Docstoc

Residency Training Application

Document Sample
Residency Training Application Powered By Docstoc
					            Residency Training Program Application Packet                                      2/26/08



GENERAL:
In order to begin residency or fellowship training in emergency and critical care, each Mentor
must have in place an approved Residency Training Program for his or her applicants.
Approved Residency Training Programs are comprised of a:
    1. Mentor
    2. Residency Training Plan
    3. Residency Training Facility
For each Mentor, up to 3 residents/fellows may be trained at any time under a single, approved
Residency Training Program, as long as all trainees are using the same approved Residency
Training Facility and Residency Training Plan. In addition, Mentors who work together in the
same facilty may use the same Residency Training Plan and Residency Training Facility
applications for their respective Programs. However, if flexibility is needed for the applicant’s
training, each of the Mentor’s trainees may have a separate Residency Training Plan. In this
case, the Mentor may have up to three approved Residency Training Programs (but may only
have a total of 3 active residents at any time).
A new Residency Training Program Application Packet must be submitted for the following
situations: (a.) If a Residency Training Plan for a potential applicant will differ from the
                Mentor’s previously approved Residency Training Plan
            (b.) All new Programs
Approval of the Residency Training Program (Plan, Mentor, & Facility) is required before an
applicant may commence training or register with the ACVECC Executive Secretary as an
emergency/critical care resident or fellow. Documents required for a Residency Training
Program Application include:
   • Signed Mentor Agreement form
   • Residency Training Plan Application
   • Residency Training Facility Application

If the trainee is entering into a Mentor’s pre-approved Residency Training Program, only a
Registration Form must be submitted. All new Residents, Fellows, and Mentors must submit
the Registration form to the Executive Secretary either before or within 30 days after the start of
training.

Annual updates of the Residency Training Program and Residency Training Facility must be
completed to maintain ACVECC approval. Any major changes to the Program or Facility need
to be submitted immediately to the Executive Secretary.
Included in this Residency Training Program Application packet are the following documents:
    • Application for Residency Training Plan
    • Application for Residency Training Facility
    • Mentor Agreement form
    • Guidelines for Veterinary Emergency and Critical Care Facilities
In addition, the following documents will be needed after approval of the Residency Training
Program:
    • Annual Update for Residency Training Program & Residency Training Facility
    • Major Change to Residency Training Program Form
                         Application for Residency Training Plan


This Proposal is for a Residency or Fellowship Training Plan. (Circle or Bold)

Is the Residency Training Program for which this Plan is proposed combined with residency
training in another specialty (e.g., ACVIM, ACVA)?         Yes No       (Circle or Bold)

 If Yes, which specialty?

What is the proposed duration of Training Program (minimum 3 years for Residency, 2 years for
Fellowship; maximum 6 years):
      Years

Proposed Resident/Fellow start date (month, day, year):*


Proposed Resident/Fellow end date (month, day, year):


                Note: Standard start date is either January 15 or July 15; however, alternate start
                dates will be considered by the Residency Training Committee:
                Alternative Requested Residency Training Plan inception date (month, day, year):


*Residents/Fellows cannot be recruited until the Residency Training Program (Facility and Plan) has been approved
and the Mentorship Agreement received by the Residency Training Committee.*



Residents may receive Emergency and Critical Care Immersion with ACVECC diplomate
supervision at any approved Residency Training Facility. For each approved Residency Training
Facility in which the Program will provide E/CC Immersion, list the affiliated Residency
Training Facility Administrator (see page 8 of the Standards and Guidelines). Also indicate the
approximate percentage time or number of weeks the Resident(s)/Fellow(s) will spend in E/CC
Immersion at the facility. Place an asterisk beside the name of any Facility that does not provide
24-hour, 7 day/week hospitalization for acutely or critically ill E/CC patients.

   Primary Approved Facility for                   Administrator                  e-mail          % time or # weeks
            Program



 Alternate Approved Facilities                 Administrator                   e-mail          % time or # weeks
At least one Mentor must be named for the Plan and Program. Mentor(s) associated with this
Residency Training Plan at the Primary Approved Residency Training Facility include:




If any of the above Mentors will not participate as a Supervisor for Immersion in Emergency and Critical Care for at
least 8 weeks of Residency Training annually, place an asterisk by the name(s), and please attach a document
proposing how this/these Mentor(s) will contribute to the Residency Training Program.



Additional Supervisor(s) for Immersion in Emergency and Critical Care associated with this
Residency Training Plan who are not listed above as Mentor(s) for the Program:

     Additional ACVECC Supervisors                          Approved Residency Training Facility




PLAN OVERVIEW

Each Residency Training Plan must consist of the following components for residents/fellows:
      1. ACVECC Immersion 72 weeks/60 weeks
      2. Specialty Immersion 22 weeks/variable (fellows waive weeks of their specialty)
      3. Independent Study 35 weeks/12 weeks

A. Plan for Emergency and Critical Care Immersion Weeks
   • All weeks will be 40 hours minimum, and will be supervised for 20 hours minimum as
      detailed in the Standards and Guidelines.
   • All weeks will occur at a Residency Training Facility approved in advance by the
      Residency Training Committee.
   • Minimum 72 weeks for Residents, 60 weeks for Fellows.

    72 weeks (residents) or 60 weeks (fellows) of E/CC Immersion time will be supervised by
the Mentor(s) and/or Supervisor(s) listed above.
B. Plan for Specialty Practice Immersion Weeks
   • All weeks will be 40 hours minimum, and will be supervised for 20 hours minimum, as
      detailed in the Standards and Guidelines.
   • When a Supervisor is board certified in more that one specialty, it is expected that s/he
      will practice primarily the one specialty for which the Resident or Fellow is receiving
      credit during that training week.
   • Supervisors must be legally and locally authorized to practice in the facility where
      supervision takes place.
   • 22 weeks for Residents; variable for Fellows
          o Fellows are exempt from weeks in their area(s) of specialty (See the Standards)

 Requirement (# weeks)     Specialist(s) already agreed to provide supervision   Site / Location
 Internal Medicine (6)




 Surgery (6)*




 Anesthesia (2)

 Cardiology (2)

 Diagnostic Imaging
 (2)

 Neurology (2)

 Ophthalmology (2)**

* See November 2007 Standards & Guidelines p. 17 for alternate option for 2 weeks of Surgery
** See November 2007 Standards & Guidelines p. 17 for alternate option for Large Animal Residents/Fellows

C. Plans for Completing Additional Requirements
   • Seminars, Continuing Education, & Coursework (p. 20 of Nov 2007 Standards & Guidelines)
   • Fellowships require the first two requirements, while residencies may combine any two
       out of the three. Please check the appropriate boxes:
           This Plan includes a minimum of 200 hours Seminars
           This Plan includes a minimum of 50 hours Continuing Education
           This Plan includes a minimum of 50 hours Coursework

Attach an addendum (not to exceed one page total) detailing the plan for completion of
Additional Requirements.
D. Plans for Completing Teaching and Lecture Requirements

Attach an addendum (not to exceed one page total) detailing the plan for completion of the
Teaching and Lecture Requirements (p. 20 of Nov 2007 Standards & Guidelines)

E. Year-by-Year Plan

  Requirement                            Year 1     Year 2      Year 3     Year 4      Year 5

  E/CC Immersion (weeks)

  Independent Study (weeks)

  Internal Medicine (weeks)

  Surgery (weeks)

  Anesthesia (weeks)

  Cardiology (weeks)

  Diagnostic Imaging (weeks)

  Neurology (weeks)

  Ophthalmology (weeks)

  Other rotations or vacation (weeks)

  Total Weeks for each year

  Seminars (hours)

  Continuing Education (hours)

  -or- Coursework (hours)

  Didactic Teaching (hours)

  Laboratory Teaching (hours)
                    Application for Residency Training Facility

      •   Please read the Standards & Guidelines (published November 2007) and refer to the
          Guidelines for Veterinary Emergency and Critical Care Facilities (pages 7-8) for
          assistance with completion of this Application.

Name of Facility:



Name of Facility Administrator (see 11/07 Standards & Guidelines p. 8):



Physical Address of Facility:




Mailing Address of Facility, if different than above:




 Phone number:             Fax number:                 Administrator:        e-mail address:


All Approved Residency Training Facilities must be affiliated with at least one ACVECC
Diplomate who is licensed and authorized to practice in the facility as a staff specialist. This
individual must be in attendance ‘full time.’ Full time for this purpose is defined as a minimum
of 40 weeks per year. Who is the affiliated diplomate for this facility?



