What is your gender?
M	F
What is your current level of training?
PGY:	1	2	3	4	5
What is your age?
20–25	26–30	31–35	36–40	>40
For the following questions please assume that “robotic assisted surgery” refers to the da Vinci surgical system.
What is your current level of interest in robotic assisted surgery?
High	Medium	Low
What is your level of knowledge with respect to robotic-assisted surgery?
High	Medium	Low
Have you been involved in any robotic assisted surgeries?
Yes	No
If yes, how many robotic assisted procedures have you been involved in?
<5		6–10		11–20		21–30	31–40	>40
Number of cases as observer:
Number of cases as assistant:
Number of cases you spent time on the console:
What do you feel will happen to the prevalence of robotic assisted surgery?
Increase		Remain unchanged		Decrease
Do you robotic assisted surgery will fulfill an increasingly important role in Urology?
Yes	No		Unsure
Do you feel use of robotic assisted surgery is feasible within the Canadian health care system?
Yes	No		Unsure
Do you feel robotic assisted surgery is superior to traditional open surgical techniques?
Yes	No		Unsure
Do you feel robotic assisted surgery is superior to laparoscopic surgical techniques?
Yes	No		Unsure
Do you feel robotic assisted surgery will become the new gold standard for certain surgical procedures in Urology?
Yes	No		Unsure
Do you feel you will use robotic assisted surgery during your career in Urology?
Yes	No		Unsure
Do you feel your residency program should increase its emphasis on robotic assisted surgery?
Yes	No		Unsure
Are you interested in pursuing fellowship training in robotic assisted surgery?
Yes	No		Unsure
Does your residency program currently have a da Vinci surgical system?
Yes	No
If NO:
How do you feel this affects your residency training?
Beneficial		Detrimental		Does not affect my training
Do you want your program to get a robot?
Yes	No
Do you want more exposure to robotic assisted surgery during residency?
Yes	No
If YES:
How do you feel this affects your residency training?
Beneficial		Detrimental		Does not affect my training
How much access do you have to the robot in your program?
As an observer:
Little	Occasional	Frequent
As assistant:
Little	Occasional	Frequent
As operator:
Little	Occasional	Frequent
Do you want more console time on the robot in your program?
Yes	No
Please make any comments: