American Head & Neck Society

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

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Your AHNS Member Panel

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.