HelpMeSee Feedback Questionnaire Please enable JavaScript in your browser to complete this form. - Step 1 of 3PurposeThank you for volunteering to participate in the HelpMeSee eye surgical simulator demonstration. Please take a few minutes to fill in this questionnaire and help us know your opinion better. General DetailsName *FirstLastPhoneEmail *Type of Practice (Select all that apply)Government/Municipal HospitalPrivate PracticeCorporate Hospital / Multi-specialty hospitalGroup PracticeCommunity / Charitable HospitalOtherIf you selected other, please specify:NextMSICS Related Details1. Do you perform MSICS? *YesNoa. If yes, how many MSICS cases do you perform annually? (On an average, over the previous 5 years)10-500/year500-1000/year1000-2500/year>2500/yearb. How many total MSICS surgeries have you performed till date?2. Are you currently involved in delivering MSICS training? Yes, with residentsYes, with fellowsYes, with residents and fellowsNoIf yes, please specify:3. Do you have any previous experience with ophthalmic surgical simulators? *YesNoIf yes, please specify:NextTask Review DetailsPlease grade considering all aspects of realism.Tunnel Dissection: How would you rate the experience in dissecting the tunnel using the Crescent blade?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7Tunnel dissection comments, if any:Stab Entry: How would you rate the experience in performing paracentesis with a side port/stab blade?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7Stab entry comments, if any:Keratome AC Entry and Lateral Extensions: How would you rate the experience with the Keratome blade for making the AC entry and extensions?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7Keratome AC Entry and Lateral Extensions comments, if any:Capsulorrhexsis: How would you rate the experience of making a capsulorrhexis?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7Capsulorrhexsis comments, if any:Cortex Aspiration: How would you rate the experience with using the Simcoe canula for cortex aspiration?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7Cortex Aspiration comments, if any:ACIOL Insertion and Dialing: How would you rate the experience on insertion and dialing the ACIOL?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7ACIOL Insertion and Dialing comments, if any: Simulator as a Training DeviceHow useful would the simulator be in developing eye hand coordination?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7How useful would the simulator be in developing depth perception?Rate 1 out of 7Rate 2 out of 7Rate 3 out of 7Rate 4 out of 7Rate 5 out of 7Rate 6 out of 7Rate 7 out of 7Do you believe that the HelpMeSee eye surgical simulator is useful for training in MSICS and MSICS Complications? *YesNoWhich other procedures in eye surgery do you think should be simulated for training?Privacy Information *The personal information we collect on this form is for the purpose of enabling you to receive information about training from Help Me See Inc. and for Help Me See Inc. to deliver that information and related services to you. Help Me See Inc. collects, uses and retains personal information in accordance with our Privacy Policy, which can be viewed at https://helpmesee.org/privacy-data-security-policies/. Submit
