MSICS questionnaire
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Surname and initial *
Email address *
Have you completed a basic microsurgical skills course? *
Required
On a scale of 1 to 5, please indicate your current competence level or degree of exposure to each of the following, where 1 is currently no exposure / not competent, and 5 is very good exposure / fully  competent.
The answers you provide will help us to determine if you are likely to benefit from this course.
Working under an operating microscope (e.g. assisting surgery, cutting sutures) *
No exposure / not competent
Very good exposure / competent
Tying knots under an operating microscope *
No exposure / not competent
Very good exposure / competent
How would you describe your current MSICS surgical exposure and experience *
Required
Number of MSICS cases assisted *
Required
Number of complete MSICS procedures performed (with or without supervision) *
Required
Are you currently working in an environment where MSICS surgery is being performed regularly? *
How soon after the course will you be able to implement the skills being taught? *
What are your expectations of this course? *
Please write a brief motivation why you should be selected to participate in the training, including how you will be able to apply the training after the course.
 *
After submitting your questionnaire, please proceed to the application form by clicking the link at the bottom of this page.
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