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NEURO-ONCOLOGY

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  • 1. NEURO-ONCOLOGY PROGRAM ACCREDITATION APPLICATION PROGRAM INFORMATION FORM (PIF) FOR NEW APPLICATIONS ONLY Revised: 08-20-08 A. INTRODUCTION The mission of the United Council for Neurologic Subspecialties (UCNS) is to provide an accreditation and certification process for fellowship training programs with the goals of enhancing quality training in Neurologic subspecialties and quality patient care. The Accreditation Council (AC) strives to develop evaluation methods and processes that are valid, effective, fair, open and ethical. The AC is a voluntary accreditation organization and functions as a council of the UCNS. To be an accredited program by the UCNS, compliance with the program requirements is monitored through completion of the Program Information Form (PIF). In creating this form, the AC has referenced the model used by the Accreditation Council for Graduate Medical Education (ACGME). B. INSTRUCTIONS APPLICATION FOR NEW PROGRAM: This form is for use by programs making initial application only. All programs, new and existing, must complete the entire Program Information Form. For new training programs where statistical data are not available, e.g., number of graduates, you should mark that section as “NA” (not applicable). The PIF template and Appendix A-G template should be downloaded and completed off-line. The PIF template question fields should not be altered. The space in text and tables for responses will expand to accommodate your program’s needs. The page numbers will automatically reformat. Once it is completed, submit the PIF form and Appendices A-G document electronically via e-mail to the UCNS at applications@ucns.org. The UCNS will send a confirmation acknowledging receipt of the application. Should you require additional space in specific fields, please e-mail the UCNS. The Program Director is responsible for the content of the completed form, and the information will not be considered complete without the Program Director’s signature. All sections of the form applicable to the program must be completed in order to be accepted for review. If any requested information is not available, an explanation should be given in the appropriate place on the form. Many items require a composed response to a specific question. Please respond briefly and concisely. The form also includes requests for the following additional data. Please use the Appendix A-G template to provide this information. Appendix A: participating institution letter from Department Chair(s) of the participating institution (not the full affiliation agreement; not Program Letter of Agreement) Appendix B: one page curriculum vitae (Program Director and faculty) Appendix C: written goals and objectives by year and rotation Appendix D: list of clinical conferences at each institution; list of clinical lectures, conferences, courses in other UCNS Program Accreditation Application Page 1 of 21 Neuro-Oncology 2008
  • 2. areas; list of other lectures Appendix E: list of neuro-oncology meetings attended by fellows Appendix F: list of research projects by fellows Appendix G: list of publications by fellows Please do not attach any unnecessary materials such as reprints, brochures, annual reports, schedules, minutes of meetings and conferences, etc. The UCNS considers only the information requested on the PIF form and provided in the appendices. Any extra material not requested will be discarded. C. APPLICATION FEE The UCNS has two program application categories: New Applicant and Continuing Applicant. You are applying for program accreditation as a New Applicant. New Applicant $3150 Application Fee ($1150 first-year accreditation fee + $2000 non-refundable application fee) The accreditation year is the academic year, July 1 through June 30. An annual accreditation fee will be assessed at $1150. Fees are subject to change. D. PAYMENT The UCNS accepts checks (or money orders) only at this time. Please submit payment in US funds (payable to United Council for Neurologic Subspecialties) to the UCNS Executive Office, 1080 Montreal Avenue, Saint Paul, MN 55116. E. APPLICATION DEADLINE The UCNS accepts applications throughout the year and reviews applications twice per year, in the spring and fall. Your application must be submitted and payment received by July 1, 2008, for fall 2008 review and accreditation for the 2009 academic year (beginning July 1, 2009). The next deadline is December 31, 2008, for spring 2009 review and accreditation for the 2009 academic year. F. PROGRAM SITE REVIEW A site review of the program will not normally be required for the first application of programs. Should the UCNS determine that a site visit is necessary; you will be notified and provided the additional necessary information. G. ADMINISTRATIVE STAFF CONTACTS FOR QUESTIONS Contact the UCNS Executive Office with questions: UCNS Executive Office, 1080 Montreal Ave., St. Paul, MN 55116 Tel: 651-695-2816 Fax: 651-361-4916 E-mail: applications@ucns.org. H. GLOSSARY OF TERMS A glossary of terms used in the Program Requirements and PIF can be found on the UCNS website at www.ucns.org. UCNS Program Accreditation Application Page 2 of 21 Neuro-Oncology 2008
