ASCRS Mentorship Program: Survey for Interested General Surgery Residents

Thank you for your interest in participating in the Mentorship Program for General Surgery Residents interested in colorectal surgery.

The program expectations are to complete at least 3 virtual or phone meetings over a 1 year time period and provide feedback on the program and your experience.

Question Title

* 1. Please provide your full name and email address.

Full Name

Email Address

Question Title

* 2. General Surgery Residency Program Information

General Surgery Residency Program

City

State

Question Title

* 3. What PGY level will you be in July 2024?

PGY 1

PGY 2

PGY 3

PGY 4

PGY 5

If on a dedicated research year, please enter the clinical year most recently completed.

Question Title

* 4. Gender

Male

Female

Nonbinary

Prefer not to say

Other (please specify)

Question Title

* 5. What topics are you interested in learning about? Rank in order of importance, 1 = most important.

Question Title

* 6. What are you looking for in a mentor? Rank in order of importance, 1 = most important.

Question Title

* 7. Does your institution have a division of colon and rectal surgery?

Yes

Question Title

* 8. Does your institution have a colon and rectal surgery residency?

Yes

ASCRS Mentorship Program: Survey for Interested General Surgery Residents

Question Title

* 1. Please provide your full name and email address.

Question Title

* 2. General Surgery Residency Program Information

Question Title

* 3. What PGY level will you be in July 2024?

Question Title

* 4. Gender

Question Title

* 5. What topics are you interested in learning about? Rank in order of importance, 1 = most important.

Question Title

* 6. What are you looking for in a mentor? Rank in order of importance, 1 = most important.

Question Title

* 7. Does your institution have a division of colon and rectal surgery?

Question Title

* 8. Does your institution have a colon and rectal surgery residency?

Question Title

* 9. Please provide any additional information that may be helpful to identify an appropriate mentor pairing.