American Head & Neck Society

Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.

AHNS Fellowship Program Evaluation Form

This form is to be completed by the graduating fellow. This is a prerequisite to receiving your Certificate of Completion, and this information will be kept strictly confidential.

ATC - Fellowship Program Evaluation

"*" indicates required fields

Graduating Fellow's Name*
Fellowship Start Date*
Fellowship End Date*
Intent in Pursuing this Fellowship*
Post Fellowship Plans

Not ApplicableStrongly AgreeAgreeUndecidedDisagreeStrongly Disagree
The program is well-rounded
Patient material is adequate in numbers
Patient material is mixed and diversified
Curriculum is approprirate
Conferences and didactic presentations are appropriate
Instruction on decision-making is adequate
Operating room experience is adequate
Availability of staff is adequate/sufficient in number
Supervision by faculty is enough
There is enough freedom for independent clinical decision-making
Clinical research exposure is available
Basic science instruction (theoretical, classroom) is adequate
Basic science training is appropriate
Overall, this is a good training program in head & neck oncologic surgery
Not Applicablestrongly AgreeAgreeUndecidedDisagreeStrongly Disagree
Basic Science Research Training
Oncological judgment
Surgical judgment
Teaching
Scholarship and academics
A sound head & neck oncologic surgeon
Not ApplicableStrongly AgreeAgreeUndecidedDisagreeStrongly Disagree
is committed to excellent patient care
participates actively to trainee (fellow/resident) education
is available for consultation
gives positive feedback on performance at regular intervals
mentors/supervises the trainee in scholastic pursuits
Not ApplicableStrongly AgreeAgreeUndecidedDisagreeStrongly Disagree
Fellows/Residents
Nurses
Physician extenders
Other colleagues
This field is for validation purposes and should be left unchanged.