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1. RESIDENCY TRAINING PROGRAM REGISTRATION 2009-2010 CARDIOLOGY New applications for ACVIM Residency Training Programs must be received by the Residency Training Committee 90 days prior to any residents beginning training. Before completing this form, please review the general and specific requirements for cardiology residency training programs in the ACVIM General Information Guide (GIG). The most current version of the GIG is available on the ACVIM website at www.ACVIM.org. If there is a discrepancy between this form and the GIG, the GIG will be considered correct, however, please contact the ACVIM office or the Residency Training Committee Chairperson for clarification. Prior to making significant changes in a residency training program, approval of the ACVIM and Cardiology Resident Training Committee must be obtained. The candidate and/or program director must notify ACVIM, in writing. Significant changes could include, but are not limited to: changes in program director or any mentors, transferring from one program to another, alterations in program duration, switching to a ‘dual board’ program, or enrolling in an institutional graduate program. Notice: Some questions in this form are included for data collection purposes. The inclusion of an item does not imply that the item is a program requirement for ACVIM. For multi-site residency programs: To ensure uniformity of training and compliance with current GIG requirements, training programs which include multiple sites must provide detailed information as to which Diplomates in the specialty of Cardiology, as well as other Specialties, will be supervising the resident(s) at each site. In this updated program registration form, the program director must provide specific, detailed information regarding supervision and facilities available at each specific site(s). Check box if this is a renewal application with unaltered information from the previous year: Part 1 Date: Program Director: (Must be a Diplomate of ACVIM in the Specialty of Cardiology or an approved ECVIM Diplomate in Cardiology) Program Director’s Contact Information: Work Phone: Fax: E-mail: Mailing Address: 1. Location of Training Program: Primary Site: Secondary Site (if applicable): (Secondary Site training supervisors must be ACVIM or approved ECVIM Diplomates in Cardiology and are expected to provide Direct Supervision. Please attach specific information regarding the percentage of time scheduled at each site and which rotation requirement shall be met at each site.) © 2009 American College of Veterinary Internal Medicine
Outside Rotations/Other Sites (if applicable): (Please attach signed Letters of Support from all ACVIM Cardiology Diplomates or other ACVIM Diplomates providing off-site training of Cardiology residents to this registration form. Each Letter of Support should contain specific information regarding the percentage of time schedule at each site and which rotation requirement shall be met at each site. Letters of Support must be submitted annually WITH program renewal forms and WITH each new program request. A second letter must be sent to the Residency Committee after the resident completes their rotation at the secondary site and must state that the training has been completed and must include a description of the training given the resident (number of invasive procedures, number of cases seen, etc.). 2. Length of Training Program: 3. Advanced Degree: Yes No Optional Masters: PhD: If advanced degree is required or optional, please briefly describe how the graduate training is incorporated into the residency training program: 4. Resident Advisor(s): (Must be a Diplomate of ACVIM in the Specialty of Cardiology or an approved ECVIM Diplomate in Cardiology) 5. Supervising Diplomate(s): (Must be a Diplomate of ACVIM in the Specialty of Cardiology or an approved ECVIM Diplomate in Cardiology) 6. Please list all Diplomates of ACVIM responsible for supervision of clinical training who are specialists in areas other than Cardiology. If off-site, please explain the situation, and the method of providing direct contact with the resident. Name Specialty Comments 7. Please list all Diplomates of the American College of Veterinary Pathology in the areas of clinical pathology or gross/histopathology associated with residency training. If off-site, please explain the situation, and the method of providing direct contact with the resident. Name Clinical or Gross Comments 8. Please list all Diplomates of the American College of Veterinary Radiology associated with residency training. If off-site, please explain the situation, and the arrangements for direct contact with the resident. Name Comments 9. Please list the Diplomates available for consultation in the areas of dermatology, surgery, ophthalmology, anesthesiology, emergency/critical care, clinical nutrition, clinical pharmacology, and/or theriogenology. If off- site, please explain the situation and the arrangements provided for contact with the resident. © 2009 American College of Veterinary Internal Medicine
Name Specialty Comments 10. Please list the residents who have completed the training program within the last five years, including the year that each individual’s training program ended. If at all possible, please indicate whether the individual has completed the board certification process. Name Program End Date Diplomate (Yes or No) © 2009 American College of Veterinary Internal Medicine
