2020 SAGES Fellowship Certification – Program Director Questionnaire Dear Program Director, You are designated by an applicant as the Fellowship Program Director in reference to his/her application for SAGES Fellowship Certification. SAGES has encouraged a staged adoption of the New Advanced GI MIS Fellowship accreditation criteria which the Fellowship Council will require in 2020-2021. This year, applicants to the SAGES Fellowship Certification program are encouraged to obtain the defined category cases for Foregut, Bariatric, Inguinal Hernia and Ventral Hernia **Due to the COVID-19 pandemic, SAGES is decreasing the overall and defined category case requirements by 25% (112 total cases, 15 Foregut, 18 Bariatric, 7 Inguinal Hernia, and 7 Ventral Hernia) if accompanied by a Program Director letter supporting fellow candidacy and approving case log. If your fellow meets this criteria, please complete this survey at your earliest convenience. Kind regards, SAGES Resident and Fellow Training CommitteeProgram Director Name* First Last Program Director Email* Fellowship Program Name/Institution(s)*Applicant NameApplying for Certification In Clinical/Medical Knowledge*ExcellentVery GoodGoodFairPoorPractitioners are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others.Patient Care*ExcellentVery GoodGoodFairPoorPractitioners are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease, and care at the end of life.Practice-Based Learning And Improvement*ExcellentVery GoodGoodFairPoorPractitioners are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices.Interpersonal And Communication Skills*ExcellentVery GoodGoodFairPoorPractitioners are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teamsProfessionalism*ExcellentVery GoodGoodFairPoorPractitioners are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society. The Joint Commission considers diversity to include race, culture, gender, religion, ethnic background, sexual preference, language, mental capacity and physical disability.Systems-Based Practice*ExcellentVery GoodGoodFairPoorPractitioners are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care. Please feel free to add other comments. To the best of your knowledge, has the applicant:Accurately documented his/her cases, and level of involvement?*YesNoSuccessfully completed the Fellowship.*YesNoSubmitted a scholarly activity for consideration for a meeting or publication.*YesNoParticipated in at least one professional development activity, such as a meeting, postgraduate course or CME certified hands-on course.*YesNoHad privileges to admit or treat patients modified, suspended, reduced or revoked?*YesNoUncertainBeen the subject of any disciplinary action by any licensing authority, health care facility or society?*YesNoUncertainEngaged in any alcohol, chemical or drug abuse/ dependency that affects the practitioner’s ability to perform safely the essential functions of the position applied for?*YesNoUncertainBeen a defendant in a medical malpractice action?*YesNoUncertainBeen convicted of a felony?*YesNoUncertainHad a physical or mental health condition that affects or is reasonably likely to affect his/her ability to perform professional or medical staff duties?*YesNoUncertainPlease clarify all "Yes" answers here* What is the best time to contact you by telephone?*Best Phone Number to Contact You:Your recommendation confirms that the applicant has:* Successfully completed your fellowship on August 1, 2020 Has demonstrated the abilities and aptitude to perform the relevant procedures safely Has demonstrated appropriate moral, ethical, and professional behavior I, the Fellowship Program Director*Recommend Applicant for SAGES Fellowship CertificationRecommend Applicant with ReservationDo Not RecommendReservations*