THE RESIDENCY REVIEW COMMITTEE FOR THORACIC SURGERY                          515 North State Street, Suite 2000 Chicago, I...
THE RESIDENCY REVIEW COMMITTEE FOR THORACIC SURGERY                           515 North State Street, Suite 2000 Chicago, ...
THE RESIDENCY REVIEW COMMITTEE FOR THORACIC SURGERY                          515 North State Street, Suite 2000 Chicago, I...
SECTION 6. INSTITUTIONAL FACILITIES (PR II)Time period covered (an academic 1 year time frame): From:                To:  ...
SECTION 7. PROGRAM GOALS AND OBJECTIVES1.   Insert the goals and objectives for the Program:2.   Congenital Cardiac Surger...
SECTION 8. OTHER RESIDENTS AND FELLOWS (PR III. D)Indicate the following information for any additional personnel assigned...
SECTION 9. CONFERENCES (PR V. E. 1)List teaching rounds, conferences, seminars, journal club, etc., in which there is part...
SECTION 10. RESIDENT EVALUATION (PR VI. A)1. At least semiannually evaluate the knowledge, skills, and professional growth...
SECTION 11. EDUCATIONAL PROGRAM - SURGICAL VOLUME (PR V. E. 2.d)1. Does each resident have an average annual caseload of 7...
APPENDIX A. CURRICULUM VITA (PR V. C)Provide DOCUMENTATION OF SCHOLARLY ACTIVITY (a limited curriculum vita) for all conge...
APPENDIX B. INSTITUTIONAL OPERATIVE EXPERIENCEMAJOR CARDIOVASCULAR PROCEDURES                         INSTITUTION 1   INST...
MAJOR CARDIOVASCULAR PROCEDURES            INSTITUTION 1   INSTITUTION 28. Transplantation   a. Single Lung   b. Double Lu...
APPENDIX C. FOR CONTINUED ACCREDITATION PROGRAMS ONLY: OPERATIVE LOG FOREACH CONGENITAL CARDIAC SURGERY RESIDENTResidents ...
MAJOR CARDIOVASCULAR PROCEDURES              SURGEON   ASSISTANT  c. Repair of Aortic Dissection  d. Pulmonary Embolectomy...
APPENDIX D. DUTY HOUR POLICYInsert the Congenital Cardiac Surgery specific policy.health-services-research1117.doc
APPENDIX E. SUPERVISION POLICYInsert the Congenital Cardiac Surgery specific supervision policy.health-services-research11...
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Health Services Research

  1. 1. THE RESIDENCY REVIEW COMMITTEE FOR THORACIC SURGERY 515 North State Street, Suite 2000 Chicago, Illinois 60610 Phone: (312) 755-7471 PROGRAM INFORMATION FORM – CONGENITAL CARDIAC SURGERY FOR CONTINUED ACCREDITATIONGENERAL INSTRUCTIONSREVIEW OF AN ACCREDITED PROGRAM OR RE-ACCREDITATION OF A PROGRAM: If the programinformation form is being completed for a currently accredited program, use the Continued Accreditation PIF inconjunction with the Web Accreditation Data System (Web ADS). Follow the provided instructions to create thecorrect PIF. Go to the Web Accreditation Data System (Web ADS) found on the ACGME home page(www.acgme.org), using your previously assigned User ID and password, update your program and resident data,retrieve Part 1 of the PIF under the Site Visit Information section, complete the shaded items (as appropriate),print all sections of Part 1 of the PIF and sign the form. If you find items displayed incorrectly change your datausing ADS update sections; in some instances you may need to contact your DIO for the entry of updatedinformation. Next proceed to the section under the RRC for Thoracic Surgery to retrieve Part 2 of the PIF forcontinued accreditation in either Word or WordPerfect. Complete Part 2 of the PIF using your preferred wordprocessor (only after Part 1 has been completed). Combine Part 1 and Part 2, number the pages consecutively onthe upper right corner, beginning with Part 1 Section 1 and complete the Table of Contents (found with the Part 2instructions). Mail one set of the forms to the site visitor at least 10 working days before the site visit. An additionalcopy should be held to permit corrections that may be required as the site visit proceeds. After the visit, threecopies must be mailed to the Executive Director at the above address, as coordinated by the site visitor.Review the Program Requirements for Residency Education in Congenital Cardiac Surgery. The ProgramRequirements or the Institutional Requirements may be downloaded from the ACGME Website (www.acgme.org):For questions regarding the site visit, contact the writer of the letter announcing the site visit. For questions regarding the completion of the form (content), contact the Accreditation Administrator (Phone: 312-755-5498). For word processing questions/problems, contact the ACGME Help Desk (Phone: 312-755-7464). For Web Accreditation Data System questions, contact 312-755-7123 to be directed to an ADS representative or email WebADS@acgme.org.For a glossary of terms, use the following link – http://www.acgme.org/acWebsite/GME_info/gme_glossary.aspTo facilitate review of the program, the information submitted should be clear, concise, and consistent. Do notattach any unnecessary materials, as extraneous materials will delay program accreditation.The program director is responsible for the accuracy of the information supplied in this form and must sign it. Itmust also be signed by the Department Chair/Chief of Service and the DIO of the sponsoring institution.health-services-research1117.doc
