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  • 1. Residency Training Program Application Packet February 2009 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 facility 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
  • 2. Application for Residency Training Plan DATE: 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? The proposed duration of Training Program (minimum 3 years for Residency, 2 years for Fellowship; maximum 6 years) is: 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 Additional Approved Administrator e-mail % time or # weeks Facilities
  • 3. 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
  • 4. 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 (fellows 100 hours) Seminars  This Plan includes a minimum of 50 hours (fellows 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
  • 5. 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)
  • 6. 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. DATE: 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 .
  • 7. 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.
  • 8. *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 in writing to the Residency Training Committee within 30 days of the date of this application. Required References Each Residency Training Facility is required to provide the Required References listed in the Knowledge Requirements on-site, and to make all Required References available to trainees 24 hours a day, 7 days a week. The most recent version of the Knowledge Requirements is available at www.acvecc.org under the Training Guidelines section. Please check one of the following two boxes regarding availability of Required References at the Proposed Residency Training Facility:  This Facility has available to trainees at all times at least the minimum Required References as detailed in the most recent version of the Knowledge Requirements.  This Facility does not have available to trainees at all times at least the minimum Required References as detailed in the most recent version of the Knowledge Requirements. I have attached a document (not to exceed one page) listing the
  • 9. Facility’s deficits and the exact plans to acquire the missing Required References prior to the initiation of training, including a timeline. I will confirm compliance in writing to the Residency Training Committee within 30 days of the date of this application. Each Residency Training Facility is required to provide on site internet access to the common veterinary and human medical databases to trainees 24 hours a day, 7 days a week. List 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:
  • 10. 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: ____________
  • 11. 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 recommended to optimize patient care and facilitate To avoid confusion on the part of the general public and to provide patient referral if necessary. guidelines for consistency in the designation of Veterinary Emergency Facilities, the following nomenclature is suggested Communications which is consistent with the AVMA guidelines. The veterinary Good communications must be maintained to allow efficient Emergency and Critical Care Society (VECCS) recommends that transfer the following terminology be used when referring to emergency of patient information between the emergency facility and primary service and facilities. care veterinarians. It is highly recommended that the emergency facility have all the clinic and home telephone numbers of primary Emergency Service: The category of service provided should be care veterinarians. A report should be sent to the primary care clearly evident to the public. veterinarian in a timely manner to ensure immediate continuity of • Veterinary Emergency Service - A veterinary service care and for inclusion in the patient's permanent record. with a veterinarian on the premises during all hours of Medical Records A complete and thorough medical record on file operation receiving and managing emergency cases. for each patient should be kept at the emergency facility. • On-Call Veterinary Emergency Service - A veterinary The Medical record must follow AVMA guidelines for the POMR service on-call or available to receive and manage and must include: emergency cases as requested if veterinarian is available. 1. Client identification Does not have constant coverage by a veterinarian 2. Patient signalment during all hours of operation. 3. Presenting complaint(s) 4. History Emergency Facility: A veterinary facility with the primary and 5. Physical examination dedicated function of receiving and managing emergency patients 6. Clinical pathology tests performed and results during its specified hours of operation. 7. Diagnostic imaging procedures and interpretation • Emergency Clinic -A facility that is specifically 8. Tentative diagnosis or rule/outs operated, staffed and equipped to provide emergency 9. All treatments including anesthesia records and surgical service. Most patients are treated on an outpatient procedures basis. The specified hours of operation are expected to 10. Progress notes be other than the normal business hours of general 11. Medications administered veterinary practices. Patients are transferred to the 12. Client instructions and other client communications primary care veterinarian the next workday. including release forms 13. Client and referring veterinarian communications • Emergency Hospital - Emergency facility similar to an 14. All entries in the medical record should clearly identify Emergency Clinic but with more advanced capabilities the individual(s) responsible for administering care and enabling hospitalization and management of multiple entering data. critical patients. • Emergency/Critical Care Center - A facility Continuing Education Continuing education must be provided for specifically designated to be operated, staffed and professional and technical staff and must allow: equipped (in accordance with Parts 1 and 2 of these • veterinarians and technicians to comply with CE guidelines) 24 hours a day to provide a broad range of requirements for state licensure. veterinary emergency and critical care service. It is suggested that professional staff include board certified • veterinarians to meet specialty board CE requirements specialists and veterinary technician specialists to maintain certification (AVECCT). Centers that share a facility with a • technicians to meet CE requirements of their respective specialty practice or primary care practice must provide certification and licensing boards staffing and equipment to ensure appropriate emergency All veterinarians should obtain at least 30 hours of accredited and critical patient care. continuing education every two years in the field of emergency and critical care medicine. Veterinarians in Animal Emergency Centers should obtain at least 40 hours of CE every two years in the field PART 1: MINIMUM GUIDELINES FOR A VETERINARY of emergency and critical care medicine. Technicians should EMERGENCY FACILITY receive at least 24 hours of continuing education in the field of Staffing emergency and During the specified hours of operation a licensed veterinarian critical care medicine every two years. A system of ongoing, should be on the premises at all times and sufficient staff must be inservice available to provide expedient patient care. Staffing should be training should be provided for veterinarians and technical sufficient to allow: staff to assure teamwork and familiarity with current procedures • Processing multiple patients and guidelines. All facilities should maintain a library containing • Performance of a wide range of life-saving procedures to current textbooks, periodicals and, ideally, electronic data sources include but not be limited to cardiopulmonary and Internet access. resuscitation and emergency surgery. This requires at least three people, including one veterinarian and one Emergency Capabilities The level of care and maintenance veterinary technician. provided in areas of laboratory, pharmacy, medicine, surgery, • Appropriate and timely consultation with veterinary radiology, diagnostic imaging, anesthesiology, infectious diseases specialists. A close association with a Diplomate of the control, and housekeeping should be consistent with currently American College of Veterinary Emergency and Critical accepted practice and procedures for a veterinary emergency and Care, or other veterinary diplomates with a special critical care facilities and comply with state, federal, and provincial interest and experience in emergency and critical care is directives. Instrumentation, pharmaceuticals, and supplies should
  • 12. be electrocardiogram, esophageal stethoscope, blood sufficient for the practice of medicine and surgery at a level of care pressure monitor and pulse oximetry when appropriate. consistent with that expected in the practice of veterinary medicine 6. Laboratory functions: Perform in a timely manner a) a as directed by the individual country, state or province practice complete blood count, BUN, refractometric total solids, acts. blood glucose, urinalysis, b) activated clotting time, c), Emergency facilities should have procedures in-place to quickly electrolyte measurements (Na, K, Cl), d) FIV/FeLV obtain specialist consults and to refer cases as appropriate. serology, e) cytology, f) heartworm testing, and g) fecal All emergency facilities should have the capacity to perform the examination (flotation, cytology and parvovirus antigen following: test). Additionally, an emergency facility must have 1. Diagnosis and management of life-threatening laboratory supplies to collect, prepare, and preserve emergencies including cardiovascular, respiratory, and samples for a complete serum biochemical profile, neurological problems to include: a) cardiopulmonary blood gas analysis, full coagulation profiles, resuscitation including electrical defibrillation b) microbiological culture, and histopathology. placement and maintenance of thoracostomy tubes, c) 7. Imaging: a) Produce good quality radiographs while emergency tracheostomy and tracheostomy tube care, d) ensuring the safety of patient and staff. A radiographic oxygen supplementation, e) assisted ventilation. machine of at least 300 mA and an automatic film 2. Monitoring capabilities should include: a) processor are highly recommended. b) On-site electrocardiogram, b) arterial blood pressure, c) central ultrasonography capability is highly recommended venous pressure, d) pulse oximetry, e) esophageal 8. Have or have ready access to endoscopy. stethoscope. 3. Emergency surgery including: a) surgical hemostasis, wound debridement and application of wound PART 2: MINIMUM GUIDELINES FOR A VETERINARY dressings, b) stabilization of musculo-skeletal injuries, EMERGENCY AND CRITICAL CARE CENTER c) aseptic thoracic, abdominal, and neurosurgery, or d) Emergency and Critical Care Centers must meet all the previous be able to refer to a facility that can perform these requirements as well as the following: procedures in a timely manner. 1. Be able to serially monitor a CBC, full serum 4. Treatment of circulatory shock using crystalloids, biochemical profile, coagulation screen and blood gases colloids and blood products and equipment such as on site. calibrated burettes or infusion pumps to allow accurate 2. Monitor direct arterial blood pressure and end tidal delivery of fluids. Facilities should have natural and/or carbon dioxide concentration. artificial blood products and the capacity to type and 3. Perform peritoneal or pleural dialysis. cross match donor and patient blood. 4. Have the ability to provide enteral and parenteral 5. Anesthetic and analgesic therapy to include opiates, nutrition. non-steroidal medication, and inhalational anesthesia. 5. Perform long-term mechanical assisted ventilation. Intra-operative monitoring should include an