  • 3. I. TABLE OF CONTENTS Section 1 1 Program Information 1.A Program Identification 1.B Program Director Information 2 Institutional Affiliates 3 Fellow Information 3.A Number of Positions 3.B Actively Enrolled Fellows 3.C Aggregate Data on Fellows Completing or Leaving the Program for the Last Three (3) Years 3.D Fellows Completing the Program in the Last Three Years 3.E Fellows Leaving the Program in the Last Three Years 4 Faculty & Personnel 4.A Program Director 4.B Program Teaching Faculty—Neuro-Oncology 4.C Other Teaching Faculty 5 Facilities and Resources 5.A Facilities 5.B Library Facilities 6 Educational Program 6.A Curriculum 6.B Seminars and Conferences 6.C Educational Program 6.D Educational Policies 7 Research and Scholarly Activity 7.A Fellow Meeting Attendance 7.B List of Research Projects by Fellows 7.C List of Publications by Fellows 7.D Scholarly Activity Summary 8 Evaluation 8.A Fellow Evaluation 8.B Program Evaluation 8.C Curriculum Development 8.D Curriculum Evaluation 9 Signatures Appendices Appendix A: participating institution letter(s) from department chair(s) of participating institution(s) (not the full affiliation agreement; not Program Letter of Agreement) Appendix B: one page curricula vitae (Program Director and faculty) Appendix C: written goals and objectives by year and rotation Appendix D: list of clinical conferences at each institution; list of clinical lectures, conferences, courses in other areas; list of other lectures Appendix E: list of neuro-oncology meetings attended by fellows Appendix F: list of research projects by fellows Appendix G: list of publications by fellows UCNS Program Accreditation Application Page 3 of 21 Neuro-Oncology 2008
  • 4. PROGRAM INFORMATION FORM (PIF) SECTION 1. PROGRAM INFORMATION A. Program Identification Date:       Name of Primary Institution:       Title of Program:       Does your program currently have fellows? Yes No If yes, how many fellows do you have each year?       How many years is the fellowship?       10 Digit UCNS Program ID# (for office use only):       B. Program Director (PD) Information Name:       Title:       Address:       City, State, Zip code:       Telephone:       FAX:       Email:       Date PD First Appointed:       Term of PD Appointment:       Primary Specialty Board Certification:       Most Recent Certification Date:       Secondary Specialty Board Certification:       Most Recent Certification Date:       Number of years spent teaching in GME in this subspecialty:       Is the Program Director a full-time faculty member of the sponsoring institution? YES NO Does the Program Director hold a current license to practice medicine in the state of the sponsoring institution? YES NO Is the Program Director ABMS certified in neurology or child neurology; neurological surgery; internal medicine and medical oncology; or pediatrics and pediatric hematology-oncology? YES NO Is the Program Director certified by the UCNS in neuro-oncology or possess appropriate equivalent qualifications? YES NO Is the PD based at primary teaching institution? YES NO What are the number of hours per week PD spends in: Clinical Supervision:       Administration:       Research:       Didactics/Teaching:       Is PD also Department Chair? YES NO If No, what is the Chair’s name:       UCNS Program Accreditation Application Page 4 of 21 Neuro-Oncology 2008
