Personal Information

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Proﬁciency Scale:

1 – Limited or no experience

2 – Experienced, but may need review or supervision

3 – Able to function independently

CIRCULATE: ENDOVASCULAR EXPERIENCE:

Endoluminal AAA

Carotid revascularization endarterectomy

Cerebral aneurysm repair

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Personal Information

Proﬁciency Scale:

WORK EXPERIENCE

GENERAL SKILLS EXPERIENCE

CIRCULATE: GENERAL SURGERY EXPERIENCE:

CIRCULATE: GYNECOLOGY EXPERIENCE

CIRCULATE: ENDOSCOPIC PROCEDURES EXPERIENCE

CIRCULATE: LAPAROSCOPIC PROCEDURES EXPERIENCE

CIRCULATE: UROLOGY EXPERIENCE:

CIRCULATE: ORTHOPEDIC EXPERIENCE:

CIRCULATE: NEUROLOGY EXPERIENCE

CIRCULATE: PLASTICS EXPERIENCE

CIRCULATE: OPHTHALMOLOGY EXPERIENCE:

CIRCULATE: EAR, NOSE & THROAT EXPERIENCE:

CIRCULATE: VASCULAR EXPERIENCE:

CIRCULATE: ENDOVASCULAR EXPERIENCE:

CIRCULATE: THORACIC / CARDIOVASCULAR EXPERIENCE:

CIRCULATE: TRANSPLANT EXPERIENCE:

CIRCULATE: TRAUMA EXPERIENCE:

CIRCULATE: EQUIPMENT EXPERIENCE:

CIRCULATE: AGE-SPECIFIC EXPERIENCE: