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ACS VA Chapter Humanitarian and Global Surgery Committee Survey

The purpose of the Humanitarian and Global Surgery Committee initially is to account for all global surgery activities from surgeons, surgical providers, and surgical trainees within the state of Virginia with the aim to build a database that can serve for networking and resources for collaboration.

Once we have determined who the main stakeholders in the Commonwealth of Virginia, the committee will work to define and provide structure and guidelines for competency-based activities in global surgery.

Additionally, we the committee will study the disparities in the state of Virginia to potentially apply lessons learned abroad to improve access to surgical care.

We invite you to participate in this voluntary survey for the Virginia Chapter of the ACS. Providing your name is NOT mandatory. All data collected and used in research will be de-identified. If you provide your name and email address, we will be able to connect you with others doing similar work as you. By filling out this survey, you are consenting for use of this data.

Edgar B. Rodas, MD, FACS
Daniel Lollar, MD, FACS

Name

Email address

Institution

* must provide value

What is your role?

* must provide value

Attending

Fellow

Resident

Nurse

Advanced Practice Provider (NP, PA)

MPH/PhD

Research Fellow

Administrator

Other

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Name "other" role

* must provide value

Specialty and Subspecialty

* must provide value

Years in practice

* must provide value

5-10

11-15

16-20

21-25

>25

reset

Years involved in Global Surgery

* must provide value

5-10

11-15

16-20

21-25

>25

reset

Select the type(s) of Global Surgery activities that apply to you:

* must provide value

Clinical care

Needs assessment

System building/strengthening

Quality improvement

Education/Training

Research

Advocacy

How are you involved in global surgical activity?

* must provide value

Through my institution

Through another institution

Through a non-governmental organization (NGO)

List the country(ies) you currently are active in:

* must provide value

Do you work at a single site or multiple sites in this country?

* must provide value

Single site

Multiple sites

reset

Who do you collaborate or partner with in the host nation?

* must provide value

Ministry of Health

Local Health System

NGO

Private

Missionary

Other

List "other" host nation collaborator

* must provide value

Do you have any partnerships with other institutions within the US?

* must provide value

Yes

reset

With who do you partner within the US?

* must provide value

Other academic institutions

NGOs

Philanthropy

Industry

Other

List "other"

* must provide value

List the country(ies) you have ever worked in previously:

* must provide value

Are there other people in your division/department involved in global surgery?

* must provide value

Yes

reset

How many people in your department are involved?

* must provide value

What role do others in your department play?

* must provide value

Attending

Fellow

Resident

Nurse

Advanced Practice Provider (NP, PA)

MPH/PhD

Research Fellow

Administrator

Other

List "other" role

* must provide value

Expand

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