List the name(s) of all ACVECC Diplomates, employed primarily at this facility, who will
provide E/CC Immersion Supervision at this Facility.

 1.
 2.
 3.
 4.
 5.
 6.
 7.
 8.
List the name(s) of any ACVECC Diplomates who will provide E/CC Immersion Supervision at
this Facility who are not employed primarily at this Facility:

      ACVECC Diplomate Supervisor         Place of primary employment
 1.
 2.
 3.

Please indicate the number of Diplomates in each of the following specialties who will be
available for Resident or Fellow interaction and/or supervision at the Facility. Individuals with
multiple board certifications may be counted twice, as long as they actively practice all the
specialties for which they’re counted. However, each immersion week for residents may only be
counted towards one requirement, even if the supervisor has multiple board certifications.


 ACVA or ECVAA (Anesthesiology)
 ACVIM (or ECVIM) – Cardiology
 ACVIM (or ECVIM) – Internal Medicine*
 ACVIM (or ECVN) – Neurology
 ACVIM (or ECVIM) – Oncology
 ACVN - Nutrition
 ACVO (or ECVO) - Ophthalmology
 ACVR (or ECVDI) - Diagnostic Imaging
 ACVR - Radiation Oncology
 ACVS (or ECVS) - Surgery


Other specialties pertinent to the Residency Training Plan(s) associated with this Facility.




*Facilities for training small animal E/CC Residents and Fellows should list only small animal
internists, and those training large animal E/CC Residents and Fellows should list only large
animal internists. If this Application is for a combined small and large animal Facility, please
indicate the number of large animal internists and small animal internists under “Other.”
Does this Facility remain open for emergency appointments and hospitalize inpatients 24 hours a
day, 7 days a week?

Yes    No      (Circle or Bold)

If “No,” please indicate the maximum # of Program Weeks any Resident or Fellow will receive
Supervised E/CC Immersion at this Facility:

 # of weeks:



Please check one of the following two boxes regarding the Proposed Residency Training
Facility, in reference to the Guidelines for Veterinary Emergency and Critical Care Facilities:

               This Facility meets or exceeds the Minimum Guidelines for a “Veterinary
               Emergency and Critical Care Center” (Part 2).

               This Facility does not meet the Minimum Guidelines for a “Veterinary
               Emergency and Critical Care Center” (Part 2). I have attached a document (not to
               exceed one page) listing the Facility’s deficits and the exact plans to bring the
               Facility up to Guideline standards prior to the initiation of training, including a
               timeline. I will confirm compliance with the Guidelines with the Residency
               Training Committee within 30 days of the date of this application.



Textbooks: The Resident or Fellow should have access on a 24-hour basis to textbooks
published within the past 10 years (or the most recent edition if an older, classic physiology text).
Available resources should include information on basic physiology, surgery, critical care,
internal medicine, endocrinology, emergency procedures, anesthesia, fluid therapy, anatomy,
hematology, radiology, nutrition, cardiology, neurology, oncology, ophthalmology, and
infectious diseases. The reading list published annually by the Exam Committee may be used as
a resource for the resident library. Please indicate which of the following texts are available:

