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.