Sages Research Network Database

Dear SAGES Member,

Are you interested in clinical trials? SAGES is creating a new exciting initiative that we want you to be a part of: the SAGES Research Network.

This Network will:

Provide an opportunity for surgeons to participate in new clinical trials
Allow surgeon-investigators to identify interested groups of surgeons and sites for participation in their studies.
Allow industry partners to identify interested groups of surgeons and sites for participation in their studies.
Promote diversity of patient populations and make explicit efforts to better represent minorities in surgical trials.

This 5-minute survey will collect information on your research interests, the patient population at your site who could potentially participate in a clinical trial and the research infrastructure that you have in place at your site (it’s okay if you do not have infrastructure in place – we aim to call upon industry partners to help support you).

By completing this survey, you are giving SAGES permission to store your data. Your responses will be confidential and will be stored within SAGES and will only be shared with a third party with your written permission.

Name(Required)

First Last

Institution

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

CLINICAL PROFILE

1. What is your primary specialty area (≥ 50% of your clinical volume)? Please do not select more than 2 areas

Other - Specify:(Required)

2. How many other surgeons are there in you primary specialty practice/group/division? (Including yourself)

b. 1-4 surgeons

c. 5-10 surgeons

d. >10 surgeons

Other

3. Among the surgeons in your primary specialty practice/group/division, how many would identify as:

Female

Male

Non-binary

4. To the best of your ability or knowledge, how many in your practice group, would identify as the following:

a. Asian (A person having origins in any of the original peoples of the Far East, Southeast Asian, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam)

b. Black or African American (A person having origins in any of the black racial groups of Africa)

c. Hispanic or Latino (A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race)

d. Mixed Race/Heritage

e. Native American or American Indian (A person having origins in any of the original peoples of North America and South America (including Central America), and who main affiliation or community attachment)

f. Native Hawaiian/other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands)

g. White (A person having origins in any of the original peoples of Europe, North Africa, or the Middle East)

h. Category not mentioned above

i. Prefer not to answer

5. How many of each of these procedures does your primary specialty practice/group/division perform per year?

a. Cholecystectomy

b. Colectomy

c. Proctectomy

d. Anorectal procedures

e. Upper endoscopy

f. Lower endoscopy

g. Advanced endoscopy

h. Pancreatic surgery

i. Liver and/or complex biliary surgery

j. Esophageal surgery

k. Gastric surgery

l. Bariatrics

m. Paraesophageal hernia

n. Fundoplication

o. Abdominal hernia

p. Inguinal hernia

q. Thyroid/parathyroid

r. Adrenalectomy

s. Splenectomy

t. Small bowel surgery

u. Donor nephrectomy

v. Other -please specify

6. For the procedures that you perform most commonly (listed above) what is your preferred approach (>50% of your cases)?

a. Open

b. Laparoscopic

c. Robotic

d. Even mix laparoscopic/robotic

e. Other -please specify (eg: transanal, endoscopic, etc.)

7. Do you or the other surgeons in your specialty group/practice/division routinely perform robotic surgery?

Yes

What proportion of the overall practice cases?

a. 0-20% of cases

b. 20-50% of cases

c. 50-75% of cases

>75% of cases

8. Given SAGES interest in Video Based Education and for trials that may require procedural video collection, sites that have a practice of routinely recording videos may be of interest. Approximately what proportion of your specialty group/practice/division cases are recorded for educational/academic purposes?

9. If you do not routinely record cases, would you have the capacity to record (equipment and time and willingness)?

a. Yes we have equipment to record but no interest/time

b. Yes we have a strong interest to record but no equipment

c. Yes we have both equipment to record and an interest to do it

d. We do not have any interest/time or equipment to record

10. How would you best define your practice?

a. Academic

b. Community (and/or private) teaching

c. Community (and/or private) non-teaching

d. Other (Safety net hospital)

e. Veteran hospital (VA)

Other

11. What region do you practice in ?

a. Northeast USA

b. Southeast USA

c. Midwest USA

d. Southwest USA

e. West USA

f. Canada

Other

12. How would you best define the region where you practice ?

a. Rural

b. Urban

c. Suburban

13. How would you best describe the racial mix of patients in your primary specialty group/division relative to the US distribution (5.6% Asian, 12.2% Black or African American, 18.5% Hispanic or Latino, 60.1% White or Caucasian, 0.7% Native American or American Indian, 0.2% Native Hawaiian or Pacific Islander, 2.7% multiple races)

a. Less diverse mix than above (please specify in what way)

b. Similar mix as above

c. More diverse mix than above (please specify in what way)

d. If your patient population varies significantly from the distribution above, please describe how

Comment

14. Of all the patients that your practice/group/division has seen last year – what proportion belong to each of these ethnic/racial/demographic groups?

