MSF CV TEMPLATE : SURGEON
Any incomplete CV will not be taken into consideration

LAST NAME(S) (Maiden name if applicable)
FIRST NAME(S)AttachPicture Email Address Private Mobile

Home Phone Number Home Address Current Address (if different from home address)

PERSONAL DETAILSEDUCATION

Date of birth

Diploma in MEDICINE

Place of birth

Place (State University/City/Country)

All current nationality(ies) :Registration No. :Duration of studies - No of years :Gender :Male Female From 			ToDate obtained diploma
Marital Status :Single 
Married Separated/Divorced  Widow(er) Fill in the spaces applicable to your studies

Diploma in SURGERY
Specify speciality :Place (State University/City/Country)

 No. of children if any :Registration No. : Mother tongue :English  French 
Other :

Duration of studies - No of years :Spanish  Other language(s), you can speak &understand fluently (written & spoken) in aworking environment :			EnglishFrench
Spanish
Other :LEVEL (explain)

From 			ToDate obtained diploma
Date obtained diploma
Diploma in SURGERY SUBSPECIALITY
Specify subspeciality :Place (State University/City/Country)
Registration No. :Duration of studies - No of years :From 			ToDate obtained diploma© A.Filot

MSF CV Template : SURGEON - Dec 2016

MSF CV TEMPLATE : SURGEON
Board of surgery or subspeciality (if any)		
Name of examining Board

Year passed

Fellow of College of Surgeon (if any)
Name of College

Registration NoYear

PROFESSIONAL EXPERIENCE
Employment History Summary including CURRENT employment

Please complete with most recent post first and give a brief description of your role

Date (start-end)

PositionType of activity

City/Country

OTHER PROFESSIONAL EXPERIENCE (MEDICAL OR NON-MEDICAL)
Date (start-end)
Position
Type of activity

City/Country

OTHER MEDICAL TRAINING(nursing education, public health, tropical disease, ATLS, including war surgery, tropical surgery, surgery in austereenvironment, DSTC etc.)

Date (start-end)© A.Filot

Position

Type of activity

MSF CV Template : SURGEON - Dec 2016

City/Country

MSF CV TEMPLATE : SURGEONSELF ASSESSMENT SKILLS I certify that the given information is complete, correct and true
SIGNATURE : 									DATE :CATEGORYPROCEDURE

Trauma &General
Surgery
Experience

1. Management ofPeritonitis

No/year/last 5years

EarlierYear last
Can PERFORM
experience performed independentlyper year
(X if yes)

2. Insertion of chest tubes
3. Thoracotomy
4. Management acute abdomen, intestinal obstruction
5. Exploratory Laparotomy
6.Colostomy
7. Closure of colostomy
8. Small bowel resection
anastomoses
9. Large bowel resection
anastomoses
10. Techniques for delayed
abdominal closure(e.g.:
Bogata Bag)
11. Esophageal surgery
12. Gastric surgery
13. Hepatobiliary
Surgery
14. Operative
Management of liver
injuries
15. Splenectomy
16. Appendectomy
17. Abdominal wall defects
repair (e.g.: hernias , laparoceles)
18. Fasciotomy
19.Vascular repair/vein
grafting
20. Vascular shunting(damage control)© A.Filot

MSF CV Template : SURGEON - Dec 2016

CanTEACH
others(X if yes)

MSF CV TEMPLATE : SURGEON
CATEGORY

PROCEDURE

Neurosurgery

1. Debridement for open
skull fractures

PediatricSurgery

1. Hypertrophic Pyloric
stenosis

No/
Earlier
year/
experience
last 5 years per year

2. Burr hole trepanation &Craniotomy

2. Disorders of theomphalo-mesenteric duct3. Ano-rectal congenital malformations

Urology

1. Suprapubic cystostomy
2. Bladder repair
3. Nephrectomy
4. Repair of ureter

Plasticsurgery

1. Management of burns
2. Skin grafts
3. Burn contracture release
4. Local flaps (muscle,fasciocutaneous)

Orthopedicexperience

1. Wound debridement
2. Traction pin placement
3. Amputation upper
extremity
4. Amputation lowerextremity
5. External fixator placement
6. External fixator
manipulation
7. External fixator removal
8. Conservative managementof fractures (i.e.-casting)
9. Pediatric fracture casting
10. Management of complexopen fractures (e.g.
comminuted, IIIB)
11. Skeletal fixation by Internal Fixation
12. Treatment of osteomyelitis
13.Treatment of tendon
injuries
14. Treatment of peripheral
nerve injury
15. Application of negative
pressure wound therapy
using (Vacuum assistedclosure)© A.Filot

MSF CV Template : SURGEON - Dec 2016

Year last
Can PERFORM Can TEACH
performed independently others(X if yes)
(X if yes)

MSF CV TEMPLATE : SURGEON
CATEGORY

PROCEDURE

Obstetricsurgery

1. Caesarean section

No/Earlier
year/
experience
last 5 years per year

Year last
Can PERFORM Can TEACH
performed independently others(X if yes)
(X if yes)

2. Management of
post-partum
hemorrhage
including Bakri-Balloon, BLynch/Compression Sutures,
Selective artery
ligation
3. Repair of uterine rupture
4. Emergency hysterectomy
5. Tubal ligation
6. Ectopic pregnancy
management
7. Foetal extraction in case ofobstructed labour neglectedfor days
8. Craniotomy (destructivedelivery)
9. Symphysiotomy

ICU

Management of complex
cases

ED
experience /Triage/Other

1. Mass casualty triage events
2. Cardiovascularresuscitation
3. Ultrasonography (FAST)

Hospitalmanagement/teaching/teamleadingexperience
Other(specify)

1. Coaching/mentoring/teaching
2. Formal management
experience

Please state THREE REFERENCES		NAME			TITLES			ADDRESS			CONTACT DETAILS
1.
2.
3.
© A.Filot

MSF CV Template : SURGEON - Dec 2016