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Otolaryngology Program Testing Site Information Form

A. Program Information:

1. Name of program

2. Program director (first, middle, last, degree, title)

3. Address of program

Street

City

State

Zip

4. Phone number

5. Fax number

6. Total number of residents in training

7. Number of residents accepted into the training program each year

8. Number of full-time faculty

9. Number of clinical faculty

B. Otologic Training:

1. Otologic training supervisor (first, middle, last, degree, title)

2. Address of otologic training supervisor

Street

City

State

Zip

3. Phone number

4. Fax number

5. Email

6. Attendance at temporal bone course:

a. What year of training?

b. Length of course? (days, weeks, etc.)

c. How many bones drilled?

d. Hours spent in lecture?

e. Hours spent in laboratory?

f. Supervised laboratory?

g. Evaluation method (check all that apply)
Subjective assessment Graded bone Written test Oral test

7. Describe otologic training program

8. What is the average number of mastoid surgeries performed during residency?

C. Contact Information:

1. Site contact (first, middle, last, degree, title)

2. Address of site contact

Street

City

State

Zip

3. Phone number

4. Fax number

5. Email

D. Technical Capabilities:

1. List your available computing platforms (repeat as necessary):

a. Platform (e.g. SGI, PC, SUN)

b. Operating system (e.g. IRIX, Linux, Windows)

c. CPU (e.g. 4xMIPS-R10k, 2xPIII-1.5GHz)

d. Graphics (e.g. Infinite Reality2, GeForce4Ti 4600)

e. List available stereoscopic display devices (e.g. VirtualResearch V8, Crystal Eyes)

f. List available haptic interfaces (e.g. Sensable Phantom 1.5)

2. Our current system has the following components. Please indicate those components that you currently have. (check all that apply)

SGI Onyx2	SGI Octane2
Virtual Research V8 Binoculars or HMD	Crystal Eyes
Sensable Phantom 1.5 or Desktop
Cereal Box	Foot-pedal

3. Our intent is to increase the system's availability. Do you currently have or do you intend to purchase any of the following components? (check all that apply)

High-end Linux PC (2 Athalon or PIV CPU's, > 1.5GHz; > 1GB memory)

nVidia GeForce3 or GeForce4 graphics, >= 64MB texture memory

Sensable Phantom 1.5 or Desktop

Virtual Research HMD, I-Glasses, or Crystal Eyes

Cereal Box and Foot-pedal