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Pediatric Ophthalmology & Strabismus Fellowship
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You are logged in as: Testing Fellow
Logoff Return To Exit Survey Home IntroductionYour Fellow Exit Survey is divided into 3 parts with access to each dependent on both a sequence and the chronology of your Fellowship. Part 1 must be completed first. Part 2 is intended to assist you in the collection of the large volume of supporting documentation you will have compiled throughout your Fellowship. Part 3 is the exit questionnaire of mostly yes/no questions that requires you to evaluate the content and quality of your Fellowship training experience. Part 3 will be available to you only after you have completed all of Part 1 and when you are within 30 days of the end of your fellowship (normally June 1st). Your Fellow Exit Survey must be completed no later than June 30th.Part 1 - Your Contact and Program InformationYou must complete this section first. Please be sure to update it if/when your information changes. Please refer to the sample survey, Part 1,Exit Survey Part I, Contact and Program Information Part 2 - Supporting Documentation - Logging SystemPlease use the logging system to enter your collected data during your fellowship year. You must complete Part 1 for the logging links to be available. Please refer to the sample surveys.
Part 3 - Questionnaire
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Pediatric Ophthalmology & Strabismus Fellowship
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You are logged in as: Testing Fellow
Logoff Return To Exit Survey Home Part 1
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| Fellow Information (current, post-fellowship contact information please) | |
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| * Fellow Name 01-020 | |
| * Street address (line 1) 01-030 | |
| Street address (line 2) 01-040 | |
| * City 01-050 | |
| * State 01-060 | |
| * Zip/Postal Code 01-070 | |
| * Country 01-080 | |
| * Day phone 01-090 | |
| Evening phone 01-100 | |
| Cell / mobile phone 01-110 | |
| * E-Mail 01-120 | |
| * Fellowship Start Date (Month-Year) 01-130 | Month Year |
| * Fellowship End Date (Month-Year) 01-150 | Month Year |
| Program Information | |
| Program ID 02-020 | 01199 |
| * Parent Institution Name 02-030 | |
| * Affiliated Medical School or Government Training Institution 02-040 | |
| * Fellowship Program Director 02-050 | |
| Ophthalmology residency affiliation: 02-060 | |
| * Affiliated General Pediatric Program: 02-070 | |
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= You will have one final opportunity to review and correct your entries. | |
Pediatric Ophthalmology & Strabismus Fellowship
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You are logged in as: Testing Fellow
Logoff Return To Exit Survey Home
Logoff
Return To Exit Survey Home
Things to remember:
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Pediatric Ophthalmology & Strabismus Fellowship
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You are logged in as: Testing Fellow
Logoff Return To Exit Survey Home Part 2-B Papers & PresentationsPlease provide a list of your papers (submitted or published) and presentations of research material at national/international meetings (for each entry please list author(s), title, and name, location and date of meeting).
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Pediatric Ophthalmology & Strabismus Fellowship
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You are logged in as: Testing Fellow
Logoff Return To Exit Survey Home Part 2-C Journal Clubs and Conferences / LecturesProvide a list of Journal Clubs and Conferences / Lectures you gave. For both, indicate the precise date. For Conferences and Lectures indicate the title, and audience. For Journal Clubs include the exact date and 'theme' of the journal club and the faculty 'leader'. If there was no common 'theme' then please include the articles discussed. Please note your entered and saved data will appear in the "Existing Entries" section at the end of the page.
