FMIGS Research Survey Application

AAGL Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS)
Research Survey Application

Primary or Senior Investigator Information

Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Name *This question is required.

E-mail Address *This question is required. This question requires a valid email address.

Phone Number

Institution *This question is required.

Survey Title *This question is required.

Status of IRB approval: *This question is required.

Requested method of distribution (check all acceptable methods): *This question is required.

direct email to FMIGS Graduates
direct email to FMIGS Fellows
direct email to FMIGS Program Directors/Associate Program Directors
web-link on FMIGS website
web-link on FMIGS newsletter

Do you agree to acknowledge the Fellowship in any publication of results from this survey? *This question is required.

Do you agree to provide a summary report to the Fellowship Board within 12 months of survey distribution? *This question is required.

Do you plan to submit results of this survey for consideration of presentation at the annual AAGL meeting and/or publication to JMIG? *This question is required.

Please provide a summary of the significance, research aims and methods of the survey design (< 1page). A brief discussion of the method of survey design, including its validity and reliability of the proposed survey, is strongly encouraged. The investigators are strongly encouraged to review the following guidelines prior to submitting their request to the Fellowship:

Burns KE et al. A guide for the design and conduct of self-administered survey of clinicians. CMAJ 2008 Jul 29; 179(3): 245-52. *This question is required.

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Please provide a copy of your survey.

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