  2. 2. THE RESIDENCY REVIEW COMMITTEE FOR THORACIC SURGERY 515 North State Street, Suite 2000 Chicago, Illinois 60610 Phone: (312) 755-7471 PROGRAM INFORMATION FORM – CONGENITAL CARDIAC SURGERY10 Digit ACGME Program I.D. #:Program Name:TABLE OF CONTENTSWhen you have the completed forms, number each page sequentially in the upper right hand corner. Starton Part 1, Section 1 of the PIF. Report this pagination in the Table of Contents and submit this cover page withthe completed PIF. 1Part 1 Section Page(s)General Program Information 1 Accreditation Information 1.A Program Director Information 1.BParticipating Institutions 2Resident Complement 3 Number of Positions 3.A Actively Enrolled Residents 3.B Aggregate Data on Residents Completing or Leaving the Program for the Last Three (3) Years 3.C Residents Who Completed the Program 3.D Withdrawn / Dismissed Residents 3.E Scholarly Activity 3.F Duty Hours 3.GFaculty 4 Faculty Roster 4.A Part 2 Section Page(s)Background Information 5 Previous Citations or Concerns 5.A Changes 5.BInstitutional Facilities 6Program Goals and Objectives 7Other Residents and Fellows 8Conferences 9Resident Evaluation 10Educational Program – Surgical Volume 11Appendix A. Curriculum VitaAppendix B. Institutional Operative ExperienceAppendix C. For Continued Accreditation Programs Only: Operative Log For Each Congenital Cardiac Surgery ResidentAppendix D. Duty Hour PolicyAppendix E. Supervision Policyhealth-services-research1117.doc
  3. 3. THE RESIDENCY REVIEW COMMITTEE FOR THORACIC SURGERY 515 North State Street, Suite 2000 Chicago, Illinois 60610 Phone: (312) 755-7471 PROGRAM INFORMATION FORM – CONGENITAL CARDIAC SURGERY (Part 2) FOR CONTINUED ACCREDITATIONSECTION 5. BACKGROUND INFORMATIONA. Previous Citations or Concerns (if applicable) List the citations from last RRC accreditation if applicable and describe briefly the steps that have been taken to address the citations or suggestions made by the RRC. If documentation is required, provide a specific reference to the information provided in the PIF or append additional support materials. If no citations were listed, indicate this in the response.B. Changes (if applicable) Briefly describe major changes, other than those included in the response to previous citations and/or concerns (above) that have been implemented since the last survey and review. Include changes in sponsoring organization, participating hospitals, required rotations, resident complement, and facility or facilities.health-services-research1117.doc
  4. 4. SECTION 6. INSTITUTIONAL FACILITIES (PR II)Time period covered (an academic 1 year time frame): From: To: Sponsoring Institution #1 Institution #21. Name Chief of Congenital Cardiac Surgery2. Patient Facilities - Total number of: a. hospital beds b. congenital cardiac surgery surgical beds c. operating rooms d. operating rooms dedicated to congenital cardiac surgery e. dedicated congenital cardiac surgery intensive care unit beds3. Laboratory Facilities - (Y/N) Does institution offer: a. cardiac catheterization b. cardiothoracic surgical researchhealth-services-research1117.doc
  5. 5. SECTION 7. PROGRAM GOALS AND OBJECTIVES1. Insert the goals and objectives for the Program:2. Congenital Cardiac Surgery residents are provided with skills in the following areas: a. Perfusion........................................................................................................................... YES ( ) NO ( ) b. Ultrasound......................................................................................................................... YES ( ) NO ( ) c. Echo cardiology................................................................................................................. YES ( ) NO ( ) d. Other imaging techniques: YES ( ) NO ( ) YES ( ) NO ( ) YES ( ) NO ( ) e. Cardiac catheterization...................................................................................................... YES ( ) NO ( ) f. Critical Care....................................................................................................................... YES ( ) NO ( ) Explain all “no” responses above: If noninvasive imaging assignments occur, please describe:3. Describe the daily role of the Congenital Cardiac Surgery resident in preoperative and post operative care, including the critical care followup for their patients.4. Describe the provisions for the Congenital Cardiac Surgery resident longitudinal responsibility for patient care.5. Describe the educational relationships between the Thoracic Surgery program and the Congenital Cardiac Surgery program.6. Describe in detail the educational and clinical relationships between the Thoracic Surgery residents and the Congenital Cardiac Surgery residents.health-services-research1117.doc
  6. 6. SECTION 8. OTHER RESIDENTS AND FELLOWS (PR III. D)Indicate the following information for any additional personnel assigned to the Congenital Cardiac Surgery serviceat any one time.Additional Physician Personnel Number Duration of Rotations on CCS ServiceGeneral Surgery ResidentsThoracic Surgery ResidentsThoracic Surgery Residents from other ProgramsOther fellowsForeign fellowshealth-services-research1117.doc
  7. 7. SECTION 9. CONFERENCES (PR V. E. 1)List teaching rounds, conferences, seminars, journal club, etc., in which there is participation by the resident. Name of Conference Individual(s) or Department Frequency (weekly, Mandatory or(teaching round, seminar, Responsible for Organization monthly, etc.) Elective journal club, etc.) of Sessionshealth-services-research1117.doc
  8. 8. SECTION 10. RESIDENT EVALUATION (PR VI. A)1. At least semiannually evaluate the knowledge, skills, and professional growth of the residents, using appropriate criteria for procedures?............................................................................................( ) YES ( ) NO2. Communicate each evaluation to the resident in a timely manner?............................................( ) YES ( ) NO3. Advance resident to positions of higher responsibility only on the basis of evidence of their satisfactory progressive scholarship and professional growth?.....................................................................( ) YES ( ) NO4. Maintain a permanent record of evaluation for each resident and have it accessible to the resident and other authorized personnel?.................................................................................................................( ) YES ( ) NO5. If no (to any of the above questions), please explain.health-services-research1117.doc
  9. 9. SECTION 11. EDUCATIONAL PROGRAM - SURGICAL VOLUME (PR V. E. 2.d)1. Does each resident have an average annual caseload of 75 major operations?......................YES ( ) NO ( ) If no, please explain.2. Did each resident document the required minimum number of cases per category?................YES ( ) NO ( )3. Do cases reflect adequate distribution of categories and complexity of procedures such that each resident is ensured a balanced and equivalent operative experience?......................................................YES ( ) NO ( ) If no, please explain.4. Does the resident participate in the diagnosis, preoperative planning, and selection of the operation for each patient?.....................................................................................................................................YES ( ) NO ( ) If no, please explain.5. Does the resident perform those technical manipulations that constitute the essential parts of the patients operation?.................................................................................................................................YES ( ) NO ( ) If no, please explain.6. Is the resident substantially involved in postoperative care?.....................................................YES ( ) NO ( ) If no, please explain.7. Are there other residents and fellows in the program that have an impact on case distribution?. YES ( ) NO ( ) If yes, please describe impact and submit a log of these fellows’ cases.health-services-research1117.doc