Part 2 The following questions will be used provide the Residency Training Committee with information needed to judge the structure, quality, scope, and consistency of training provided. NOTE: Direct supervision is required during clinical training, with the time required specified by each particular specialty. Direct supervision is defined as follows: The Supervising Diplomate and resident are participating in a clinical practice in which both the Diplomate and the resident are on duty and interactively and concurrently managing cases. The Diplomate need not personally examine each patient seen by the resident, but must remain physically available for consultation. Please use this definition when responding to the following questions regarding clinical rotations. 1. Is this a conforming or a nonconforming residency training program? (If the program is nonconforming, then the applicant and/or Program Director must submit a program description for approval. Please refer to the most recent General Information Guide for requirements.) Conforming Nonconforming Description of Nonconforming Program: 2. Does your training program consist of a minimum of 24 months? Yes No Comments: 3. Does each resident in your program spend a minimum of 18 months training under the direct supervision of either a Diplomate of ACVIM in the Specialty of Cardiology or an approved ECVIM Diplomate in Cardiology? Yes No Comments: 4. Does each resident in your program spend an additional 6 months (minimum) clinical training under the direct supervision of a Diplomate of ACVIM in the Specialty of Small Animal Internal Medicine, Large Animal Internal Medicine, or an ABVS recognized specialist in other related disciplines? Yes No Comments: 5. Does the resident participate in clinical rounds on a daily basis while on clinical rotations? Is a supervising Diplomate available for the majority of rounds? If no, please describe how rounds are attended and supervised. Yes No Comments: 6. Are candidates selected through the matching program? Yes No 7. Is an internship or equivalent practice required for admission to the residency program? Yes No © 2009 American College of Veterinary Internal Medicine
8. Is a graduate program with this program? Yes No If yes, is the program required or offered? Required Offered a) What degree does the program lead to? b) What is the approximate time (%) of graduate work? c) Number of persons in the residency with a degree program? d) Number of persons in the residency without a degree program? 9. Please provide a description of the graduate degree program if offered, including the didactic program and inter-relationship with the residency program. 10. Is a research project required of each resident in the program? Yes No 11. Approximate time spent in research 12. Do residents provide patient care with Diplomate supervision? Yes No 13. Please give the approximate total hours that each resident spends in training with: Radiologists: Clinical Pathologists: Cardiovascular Physiologists: Cardiac Pathologists: 14. Are outside rotations required or recommended? Please describe the rotations briefly. Required: Recommended: © 2009 American College of Veterinary Internal Medicine
15. Please indicate the availability of the following facilities or equipment. Indicate if these are available at the primary training site, or at a different location. (In the Location column, indicate on-site for primary location or the name of the facility where the equipment is located if off-site.) For facilities that are not on-site, please describe the situation and availability in the space at the end of this section. Available? Location Yes No of equipment? (On-site or list site name) a) Standard radiological equipment b) Ultrasonographic equipment c) Color flow/Doppler equipment d) Cardiac catheterization capability e) Endoscopy equipment GI equipment Bronchoscopy Cystoscopy Rhinoscopy Laparoscopy f) Clinical Pathology capabilities: (includes CBC, serum chemistries, blood gases, urinalysis, cytology, parasitology, microbiology, and endocrinology) g) Serum osmolality measurement h) Colloid oncotic pressure measurement i) Electrocardiography j) Blood Pressure Measurement k) Electroencephalography l) Electromyography m) Brainstem Auditory Evoked Response Equipment n) Nuclear Medicine o) Computed Tomography p) Magnetic Resonance Imaging q) Radiation Therapy Facility r) Veterinary Library w/Literature Searching Capabilities s) Computerized Medical Records w/Searching Capabilities t) Medical Library w/Literature Searching Capabilities u) Intensive Care Facility – 24 hours v) Urethral pressure profile & cystometrography w) Hemodialysis capability x) Total parenteral nutrition capability If any of the above equipment or facilities are available off-site, please explain how the resident can access them for case management, research, or study. 16. Are formal conferences, such as clinicopathologic conferences, journal clubs, or seminars held on a weekly basis? Yes No Comments: 17. Please provide a description of the conferences, etc., that are provided and the typical schedule. © 2009 American College of Veterinary Internal Medicine
18. Is the resident required to give one or more formal presentations at a conference or in an educational setting on a yearly basis? Yes No Comments: 19. How many major veterinary medical or medical meetings is each resident able to or expected to attend during his/her training program? None One Two > Two Comments: 20. Does the training program require a research project? Please indicate the number of research projects required. Yes No Optional Number Comments: 21. Are one or more publications required as part of the training program? Yes No Number Comments: 22. Briefly describe the diagnostic facilities and equipment, including the following: a) Radiographic/Catheterization Yes No Description: b) Ultrasound Yes No Description: c) Electrodiagnostics Yes No Description: d) Pathology Yes No Description: e) Library Yes No Description: f) Surgery Yes No Description: © 2009 American College of Veterinary Internal Medicine
g) CT / MRI / Nuclear Medicine Yes No Description: h) Retrievable Record System Yes No Description: 23. Please provide a description of the cardiology residency program, including the recommended didactic program. 24. Please provide a typical weekly schedule. 25. Total cardiology caseload per year: Number of cardiac catheterizations per year: Number of echocardiographic examinations per year: Number of Doppler examinations per year: 26. Please list the residents currently participating in your training program, along with the beginning date of the program, expected ending date of the program, and designated resident advisor. Resident Name Start date (mm/dd/yyyy ) End Date (mm/dd/yyyy ) Resident Advisor **Please note, any candidate that significantly changes or alters their residency training program before completion must notify ACVIM, in writing, before the changes are made to ensure that the proposed changes are approved. Significant changes could include, but are not limited to: - transferring from one program to another - alterations in program duration - switching to a ‘dual board’ program - enrolling in an institutional graduate program - change of Program Director © 2009 American College of Veterinary Internal Medicine
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