   Textbook of Critical Care Medicine, Fink et. al.
   Critical Care Medicine, Parrillo and Dellinger (3rd ed).
   The ICU Book, Marino et al.
   The Veterinary ICU Book, Wingfield and Raffe
   Small Animal Critical Care Medicine, Silverstein and Hopper
   Manual of Small Animal Emergency and Critical Care, Macintire et al.
   Handbook of Veterinary Procedures and Emergency Treatment, Kirk and Bistner
   Textbook of Critical Care, Shoemaker, et al (4th ed).
   Current Veterinary Therapy XII, XIII, Kirk ed.
   Plumb’s Veterinary Drug Handbook
   The Pharmacologic Approach to the Critically Ill Patient, Chernow
   Lumb and Jones’ Veterinary Anesthesia, Thurmon et. al.
   Fluid Therapy in Small Animal Practice, DiBartola
   Clinical Physiology of Acid-Base and Electrolyte Disorders, Rose
   Applied Respiratory Physiology, Nunn
   Principles and Practice of Mechanical Ventilation, Tobin
   Textbook of Small Animal Surgery, Slatter or Fossum
   Small Animal Surgery – Fossum
   Complications in Small Animal Surgery - Lipowitz; Caywood, et al
   Disease Mechanisms in Small Animal Surgery, Bojrab
   Decision Making in Small Animal Radiology, Farrow
   Textbook of Diagnostic Radiology, Thrall
   Textbook of Veterinary Internal Medicine, Ettinger and Feldman
   Textbook of Respiratory Diseases in Dogs and Cats, King
   Canine and Feline Endocrinology and Reproduction, Feldman and Nelson
   Canine and Feline Cardiology, Fox or Kittleson
   Canine and Feline Electrocardiography, Tilley
   Small Animal Gastroenterology, Strombeck
   Veterinary Pediatrics, Hoskins
   Small Animal Toxicology – Peterson
   Infectious Diseases of the Dog and Cat, Greene
   Textbook of Veterinary Anatomy, Dyce, et al
   Small Animal Clinical Diagnosis by Laboratory Methods, Willard, et al

List other available, relevant textbooks and their publication dates:
                         Text                                     Author   Date
Periodicals: At least the previous 5 years should be available in hard or electronic copy form, 24
hours a day. Check such available resources:

   Journal of Veterinary Emergency and Critical Care
   Journal of the American Veterinary Medical Association
   American Journal of Veterinary Research
   Veterinary Surgery
   Journal of Veterinary Internal Medicine
   Veterinary Anesthesia and Analgesia
   Veterinary Clinics of North America (small or large animal as pertains to the practice)
   Compendium of Continuing Education for Veterinarians
   Journal of the American Animal Hospital Association
   Critical Care Medicine
   New England Journal of Medicine
   Intensive Care Medicine
   American Journal of Respiratory and Critical Care Medicine (The “Blue” Journal)
   Annals of Emergency Medicine
   Journal of Trauma

Other pertinent journals available 24 hours a day:




List other internet resources available to trainees 24 hours a day:




List other medical Facilities or resources available to trainees (human medical schools or centers,
medical libraries, etc.) – List only those resources to which the trainee(s) actually have access,
not just to those geographically nearby the Facility:
                                    Mentorship Agreement


I agree that for all of my residents and/or fellows, as Program Mentor, I:
   •   and the registering resident must complete and submit the ACVECC Resident/Fellow registration form and
       required registration fee to the executive secretary within 30 days of initiation of training.
   •   will ensure that the resident or fellow’s schedule is consistent with the Residency Training Plan approved
       for this Residency Training Program.
   •   will be available to the resident or fellow on a continuing basis.
   •   must remain an ACVECC member in good standing for the duration of my resident or fellow’s training in
       order to remain his/her Mentor.
   •   will directly oversee the approved Residency Training Plan, monitor my resident or fellow’s progress, and
       ensure that both the Core Curriculum and Spirit (high standards) are accomplished.
   •   will meet with the resident or fellow at least once every 3 months to evaluate his/her progress through the
       Program.
   •   will accept ultimate responsibility for the quality and educational experiences of the residency or
       fellowship, including the quality of supervision by other Diplomates.
   •   will review and critique the resident or fellow’s annual progress report, knowledge & experience
       requirements, skills log, and training benchmarks (as required).
   •   will report any major change in the Residency Training Program or Facility immediately to the Residency
       Training Committee.
   •   am responsible for informing the Credentials Committee of the resident or fellow’s progress on an annual
       basis.
   •   am responsible for signing a letter at the time of credential application verifying the resident or fellow’s
       successful completion of all aspects of the program.
   •   will act as (or ensure that another individual acts as) the Residency Training Facility Administrator to
       ensure that all administrative tasks and communication with ACVECC are completed in a correct and
       timely manner.
   •   will continue to work with the candidate until s/he is successful in passing the certifying examination and
       achieves Diplomate status, or for as long as is mutually agreeable.



Mentor Name: ______________________________

Mentor Signature: ___________________________                                  _________
                                                                               Date
For ACVECC Use:


Received by: _____________________                  Date: ____________

Approved by: ____________________                   Date: ____________
        GUIDELINES FOR VETERINARY EMERGENCY AND CRITICAL CARE FACILITIES

These guidelines are intended to provide minimum standards for veterinary emergency and critical
care facilities.
DEFINITIONS/TERMINOLOGY                                               American College of Veterinary Emergency and Critical
To avoid confusion on the part of the general public and to provide   Care, or other veterinary diplomates with a special
guidelines for consistency in the designation of Veterinary           interest and experience in emergency and critical care is
Emergency Facilities, the following nomenclature is suggested         recommended to optimize patient care and facilitate
which is consistent with the AVMA guidelines. The veterinary          patient referral if necessary.
Emergency and Critical Care Society (VECCS) recommends that
the following terminology be used when referring to emergency         Communications
service and facilities.                                               Good communications must be maintained to allow efficient
                                                                      transfer
Emergency Service: The category of service provided should be         of patient information between the emergency facility and primary
clearly evident to the public.                                        care veterinarians. It is highly recommended that the emergency
•  Veterinary Emergency Service - A veterinary service                facility have all the clinic and home telephone numbers of primary
                                                                      care veterinarians. A report should be sent to the primary care
with a veterinarian on the premises during all hours of
                                                                      veterinarian in a timely manner to ensure immediate continuity of
operation receiving and managing emergency cases.
                                                                      care and for inclusion in the patient's permanent record.
•  On-Call Veterinary Emergency Service - A veterinary
service on-call or available to receive and manage                    Medical Records A complete and thorough medical record on file
emergency cases as requested if veterinarian is available.            for each patient should be kept at the emergency facility.
Does not have constant coverage by a veterinarian                     The Medical record must follow AVMA guidelines for the POMR
during all hours of operation.                                        and must include:
                                                                      1. Client identification
Emergency Facility: A veterinary facility with the primary and        2. Patient signalment
dedicated function of receiving and managing emergency patients       3. Presenting complaint(s)
during its specified hours of operation.                              4. History
•  Emergency Clinic -A facility that is specifically                  5. Physical examination
operated, staffed and equipped to provide emergency                   6. Clinical pathology tests performed and results
service. Most patients are treated on an outpatient                   7. Diagnostic imaging procedures and interpretation
basis. The specified hours of operation are expected to               8. Tentative diagnosis or rule/outs
be other than the normal business hours of general                    9. All treatments including anesthesia records and surgical
veterinary practices. Patients are transferred to the                 procedures
primary care veterinarian the next workday.                           10. Progress notes
                                                                      11. Medications administered
•   Emergency Hospital - Emergency facility similar to an             12. Client instructions and other client communications
Emergency Clinic but with more advanced capabilities                  including release forms
enabling hospitalization and management of multiple                   13. Client and referring veterinarian communications
critical patients.                                                    14. All entries in the medical record should clearly identify
•   Emergency/Critical Care Center - A facility                       the individual(s) responsible for administering care and
specifically designated to be operated, staffed and                   entering data.
equipped (in accordance with Parts 1 and 2 of these
guidelines) 24 hours a day to provide a broad range of                Continuing Education Continuing education must be provided for
veterinary emergency and critical care service. It is                 professional and technical staff and must allow:
suggested that professional staff include board certified             •  veterinarians and technicians to comply with CE
specialists and veterinary technician specialists                     requirements for state licensure.
(AVECCT). Centers that share a facility with a
specialty practice or primary care practice must provide
                                                                      •  veterinarians to meet specialty board CE requirements
staffing and equipment to ensure appropriate emergency                to maintain certification
and critical patient care.                                            •   technicians to meet CE requirements of their respective
                                                                      certification and licensing boards
                                                                      All veterinarians should obtain at least 30 hours of accredited
PART 1: MINIMUM GUIDELINES FOR A VETERINARY                           continuing education every two years in the field of emergency and
EMERGENCY FACILITY                                                    critical care medicine. Veterinarians in Animal Emergency Centers
Staffing                                                              should obtain at least 40 hours of CE every two years in the field
During the specified hours of operation a licensed veterinarian       of emergency and critical care medicine. Technicians should
should be on the premises at all times and sufficient staff must be   receive at least 24 hours of continuing education in the field of
available to provide expedient patient care. Staffing should be       emergency and
sufficient to allow:                                                  critical care medicine every two years. A system of ongoing,
•   Processing multiple patients                                      inservice
                                                                      training should be provided for veterinarians and technical
•  Performance of a wide range of life-saving procedures to           staff to assure teamwork and familiarity with current procedures
include but not be limited to cardiopulmonary                         and
resuscitation and emergency surgery. This requires at                 guidelines. All facilities should maintain a library containing
least three people, including one veterinarian and one                current textbooks, periodicals and, ideally, electronic data sources
veterinary technician.                                                and Internet access.
•  Appropriate and timely consultation with veterinary
specialists. A close association with a Diplomate of the              Emergency Capabilities The level of care and maintenance
provided in areas of laboratory, pharmacy, medicine, surgery,             5. Anesthetic and analgesic therapy to include opiates,
radiology, diagnostic imaging, anesthesiology, infectious diseases        non-steroidal medication, and inhalational anesthesia.
control, and housekeeping should be consistent with currently             Intra-operative monitoring should include an
accepted practice and procedures for a veterinary emergency and           electrocardiogram, esophageal stethoscope, blood
critical care facilities and comply with state, federal, and provincial   pressure monitor and pulse oximetry when appropriate.
directives. Instrumentation, pharmaceuticals, and supplies should         6. Laboratory functions: Perform in a timely manner a) a
be                                                                        complete blood count, BUN, refractometric total solids,
sufficient for the practice of medicine and surgery at a level of care    blood glucose, urinalysis, b) activated clotting time, c),
consistent with that expected in the practice of veterinary medicine      electrolyte measurements (Na, K, Cl), d) FIV/FeLV
as directed by the individual country, state or province practice         serology, e) cytology, f) heartworm testing, and g) fecal
acts.                                                                     examination (flotation, cytology and parvovirus antigen
Emergency facilities should have procedures in-place to quickly           test). Additionally, an emergency facility must have
obtain specialist consults and to refer cases as appropriate.             laboratory supplies to collect, prepare, and preserve
All emergency facilities should have the capacity to perform the          samples for a complete serum biochemical profile,
following:                                                                blood gas analysis, full coagulation profiles,
1. Diagnosis and management of life-threatening                           microbiological culture, and histopathology.
emergencies including cardiovascular, respiratory, and                    7. Imaging: a) Produce good quality radiographs while
neurological problems to include: a) cardiopulmonary                      ensuring the safety of patient and staff. A radiographic
resuscitation including electrical defibrillation b)                      machine of at least 300 mA and an automatic film
placement and maintenance of thoracostomy tubes, c)                       processor are highly recommended. b) On-site
emergency tracheostomy and tracheostomy tube care, d)                     ultrasonography capability is highly recommended
oxygen supplementation, e) assisted ventilation.                          8. Have or have ready access to endoscopy.
2. Monitoring capabilities should include: a)
electrocardiogram, b) arterial blood pressure, c) central
venous pressure, d) pulse oximetry, e) esophageal                         PART 2: MINIMUM GUIDELINES FOR A VETERINARY
stethoscope.                                                              EMERGENCY AND CRITICAL CARE CENTER
3. Emergency surgery including: a) surgical hemostasis,                   Emergency and Critical Care Centers must meet all the previous
wound debridement and application of wound                                requirements as well as the following:
dressings, b) stabilization of musculo-skeletal injuries,                 1. Be able to serially monitor a CBC, full serum
c) aseptic thoracic, abdominal, and neurosurgery, or d)                   biochemical profile, coagulation screen and blood gases
be able to refer to a facility that can perform these                     on site.
procedures in a timely manner.                                            2. Monitor direct arterial blood pressure and end tidal
4. Treatment of circulatory shock using crystalloids,                     carbon dioxide concentration.
colloids and blood products and equipment such as                         3. Perform peritoneal or pleural dialysis.
calibrated burettes or infusion pumps to allow accurate                   4. Have the ability to provide enteral and parenteral
delivery of fluids. Facilities should have natural and/or                 nutrition.
artificial blood products and the capacity to type and                    5. Perform long-term mechanical assisted ventilation.
cross match donor and patient blood.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:79
posted:8/12/2011
language:English
pages:13
Description: Residency Training Application document sample