ESCP Pre-Congress Placements

Your Details:

Name

Work Address

Contact Number

Referee Details:

Referee Name

Referee Email

Referee Address

Relation to the Candidate

1. Age

How old are you? *

<35 years 35-40 years >40 years

2. ESCP membership

3. Committees or young ESCP membership?

Are you member of ESCP committees or young ESCP? *

Yes No

4. Time from Graduation from medical school

How long ago you graduated from medical school? *

<8 years 8-12 years 12-15 years >15 years

5. Country of medical school

Which country you studied in for your medical degree? *

Eastern Europe Western Europe (inc. UK) Central Europe Outside EU

6. Country of surgical practice

Which country you are practising in currently? *

Eastern Europe Western Europe Central Europe Outside EU

7. EBSQ

Have you passed EBSQ examination? *

Yes No

8. Attendance to ESCP annual conference?

9. Time in colorectal surgery practice

How much time you have spent in colorectal surgery practice during and after completion of residency training? *

<6 years 6-10 years 10-15 years >15 years

10. Number of Publications

How many publications you had in the past 5 years in peer reviewed journals (exclude case reports and abstracts)? *

11. Number of Publications in the field of coloproctology

How many publications you had in the past 5 years in peer reviewed journals in the field of coloproctology (exclude case reports and abstracts)? *

12. Number of National/International Presentations in past 5 years

13. ESCP snapshot audits

14. Have you been awarded a fellowship by ESCP in the past

Have you been awarded a fellowship by ESCP in the past? Select all options if applicable.

Pre-conference placement KSCP travelling fellowship JSCP travelling fellowship ASCRS travelling fellowship Observership 3 months fellowship 6 months fellowship

15. Operative experience past 5 years

Open right hemicolectomy: assisted *

<10 >10, <20 >20

Open right hemicolectomy: supervised trainer scrubbed *

<10 >10, <20 >20

Open right hemicolectomy: independent *

<10 >10, <20 >20

Open segmental resection: assisted *

<10 >10, <20 >20

Open segmental resection: supervised trainer scrubbed *

<10 >10, <20 >20

Open segmental resection: independent *

<10 >10, <20 >20

Open anterior resection: assisted *

<10 >10, <20 >20

Open anterior resection: supervised trainer scrubbed *

<10 >10, <20 >20

Open anterior resection: independent *

<10 >10, <20 >20

Emergency laparotomy: supervised trainer scrubbed *

<20 >20, <100 >100

Emergency laparotomy: independent *

<50 >50, <100 >100

Laparoscopic appendicectomy: supervised trainer scrubbed *

<20 >20, <50 >50

Laparoscopic appendicectomy: independent *

<50 >50, <100 >100

Laparoscopic cholecystectomy: supervised trainer scrubbed *

<20 >20, <50 >50

Laparoscopic cholecystectomy: independent *

<50 >50, <100 >100

Laparscopic right hemicolectomy: assisted *

<10 >10, <20 >20

Laparscopic right hemicolectomy: supervised trainer scrubbed *

<10 >10, <20 >20

Laparscopic right hemicolectomy: independent *

<10 >10, <20 >20

Laparoscopic anterior resection / left colonic resection: assisted *

<10 >10, <20 >20

Laparoscopic anterior resection / left colonic resection: supervised trainer scrubbed *

<10 >10, <20 >20

Laparoscopic anterior resection / left colonic resection: independent *

<10 >10, <20 >20

Haemorrhoid surgery: supervised trainer scrubbed *

<10 >10, <20 >20

Haemorrhoid surgery: independent *

<10 >10, <20 >20

Fistula surgery: supervised trainer scrubbed *

<10 >10, <20 >20

Fistula surgery: independent *

<10 >10, <20 >20

Centres

Dr. Ingrid Haunold

Krankenhaus der Barmherzigen
Schwestern Wien
Betriebsgesellschaft m.b.H.
Stumpergasse 13
1060 Wien

Prof. Stefan Riss

Department of Surgery
Medical University of Vienna
Spitalgasse 23
1090 Wien

Dr. Michaela Lechner

Chirurgie
Krankenhaus Göttlicher Heiland GmbH
FN 157355 f, Handelsgericht Wien, Firmensitz Wien
Dornbacher Straße 20-28
1170 Wien

Prof. Friedrich Herbst

Krankenhaus der Barmherzigen Brüder
Johannes von Gott-Platz 1
1020 Wien

Prof. Friedrich Laengle

LKH Wiener Neustadt
Corvinusring 3-5
2700 Wiener Neustadt
Austria

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ESCP Pre-Congress Placements Application

Your Details:

Referee Details:

1. Age

2. ESCP membership

3. Committees or young ESCP membership?

4. Time from Graduation from medical school

5. Country of medical school

6. Country of surgical practice

7. EBSQ

8. Attendance to ESCP annual conference?

9. Time in colorectal surgery practice

10. Number of Publications

11. Number of Publications in the field of coloproctology

12. Number of National/International Presentations in past 5 years

13. ESCP snapshot audits

14. Have you been awarded a fellowship by ESCP in the past

15. Operative experience past 5 years

About ESCP

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Research

Members

Contact Us

ESCP Pre-Congress Placements Application

Your Details:

Referee Details:

1. Age

2. ESCP membership

3. Committees or young ESCP membership?

4. Time from Graduation from medical school

5. Country of medical school

6. Country of surgical practice

7. EBSQ

8. Attendance to ESCP annual conference?

9. Time in colorectal surgery practice

10. Number of Publications

11. Number of Publications in the field of coloproctology

12. Number of National/International Presentations in past 5 years

13. ESCP snapshot audits

14. Have you been awarded a fellowship by ESCP in the past

15. Operative experience past 5 years

About ESCP

News & Events

Education

Research

Members

Contact Us

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