Add Fellowship Council Case Participant and Test InformationOnly observer verified scores are eligible for post-test/LeaderboardWho is entering this data?(Required) Participant (self-reporting) Proctor This is a:(Required) Pre-Test Practice Test Post-Test Ad-hoc Data Submission Please indicate if this entry is part of one of the following groups Fellowship Council Please select Post Test NowThis field is hidden when viewing the formID of Data Entry Person(Required)Entering Data for Which Participant(Required)Abou Assali MarcAbusheikha ObadaCamarena AdrianHassan OmerHla Win Kay ZarJonas NicholasKafadar Yusuf Emrekaur hashmeenKovalev VitaleyLevine JasonLouis MenaMaung Maung Pyae PhyoMURILLO MANRIQUEZ SERGIO ANTONIONagaraj MadhuriNAGATA KENnepomnayshy dmitryRail BenjaminRicard CarolineRucinski JamesSALVADOR HELENAScott DanielSehat AlvandSyed SafiyaWisnik ChristopherWong KailenTest Date(Required) MM slash DD slash YYYY Date test was performedTime the Test Was Completed(Required) Hours : Minutes AM PM AM/PM Time test was performedWhich platform is being used:(Required) Laparoscopic instruments Robotic surgery Endostitch Other Task Results and ScoresTask 1 - Needle HandlingThis task requires passing a needle through 6 standardized holes oriented at different angles on a circular task platform. Maximum time for task completion is 5 minutes (300 seconds). If the task is not completed within the allotted time, you will be asked to stopTime in Seconds(Required)Were There Any Needle Handling Errors?(Required) Yes No Needle Handling Errors(Required) Needle Drop Outside of Instrument Access Bending/Straightening Needle Needle Handling ScoreTask 2 - Offset Camera Forehand SutureTime in Seconds(Required)Were There Any Forehand Suture Errors(Required) Yes No Accuracy(Required)Please enter a number greater than or equal to 0.Total distance in (mm) suture is outside of the target black dotsTissue Gap(Required)Please enter a number greater than or equal to 0.Distance in (mm) between knot and tissue Number of Airknots(Required)Please enter a number greater than or equal to 0.Number of Square Knots Errors(Required)Please enter a number greater than or equal to 0.Number of Breakages(Required)Please enter a number greater than or equal to 0.Number of Non-Full Thickness Bites(Required)Please enter a number greater than or equal to 0.Forehand Suture Errors Bunny ear (tail caught in knot) Holding the needle while tying knots Not performing surgeon's knot Number of Tails < 5mm or > 20mm(Required)Please enter a number greater than or equal to 0.Forehand Suture ScoreTask 3 - Offset Camera Backhand SutureTime in Seconds(Required)Were There Any Backhand Suture Errors(Required) Yes No Accuracy(Required)Please enter a number greater than or equal to 0.Distance in (mm) suture is outside of the target black dotsTissue Gap(Required)Please enter a number greater than or equal to 0.Distance in (mmm) between model edges between the black dotsGap (Air knot)(Required)Please enter a number greater than or equal to 0.Distance in (mm) between knot and tissue Number of Square Knots(Required)Please enter a number greater than or equal to 0.Correct loop formation and alternating the tails 180deg during each throwNumber of Breakages(Required)Please enter a number greater than or equal to 0.Not a full thickness bite(Required)Please enter a number greater than or equal to 0.Including a lembertTail length <5mm or >20mm(Required)Please enter a number greater than or equal to 0.Backhand Suture Errors Bunny ear (tail caught in knot) Holding the needle while tying knots Not performing surgeon's knots Backhand Suture ScoreTask 4 - Confined Space SuturingTime in Seconds(Required)Were there any Confined Space Suturing Errors?(Required) Yes No Accuracy(Required)Please enter a number greater than or equal to 0.Distance in (mm) suture is outside of the target black dotsTissue Gap(Required)Please enter a number greater than or equal to 0.Distance in (mmm) between model edges between the black dotsGap (Air knot)(Required)Please enter a number greater than or equal to 0.Distance in (mm) between knot and tissue Number of Square Knots(Required)Please enter a number greater than or equal to 0.Correct loop formation and alternating the tails 180deg during each throwNumber of Breakages(Required)Please enter a number greater than or equal to 0.Not a full thickness bite(Required)Please enter a number greater than or equal to 0.Including a lembertConfined Space Suture Errors Bunny ear (tail caught in knot) Holding the needle while tying knots Dislodging space constrainer Not performing surgeon's knots Confined Space Suture ScoreTask 5 - Suturing Under TensionTime in Seconds(Required)Were there any suture under tension errors?(Required) Yes No Accuracy(Required)Please enter a number greater than or equal to 0.Distance in (mm) suture is outside of the target black dotsTissue Gap(Required)Please enter a number greater than or equal to 0.Distance in (mmm) between model edges between the black dotsGap (Air knot)(Required)Please enter a number greater than or equal to 0.Distance in (mm) between knot and tissue Number of Square Knots(Required)Please enter a number greater than or equal to 0.Correct loop formation and alternating the tails 180deg during each throwNumber of Breakages(Required)Please enter a number greater than or equal to 0.Not a full thickness bite(Required)Please enter a number greater than or equal to 0.Including a lembertSuture Under Tension Errors Bunny ear (tail caught in knot) Holding the needle while tying knots Not performing slip knot Tail length <5mm or >20mm(Required)Please enter a number greater than or equal to 0.Suture Under Tension ScoreTask 6 - Running SutureTime in Seconds(Required)Were there any Running Suture Errors?(Required) Yes No Accuracy(Required)Please enter a number greater than or equal to 0.Distance in (mm) suture is outside of the target black dotsLooseness of stitch Mild Severe Gap (Air knot)(Required)Please enter a number greater than or equal to 0.Distance in (mm) between knot and tissue Number of Square Knots(Required)Please enter a number greater than or equal to 0.Correct loop formation and alternating the tails 180deg during each throwNumber of Breakages(Required)Please enter a number greater than or equal to 0.Not a full thickness bite(Required)Please enter a number greater than or equal to 0.Including a lembertRunning Suture Errors Bunny ear (tail caught in knot) Holding the needle while tying knots Not performing surgeon's knots Locked stitch Tail length <5mm or >20mm(Required)Please enter a number greater than or equal to 0.Running Suture ScoreWitness/Proctor VerificationIf you are self-reporting this data but have a witness/proctor present who can attest to the scores, please enter that person's information now.Name First Last Witness/Proctor Email Proctor Comments
