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The Joint Program in Nuclear Medicine sponsors an accredited ...

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    The Joint Program in Nuclear Medicine sponsors an accredited ... The Joint Program in Nuclear Medicine sponsors an accredited ... Document Transcript

    • The Joint Program in Nuclear Medicine sponsors an accredited clinical residency training program in nuclear medicine with the goal of providing an opportunity for qualified physicians to gain the knowledge and experience needed to practice nuclear medicine at the highest level, and as well to meet the eligibility requirements for board certification. The training program also aims to foster the development of nuclear medicine and the careers of its trainees by providing an environment conducive to obtaining skills needed to assume leadership roles in academic and community hospitals. Exposure to a wide range of clinical applications, interaction with clinical staff and faculty with varied interests and areas of expertise as well as the availability of consolidated basic and applied nuclear medical research resources provide a unique environment which fosters a commitment of excellence on the part of the trainees. Graduates are expected to be capable of directing a nuclear medicine division, teaching nuclear medicine at the postgraduate level, critically assessing the literature, and actively engaging in research. In short, the program strives to enable its graduates to advance nuclear medicine as well as to advance with nuclear medicine. Training program goals and objectives are accomplished via a fully integrated program among six institutions including: Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Children's Hospital, Dana- Farber Cancer Institute, Massachusetts General Hospital, and the VA Boston Health Care System. In order to provide a wide range of clinical material, trainees rotate through a number of these institutions. Those enrolled in the one-year training program will typically rotate through a limited number of sites while those in the two-year program are able to rotate through all six. Provisions are made in select cases for individuals who desire more focused training in specific areas of interest such as pediatric nuclear medicine, oncologic nuclear medicine, PET, or nuclear cardiology. Trainee competencies are evaluated and educational outcomes are assessed in the following general areas using a number of tools including didactic course examinations, a comprehensive In-Training examination, evaluations completed by faculty from each rotation, procedure logs, and other methods: 1. Patient Care 2. Medical Knowledge 3. Interpersonal Skills and Comunication 4. Practice Based Learning 5. Professionalism 6. System Based Practice Resident-trainees are encouraged as well to participate in formal written evaluations of the training program and faculty. The Joint Program in Nuclear Medicine invites applications for its one- and two- year residency programs that begin July 1st, 2004.
    • Eligibility Applications will be accepted from candidates who have completed preparatory post-doctoral training consisting of one or more years of residency training via selected pathways*: *Variations to these training pathways may be given consideration in exceptional circumstances. TRAINING PATHWAYS AND BOARD EXAMINATION ELIGIBILITY REQUIREMENTS Internship/ Nuclear Total Years Medicine of Training Pathways Residency PLUS Board Certification Years Years 4 Years Radiology American Board of Nuclear Medicine Radiology 1 (Including 6 1 6 months of American Board of Radiology Nuclear Medicine) Clinical Specialty Internal Medicine American Board of Nuclear Medicine 2 Years 1 2 5 Specialty Cardiology Specialty Board Neurology Candidates are also encouraged to review the REQUIREMENTS FOR CERTIFICATION IN NUCLEAR MEDICINE of the American Board of Nuclear Medicine (ABNM) which may be obtained by visiting the American Board of Nuclear Medicine Website at www.abnm.org This training program is recognized and approved by the Residency Review Committee for Nuclear Medicine of the Accreditation Council for Graduate Medical Education (ACGME) and meets the examination eligibility requirements of the American Board of Nuclear Medicine (ABNM). Research Training In addition to training opportunities provided by its clinical residency, the Joint Program in Nuclear Medicine is dedicated to research training with the goal of developing nuclear medical physician-scientists who wish to pursue academic careers as productive researchers and who aspire to play a major role in defining the future of the field. In order to achieve these goals, the JPNM offers formal research training in its Laboratory for Experimental Nuclear Medicine in various disciplines necessary for conceptualizing research issues, formulating research questions, and understand the ethics of research. Currently, opportunities funded by the National Institutes of Health exist in radiation biology/biophysics of administered radionuclides, radiopharmaceutical design and development for diagnosis and therapy, molecular imaging, and targeted radionuclide therapy. The training combines formal courses, clinical conferences and seminars, as well as active participation in ongoing nonclinical research investigations. One or more years of research fellowship training in nuclear medicine will be supported under an NRSA research training grant at the JPNM Laboratory for Experimental Nuclear Medicine. Eligibility In order to be considered for the JPNM research training program, an individual must be a US citizen or permanent resident and either enrolled in/accepted for enrollment in the JPNM clinical residency training program or graduated from a nuclear medical residency training program elsewhere.