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Pediatric Ophthalmology & Strabismus Fellowship
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You are logged in as: Testing Fellow
Logoff Return To Exit Survey Home Part 3
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| Faculty Assessment: | |
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| Did the Fellowship Program Director: | |
| * limit at least 75% of his/her practice to pediatric ophthalmology/strabismus? 03-030 | Yes No |
| * maintain an active clinical practice in pediatric ophthalmology and/or strabismus at the parent institution? 03-040 | Yes No |
| * periodically assess your experience? 03-050 | Yes No |
| * certify satisfactory completion of training? 03-060 | Yes No |
| * provide you, at the time of your application, an information sheet concerning approval status of fellowships and positions? 03-070 | Yes No |
| * inform you, prior to the start of your training, whether you were in a Fellowship in compliance with AUPO-FCC requirements? 03-080 | Yes No |
| * evaluate your performance during your fellowship? 03-090 | Yes No |
| Program Assessment: | |
| * Was the program at least twelve months in duration? 04-020 | Yes No |
| * Did you spend at least six months at the parent institution? 04-030 | Yes No |
| * Did you obtain your fellowship position through the SF Fellowship Match? 04-040 | Yes No |
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If you did not obtain your fellowship position through the SF Fellowship Match, please explain (required if you answered no to Question 04-040 above). 04-041 |
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| * How many other fellows trained with you? 04-050 | |
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List other faculty (full-time or voluntary) who played a role in your training (list each on a new line): 04-060 |
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| Fellow. Did you: | |
| * receive any financial support (salary/stipend)? 05-020 | Yes No |
| If yes, was the support as described/expected? 05-030 | Yes No |
| * receive medical liability coverage? 05-040 | Yes No |
| * have your medical & surgical cases supervised? 05-050 | Yes No |
| * participate in at least six journal clubs per year which were specific to pediatric ophthalmology/strabismus? 05-060 | Yes No |
| * prepare and present teaching conferences? 05-070 | Yes No |
| * participate in teaching residents and/or medical students? 05-080 | Yes No |
| * participate in ongoing research activities? 05-090 | Yes No |
| * perform or assist in at least 75 major cases? 05-100 | Yes No |
| * perform at least 50 strabismus cases done with AAPOS faculty supervision? 05-110 | Yes No |
| * have adequate and appropriate clinical material? (i.e. patients for examination/treatment/discussion) 05-120 | Yes No |
| * spend at least 20% of your time with the other AAPOS member faculty? 05-130 | Yes No |
| PROGRAM EDUCATIONAL CONTENT | |
| Was there at least some teaching for each of the following areas (including lectures, conferences, and informal sessions all together)? | |
| Related to Strabismus: | |
| * Anatomy, physiology, neuro-anatomy 06-040 | Yes No |
| * Sensory adaptation and testing 06-050 | Yes No |
| * Amblyopia diagnosis and treatment 06-060 | Yes No |
| * Refraction management 06-070 | Yes No |
| * Esodeviations and Exodeviations 06-080 | Yes No |
| * Vertical and incomitant strabismus 06-090 | Yes No |
| * Ophthalmoplegic syndromes 06-100 | Yes No |
| * Surgery; primary and complex 06-110 | Yes No |
| * Oculinum 06-120 | Yes No |
| * Nystagmus evaluation and management including eye movement recordings (EMR) 06-130 | Yes No |
| Related to Pediatric Ophthalmology: | |
| * Vision development in infancy and childhood 06-150 | Yes No |
| * Embryological basis of conditions relative to pediatric ophthalmology 06-160 | Yes No |
| * Neonatal ophthalmology (including retinopathy of prematurity) 06-170 | Yes No |
| * Genetics, inborn errors of metabolism, and syndromes with ocular findings 06-180 | Yes No |
| * Electrodiagnostic testing 06-190 | Yes No |
| * Ocular manifestations of systemic disease in children 06-200 | Yes No |
| * Vision and learning; dyslexia 06-210 | Yes No |
| * Vision screening 06-220 | Yes No |
| * Treating the visually handicapped child; low vision management 06-230 | Yes No |
| * Pediatric ocular trauma 06-240 | Yes No |
| * Pediatric ocular tumors 06-250 | Yes No |
| * Ultrasound, CT and MRI in pediatric ophthalmology 06-260 | Yes No |
| Related to Pediatric Ophthalmology and Vision Development: | |
| * External ocular disease 06-280 | Yes No |
| * Lacrimal disorders 06-290 | Yes No |
| * Lid disorders 06-300 | Yes No |
| * Corneal disorders 06-310 | Yes No |
| * Uveal disorders 06-320 | Yes No |
| * Lens disorders 06-330 | Yes No |
| * Pediatric glaucoma; primary and secondary 06-340 | Yes No |
| * Retina and vitreous 06-350 | Yes No |
| * Neuro-ophthalmology 06-360 | Yes No |
| Fellow Supporting Documentation | |
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Provide a representative weekly schedule of your activities that indicates faculty staffing and/or method(s) of supervision (if your weekly schedule underwent material change during your training, please submit multiple schedules and label them as to their period in effect).(LIMIT - 1,500 WORDS) 07-060 |
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Comments: Please submit a brief summary (less than 200 words) of your overall impression of your training. 07-070 |
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| * E-Mail Please enter your email a second time (in addition to above) as your signature. It must match the email you entered in Question #01-12 07-090 | |
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= You will have one final opportunity to review and correct your entries. | |
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