Please enter values in percentages.

East Asian

South Asian

Black, African, African American, or Afro-Caribbean

Middle Eastern or North African

Native American or American Indian

White

Other

Prefer not to answer

15. Among other surgeons in your specialty group/practice/division, how many do you anticipate would be interested in contributing patients to a clinical trial in your area of expertise ?

a. None

b. 1-4 surgeons

c. 5-10 surgeons

d. >10 surgeons

Other

16. Did you complete fellowship training after general surgery residency? (Check all that apply)

a. Minimally Invasive Surgery

b. Bariatric Surgery

c. Colorectal Surgery

d. Trauma

e. Surgical Oncology

f. Breast Surgery

g. Pediatric Surgery

h. Acute Care/Critical Care

i. Other: specify

Research Profile

1. What type of clinical trials is your group/practice/division interested in participating in (check all that apply)

a. Interventional trials (drug, device, procedure)

b. Observational trials

c. Registries

d. Quality of life/PROMS trials

e. IDE trials (for FDA approval)

f. Multicenter trials

g. All of the above

2. Are you interested in participating in industry-sponsored trials ?

Yes

3. Please specify the type of research funding model you/your group/practice division would be able to support (Check all that apply)

1. Sponsored research only (industry, NIH, foundation, society, donation etc)

2. Non-sponsored research (non-funded multicenter society registries, collaboratives, etc)

3. Both sponsored and non-sponsored research

4. Does your institution have an IRB?

Yes

I don't know

5. Does your institution routinely use WIRB (Western / Centralized IRB) for industry trials ?

Yes

I don't know

6. Does your institution use REDCap for clinical research data entry?

Yes

I don't know

7. Does your institution have a dedicated committee to review cancer protocols?

Yes

I don't know

RESEARCH CORE INFRASTRUCTURE

1. Does your division have a dedicated research team? (Check all that apply)

a. Research assistant(s)

b. Research coordinator(s)

c. Research manager

d. Full-time Funded (Salaried) Faculty Researcher / Surgeon-Scientist (protected funded research time (>0.25 FTE)

e. Full-time research resident or research fellow

1a. Number

2-5

1b. Number

2-5

1e. Number

2-5

1a. Shared with other groups/divisions

Yes

1b. Shared with other groups/divisions

Yes

2. Has your group/division recently (in last 5 years) participated in clinical trials?( Check all that apply)

a. FDA trial

b. single center industry-sponsored clinical trial

c. multicenter industry-sponsored clinical trial

d. multicenter investigator-initiated clinical trial

e. multicenter randomized trial

2a. Number

2-5

2b. Number

2-5

2c. Number

2-5

2d. Number

2-5

2e. Number

2-5

If yes to the above question, what was your role in any of the above trials ? (Check all that apply)

a. overall (lead) PI

b. site PI

c. co-investigator (enrolling only)

3. What is your institution’s overhead for industry-sponsored clinical trials?

a. <25%

b. 26%-30%

c. 31%-35%

d. 36%-40%

e. >40%

f. I don’t know

Comments

This field is for validation purposes and should be left unchanged.

Sages Research Network Database

CLINICAL PROFILE

3. Among the surgeons in your primary specialty practice/group/division, how many would identify as:

4. To the best of your ability or knowledge, how many in your practice group, would identify as the following:

5. How many of each of these procedures does your primary specialty practice/group/division perform per year?

14. Of all the patients that your practice/group/division has seen last year – what proportion belong to each of these ethnic/racial/demographic groups?

Research Profile

RESEARCH CORE INFRASTRUCTURE

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