  10. 10. APPENDIX A. CURRICULUM VITA (PR V. C)Provide DOCUMENTATION OF SCHOLARLY ACTIVITY (a limited curriculum vita) for all congenital cardiacsurgery faculty.When listing publications, do not include manuscripts that are in preparation or have been submitted but not yetaccepted. Articles that have been accepted but not yet published should be listed as In Press and should includethe name of the journal. It is not necessary to enclose a copy of the letter of acceptance with the application butthis letter should be available for inspection by the site visitor.Name:Address:Principal hospital base:Current professional and academic appointments (Include starting date):Undergraduate medical education (including dates and degrees):Postgraduate medical education (including dates of internships, residencies, fellowships, etc.):Licensure(s):Education activities and recognition:Resident contact - Teach thoracic surgery resident(s) basic Bedside teachinghours/week science - hours/year rounds - hours/weekTeach ATLS? ( ) YES ( ) NO ACLS? ( ) YES ( ) NO Hours of lecture CME course/year (lectures given):Documented participation in the undergraduate curriculum? ( ) YES ( ) NOResearch ActivitiesBasic ResearchProjects: Funding Source:Clinical ResearchRetrospective reviews: Funding Source:Pharmaceutical trials: Funding Source:Therapeutic interventions: Funding Source:Health Services ResearchProjects: Funding Source:Evidenced based Practice guidelines:Prospective randomized trials:System analysis:Ethics:Outcomes:health-services-research1117.doc
  11. 11. APPENDIX B. INSTITUTIONAL OPERATIVE EXPERIENCEMAJOR CARDIOVASCULAR PROCEDURES INSTITUTION 1 INSTITUTION 21. Closed Operations for Congenital Heart Disease a. Patent Ductus Arteriosus b. Coarctation of Aorta c. Shunting Procedure d. Vascular Ring or Arch Anomalies e. Valvotomy f. Pulmonary Artery Banding g. Atrial Septectomy h. Others (Specify) TOTAL2. Open Operations for Congenital Heart Disease a. Tetralogy of Fallot b. Transposition c. Truncus Arteriosus d. A-V Septal Defect e. Anomalous Pulmonary Venous Drainage f. Ventricular Septal Defect g. Atrial Septal Defect h. Interrupted Arch/Hypoplastic Left Heart i. Fontan Procedure j. Others (Specify) TOTAL3. Valvular Heart Disease a. Mitral Commissurotomy b. Mitral/Aortic Valve Repair c. Valve Replacement d. Combined Valve/Coronary e. Aortic Root Replacement f. Others (Specify) TOTAL4. Resection of Cardiac Tumor TOTAL5. Pericardium a. Pericardial Window b. Pericardiectomy c. Others (Specify) TOTAL6. Other Cardiac Procedures a. Arrhythmia Surgery b. Insertion/Removal Cardiac Assist Device c. Removal of Intra-Cardiac Foreign Body d. Repair Cardiac Trauma e. Re-exploration for Bleeding f. Others (Specify) TOTAL7. Thoracic Vascular a. Traumatic Injury b. Repair of Aneurysm c. Repair of Aortic Dissection d. Pulmonary Embolectomy/Endarterectomy e. Others (Specify) TOTALhealth-services-research1117.doc
  12. 12. MAJOR CARDIOVASCULAR PROCEDURES INSTITUTION 1 INSTITUTION 28. Transplantation a. Single Lung b. Double Lung c. Heart d. Procurement of Lung e. Procurement of Heart f. Others (Specify) TOTALhealth-services-research1117.doc
  13. 13. APPENDIX C. FOR CONTINUED ACCREDITATION PROGRAMS ONLY: OPERATIVE LOG FOREACH CONGENITAL CARDIAC SURGERY RESIDENTResidents NameLog Covering Period (dates)MAJOR CARDIOVASCULAR PROCEDURES SURGEON ASSISTANT1. Closed Operations for Congenital Heart Disease a. Patent Ductus Arteriosus b. Coarctation of Aorta c. Shunting Procedure d. Vascular Ring or Arch Anomalies e. Valvotomy f. Pulmonary Artery Banding g. Atrial Septectomy h. Others (Specify) TOTAL2. Open Operations for Congenital Heart Disease a. Tetralogy of Fallot b. Transposition c. Truncus Arteriosus d. A-V Septal Defect e. Anomalous Pulmonary Venous Drainage f. Ventricular Septal Defect g. Atrial Septal Defect h. Interrupted Arch/Hypoplastic Left Heart i. Fontan Procedure j. Others (Specify) TOTAL3. Valvular Heart Disease a. Mitral Commissurotomy b. Mitral/Aortic Valve Repair c. Valve Replacement d. Combined Valve/Coronary e. Aortic Root Replacement f. Others (Specify) TOTAL4. Resection of Cardiac Tumor TOTAL5. Pericardium a. Pericardial Window b. Pericardiectomy c. Others (Specify) TOTAL6. Other Cardiac Procedures a. Arrhythmia Surgery b. Insertion/Removal Cardiac Assist Device c. Removal of Intra-Cardiac Foreign Body d. Repair Cardiac Trauma e. Re-exploration for Bleeding f. Others (Specify) TOTAL7. Thoracic Vascular a. Traumatic Injury b. Repair of Aneurysmhealth-services-research1117.doc
  14. 14. MAJOR CARDIOVASCULAR PROCEDURES SURGEON ASSISTANT c. Repair of Aortic Dissection d. Pulmonary Embolectomy/Endarterectomy e. Others (Specify) TOTAL8. Transplantation a. Single Lung b. Double Lung c. Heart d. Procurement of Lung e. Procurement of Heart f. Others (Specify) TOTALhealth-services-research1117.doc
  15. 15. APPENDIX D. DUTY HOUR POLICYInsert the Congenital Cardiac Surgery specific policy.health-services-research1117.doc
  16. 16. APPENDIX E. SUPERVISION POLICYInsert the Congenital Cardiac Surgery specific supervision policy.health-services-research1117.doc

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