortable

2 neutral

3 comfortable

4 very comfortable

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* 6. Have you signed up or have taken a formal TME/Tamis?

Where

When

Instructor