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* Name

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* Date

Date

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* PGY Level

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* Gender

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* Number of TVH procedures you've performed as PRIMARY Surgeon

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* Please rate your TVH performance below using a scale from 1 to 5. .

  Not at All Confident Very Confident (level of attending surgeon)
How confident are you OVERALL regarding your performance of TVH?

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* .

  I feel I have no skills whatsoever Average, as required of a resident at my level Well above average and only rarely encountered in a resident of my level
What is your surgical skill level regarding TVH?

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* .

  Constantly worry that something might go wrong (life-threatening complication) or that I am not operating at the required level Occasionally worried I feel completely calm, not worried at all
Are you worried about performing this procedure?

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* .

  Very anxious, I have "flutters in my stomach" just thinking about performing a TVH Occasionally anxious Not anxious at all
Are you anxious about performing this procedure?

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* .

  Yes, most definitely I would consider this mode of hysterectomy for my patients On the contrary, I would like to perform TVH anytime
Would you like to avoid this procedure altogether?

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* .

  Very uncomfortable Average Very comfortable (level of an attending surgeon)
How comfortable are you with independent planning and performance of this procedure?

T