  • 5. SECTION 2. INSTITUTIONIONAL AFFILIATES (Program Requirements II, A, B) SPONSORING INSTITUTION: (Institution #1) (The university, hospital, or foundation that has ultimate responsibility for this program.) Name of Sponsor:       Address:       Sponsoring Core Residency Program? YES NO City, State, Zip code:       Type of Institution: (e.g., Teaching Hospital, General Hospital, Medical School):       Ownership Type: (e.g., State, Corporation, Church):       Is Institution ACGME Accredited YES NO Length of Accreditation:       Next review date:       Name of DIO (Designated Institutional Official) Responsible for Oversight of Training at this Institution:       Does SPONSOR have an affiliation with a medical school (could be the sponsoring institution)? YES NO If yes, name the medical school below. Name of Medical School #1:       Name of Medical School #2:       PRIMARY INSTITUTION (Institution #2) If different than the sponsoring institution. Name:       Address:       City, State, Zip Code:       Name of Individual Responsible for Oversight of Training at This Institution: (Site Coordinator):       Type of Institution: (e.g., Teaching Hospital, General Hospital, Medical School):       PARTICIPATING INSTITUTION (Institution #3) If more than one participating institution, please e-mail applications@ucns.org. Name:       Address:       City, State, Zip Code:       Distance between Institutions 1 & 2: Miles:       Minutes:       Type of Rotation (select one) Elective Required Both Length of Fellows Rotation (in months) Year 1:       Year 2:       Name of Individual Responsible for Oversight of Training at This Institution (Site Coordinator):       Type of Institution: (e.g., Teaching Hospital, General Hospital, Medical School):       Brief Educational Rationale for Use of This Institution:       UCNS Program Accreditation Application Page 5 of 21 Neuro-Oncology 2008
  • 6. RELATED CORE PROGRAM IN NEUROLOGY OR CHILD NEUROLOGY Name of Institution or Hospital:       Address:       City, State, Zip Code:       Website Address:       Date Program Approved for Accreditation:       Next Review Date:       Name of Program Director:       Total Number of Faculty:       RELATED CORE PROGRAM IN NEUROLOGICAL SURGERY Name of Institution or Hospital:       Address:       City, State, Zip Code:       Website Address:       Date Program Approved for Accreditation:       Next Review Date:       Name of Program Director:       Total Number of Faculty:       RELATED CORE PROGRAM IN INTERNAL MEDICINE AND MEDICAL ONCOLOGY Name of Institution or Hospital:       Address:       City, State, Zip Code:       Website Address:       Date Program Approved for Accreditation:       Next Review Date:       Name of Program Director:       Total Number of Faculty:       RELATED CORE PROGRAM IN PEDIATRICS AND PEDIATRIC HEMATOLOGY-ONCOLOGY Name of Institution or Hospital:       Address:       City, State, Zip Code:       Website Address:       Date Program Approved for Accreditation:       Next Review Date:       Name of Program Director:       Total Number of Faculty:       SECTION 3. FELLOW INFORMATION A. Number of Positions (For the current academic year) UCNS Program Accreditation Application Page 6 of 21 Neuro-Oncology 2008
  • 7. Positions Year 1 Year 2 Total Number of Requested Positions                   Number of Filled Positions*                   *For established programs without currently active fellows, complete table with 0 and indicate here when last fellow finished: For programs that have never had fellows, complete table with “NA”. Note: The total number of fellows in years 1 and 2 should not exceed the 2:1 faculty to fellow ratio for the fellowship program. Faculty included in determining the ratio are those listed in section 4.B. See Program Requirements III.A.4. B. Actively Enrolled Fellows (if applicable) (Program Requirements III) 1. List all fellows actively enrolled in this program as of August 31 of current academic year (see Section 3.A). List names alphabetically. Indicate fellows accepted as transfer with an asterisk (*). YEAR ONE Name Medical School Prior GME training program ABPN/RCPSC eligible or Certified?                   YES NO                   YES NO                   YES NO                   YES NO                   YES NO                   YES NO YEAR TWO Name Medical School Prior GME training program ABPN/RCPSC eligible or Certified?                   YES NO                   YES NO                   YES NO                   YES NO                   YES NO                   YES NO 2. Are you planning to train non-ACGME or non-RCPSC trained fellows? If yes, be aware that non- UCNS certifiable trainees must be included in the faculty to fellow ratio. What effect will this have on your faculty to fellow ratio?       C. Aggregate Data on Fellows Completing or Leaving the Program for the Last Three (3) Years (if applicable) UCNS Program Accreditation Application Page 7 of 21 Neuro-Oncology 2008