    • APPLICATION INSTRUCTIONS-2004/2005 Application for residency training in the Joint Program in Nuclear Medicine (JPNM) is a two-step procedure. STEP 1.- Candidates will first be considered for enrollment in the nuclear medicine training program based upon review of the information submitted to the Training Program Office in the APPLICATION FORM FOR RESIDENCY IN NUCLEAR MEDICINE. Interviews with successful applicants will be conducted with members of the JPNM Faculty. Applicants interested in research should include a 100-150 word statement of interest in and purpose of research. STEP 2.- Candidates who are offered enrollment in the training program will then be required to successfully complete the credentialing process of the Brigham and Women’s Hospital as institutional sponsor of the nuclear medicine training program. It should be understood that the credentialing application and procedure are a completely separate process from that described in STEP 1., and in some instances may require applicants to submit similar or the same information to the Credentialing Office as submitted to the JPNM. All information must be LEGIBLE, VERIFIABLE and COMPLETE. A curriculum vitae may not be used or referenced in response to any question. Failure to respond to all questions completely will delay processing and could result in rejection of this application. All applications are reviewed on a continuing basis but it is strongly encouraged that completed application materials are submitted in a timely manner. APPLICATION CHECKLIST-To be returned with the completed APPLICATION FORM.. Completed application form (attached) Current curriculum vitae Evidence of USMLE scores 3 letters of professional reference (May not be addressed “To Whom It May Concern”) Copy of ECFMG certificate (if applicable) Evidence of Board certification and current licenses to practice medicine in the U.S. 500 word personal statement briefly describing your background and your interest in pursing training in Nuclear Medicine For applicants interested in research, 100–150 word statement summarizing interest in and purpose of research Note: Applicants are encouraged to visit the Partners Healthcare website and to review the House Officers Manual which contains extensive information about conditions of employment, the Trainee Contract and other important policies, procedures, and services at the following URL: http://www.partners.org/departments/teaching/gme/homdir.htm ______________________________ ____________________________________ Applicants Name (Print) Applicants Signature (Date)
    • MAILING INSTRUCTIONS Jennifer Duane Phone (617) 355-4004 Training Program Coordinator Fax (617) 730-0620 Joint Program in Nuclear Medicine jennifer.duane@childrens.harvard.edu Children’s Hospital 300 Longwood Avenue Boston, Massachusetts 02115 ________________________________________ _____________________ PRINT APPLICANTS NAME DATE
    • APPLICATION FORM RESIDENCY IN NUCLEAR MEDICINE-2004/2005 I. Desired Start Date: ______/______/______ 12 Month Training Program II. Personal Data 24 Month Training Program Applicants interested in research training please mark this box and include a 100 – 150 word statement of interest in, and purpose of research. 1. Name in full (no initials): Last_____________________________ First___________________________________ Middle___________________________ Suffix (Ex: Jr., III) ____________________ Other name(s) used in professio nal practice: _________________________________ U.S. Social Security Number: ____________________________________________ Date of Birth: Month____________ Day ___________ Year ___________________ Place of Birth: City_____________ State ___________ Country ________________ Country of Citizenship: _________________________________________________ 2. Current Hospital/Group/Practice Name: ____________________________________ Hospital/Office Street Address: ___________________________________________ City/Town: __________________________ State: _______Zip Code: ____________ Country: ____________________________ Phone: (____)_____________________ 3. Current Home Street Address: ____________________________________________ City/Town: ______________________________________ State: _______________ Zip Code: _______________ Country: _____________________________________ Phone: (____)____________________ Email: _______________________________ 4. Permanent Home Street Address: _________________________________________ City/Town: ______________________________________ State: _______________ Zip Code: _______________ Country: _____________________________________ Phone: (____)____________________ Email: _______________________________ FAX: __________________________ - 1-
    • If you are not a citizen of the United States, what kind of visa will you hold while you are here? Type: ___________________ Visa No.: ___________ Expiration Date: __________ 5. If applicable, foreign medical school graduates please indicate below your certificatio n by the Education Council for Foreign Medical Graduates (ECFMG). Certificate Number: ____________________ Date of Passing: __________________ - 2-
    • III. Education: Provide complete mailing address where requested Pre-Medical education (undergraduate): College or University: _________________________________ Graduation Date: ________ Dates attended: __________________________________ Degree: ____________________ Medical education: college or university College or University: _________________________________ Graduation Date: ________ City and State: ___________________________________ Degree: ____________________ Post-Graduate: college or university College or University: _________________________________ Graduation Date: ________ City and State: ___________________________________ Degree: ____________________ IV. Training: Internship(s): please use additional sheets if necessary. Specialty: ___________________________ Hospital: ____________________________ Dates attended (Month/Year): From: _________ To: _______________________________ Street Address: ____________________________________________________________ City/Town: __________________________ State: ___________________ Zip Code: ______ Country: ____________________________ Phone: (____)____________________________ Contact person: ______________________________________________________________ - 3-
    • Residency(ies) (most recent first). Please use additional sheets if necessary. Specialty: ___________________________ Hospital: _____________________________ Dates attended (Month/Year): From: _________ To: ________________________________ Street Address: _____________________________________________________________ City/Town: __________________________ State: ___________________ Zip Code: ______ Country: ____________________________ Phone: (____)___________________________ Contact person: ______________________________________________________________ Specialty: ___________________________ Hospital: _______________________________ Dates attended (Month/Year): From: _________ To: ________________________________ Street Address: ______________________________________________________________ City/Town: __________________________ State: _______________ Zip Code: __________ Country: ____________________________ Phone: (____)___________________________ Contact person: ______________________________________________________________ Specialty: ___________________________ Hospital: ___________________________ Dates attended (Month/Year): From: _________ To: ______________________________ Street Address: ___________________________________________________________ City/Town: __________________________ State: ___________________ Zip Code: ______ Country: ____________________________ Phone: (____)___________________________ Contact person: _____________________________________________________________ Specialty: ___________________________ Hospital: ______________________________ Dates attended (Month/Year): From: _________ To: _______________________________ Street Address: ____________________________________________________________ City/Town: __________________________ State: ___________________ Zip Code: ______ Country: ____________________________ Phone: (____)____________________________ Contact person: ______________________________________________________________ Fellowship(s) (most recent first). List the subspecialty training programs you attended. Please use additional sheets if necessary. Specialty: ___________________________ Hospital: ______________________________ Dates attended (Month/Year): From: _________ To: ________________________________ Street Address: _____________________________________________________________ City/Town: __________________________ State: ___________________ Zip Code: ______ Country: ____________________________ Phone: (____)___________________________ Contact person: ______________________________________________________________ - 4-
    • V. Board Certification/ Professional Associations: Please list all current board certifications that you hold in any jurisdiction, foreign or domestic. Specialty/sub-specialty Board name: _______________________________ Date Certified: _________________________ Specialty/sub-specialty Board name: _______________________________ Date Certified: _________________________ Specialty/sub-specialty Board name: _______________________________ Date Certified: _________________________ 1. Have you ever been examined by any specialty board, but failed to pass? No Yes: If yes, please provide a full explanation on a separate sheet and attach. 2. If not certified, have you applied for a certification examination? No Yes: Board name: _________________________________________ If No, do you intend to apply for certification examination? No ___Yes: Board name: ________________________________________ If Yes, have you been accepted to take a certification examination? No ___Yes: Board name: ________________________________________ Oral Exam dates: ______________________ Written Exam dates: ______________ 3. Are you planning to or have you applied for a certification examination by a second or third specialty board? No Yes: Board name: ________________________________________ - 5-
    • VI. Current State Licenses: Type: ________________________________________________________________ Date Licensed: ________________ Date Expires: _________________ Type: ________________________________________________________________ Date Licensed: ________________ Date Expires: _________________ Type: ________________________________________________________________ Date Licensed: ________________ Date Expires: ________________ - 6-
    • VII. Additional Data: 1. Has your professional employment ever been suspended, diminished, revoked or terminated at any hospital or healthcare facility or are any proceedings which may result in any such action currently pending? Yes No 2. Has your medical staff appointment/privileges ever been limited, suspended, diminished, revoked, refused, terminated, restricted, not renewed, relinquished (whether voluntarily or involuntarily) at any hospital or healthcare facility or are proceedings currently pending which may result in any such action? Yes No 3. Have you ever withdrawn (or voluntarily relinquished) your application for appointment, reappointment, or privileges or resigned from the medical staff, because a disciplinary action or loss or restriction of clinical privileges was threatened or before a decision about your appointment and/or privileges was rendered by a hospital's or healthcare organization's governing board? Yes No 4. Have you ever been the subject of disciplinary proceedings at any hospital or healthcare facility? Yes No 5. Have you ever been investigated for scientific misconduct? Yes No 6. Have you ever been suspended, sanctioned or restricted from participating in any private, federal or state health insurance program (e.g., Medicare, Medicaid or Blue Cross/Blue Shield)? Yes No - 7-
    • Professional References: Three letters of reference are required. One reference must be a physician who has supervised your clinical performance or training. The other two must be from individuals who have worked extensively with you. Please list these references below. Please make note that it is the responsibility of the applicants to arrange for letters of reference. Letters are to be sent directly by the individual authors to S. Ted Treves, M.D., Director of Residency Training at the following address: S.Ted Treves, M.D, Director of Residency Training Harvard Medical School Joint Program in Nuclear Medicine Division of Nuclear Medicine Children's Hospital 300 Longwood Ave. Boston, MA 02115, USA For any questions, please contact Jennifer Duane at 617-355-4004, FAX: 617-730-0620 Reference Name: ____________________________________________________________ Title: _______________________________________________________________________ Name of Organization: _____________________________ Department; ________________ Street Address________________________________________________________________ City/Town: __________________ State: __________________ Zip Code: _______________ Country: __________________________ Phone: (____)_____________________________ Reference Name: ____________________________________________________________ Title: _______________________________________________________________________ Name of Organization: _____________________________ Department; ________________ Street Address________________________________________________________________ City/Town: __________________ State: __________________ Zip Code: _______________ Country: __________________________ Phone: (____)______________________________ - 8-
    • Reference Name: ____________________________________________________________ Title: _______________________________________________________________________ Name of Organization: _____________________________ Department; ________________ Street Address________________________________________________________________ City/Town: __________________ State: __________________ Zip Code: _______________ Country: __________________________ Phone: (____)______________________________ Please sign and date below hereby acknowledging that the above information printed on this application is both accurate and current. SIGNATURE: _______________________________ DATE SIGNED: __________ PRINT NAME: ______________________________________________________ - 9-