  • 8. Academic year ending: June 30,       (indicate year) June 30,       (indicate year) June 30,       (indicate year) Number of Graduates                   Number of Fellows Who Withdrew from the Program                   Number Who Transferred Out of the Program                   Number on Leave of Absence from the Program                   Number Dismissed from the Program                   *Please provide specific reasons for fellows who left the program in the last three years (e.g., withdrawn, transferred, leave of absence, or dismissed).       D. Fellows Completing Program in the Last Three Years (if applicable). List of fellows who completed all training for this subspecialty based on the last full academic year ending June 30,      . Name Start Date Actual Date of Completion Practice Position ABPN/RCPSC Certified? UCNS Certified?                         YES NO YES NO                         YES NO YES NO                         YES NO YES NO List of fellows who completed all training for this subspecialty based on the last academic year ending June 30,      . Name Start Date Actual Date of Completion Practice Position ABPN/RCPSC Certified? UCNS Certified?                         YES NO YES NO                         YES NO YES NO                         YES NO YES NO List of fellows who completed all training for this subspecialty based on the last academic year ending June 30,     . Name Start Date Actual Date of Completion Practice Position ABPN/RCPSC Certified? UCNS Certified?                         YES NO YES NO                         YES NO YES NO                         YES NO YES NO UCNS Program Accreditation Application Page 8 of 21 Neuro-Oncology 2008
  • 9. SECTION 4. FACULTY AND PERSONNEL A. Program Director (Program Requirements IV, A, B) 1. Describe the Program Director’s qualifications in neuro-oncology. Indicate appropriate qualifications, including subspecialty expertise in neuro-oncology and at least five years in post graduate practice, as well as documented clinical, educational and administrative abilities, and experience in his/her field.       2. Describe the Program Director’s prior experience in the training of medical students or post-doctoral medical or surgical trainees.       3. Describe how the Program Director is able to foster and optimize multidisciplinary interactions and teaching in neuro-oncology within the institution(s).       4. Give a brief description of the Program Director’s responsibilities and activities. Attach one page curriculum vitae (Appendix B) for the Program Director (use Appendix B form). CVs using the NIH Biographical Sketch format will be accepted as long as it provides current hospital staff privileges.       B. Required Faculty - Neuro-Oncology (Program Requirements IV, D) 1. Neuro-Oncologist a) Is a board certified neurologist or child neurologist a member of the program faculty? YES NO If yes, is this neurologist also board certified in medical or pediatric oncology? YES NO If no, is neurologist supported by a faculty member who is board certified in either medical or pediatric oncology? YES NO b) Is a board certified medical or pediatric oncologist a member of the program faculty? YES NO If yes, is this oncologist board also certified in neurology or child neurology? YES NO If no, is oncologist supported by a faculty member who is board certified in either neurology or child neurology? YES NO c) Is a board certified (in neurological surgery) neurosurgeon a member of the program faculty? YES NO Is the neurosurgeon supported by a faculty member who is board certified in medical or pediatric oncology? YES NO 2. Is a neurosurgeon with reasonable experience in surgical treatment of neuro-oncology patients and management of patients with central nervous system tumors a member of the program faculty? YES NO 3. Is a radiation oncologist a member of the program faculty? YES NO UCNS Program Accreditation Application Page 9 of 21 Neuro-Oncology 2008
  • 10. 4. Is a neuro-radiologist a member of the program faculty? YES NO 5. Is a neuro-pathologist or general pathologist a member of the program faculty? YES NO 6. Is a medical oncologist a member of the program faculty? YES NO 7. Does your program offer pediatric neuro-oncology fellowships? YES NO If yes, is a pediatric neuro-oncologist a member of the program faculty? YES NO UCNS Program Accreditation Application Page 10 of 21 Neuro-Oncology 2008
  • 11. List all members of the program responsible for training. For those with dual appointments, identify primary appointment (neurology or other department) in parentheses. Note: These faculty members count toward the program’s faculty to fellow ratio. See Section 2 for institution numbers. Name, Degree, Title and Position Role in Curriculum Privileges at Institution #1,2,3,4 Full-Time If Part-time, State Current Certification*Wks/ Yr Hrs/ Wk                   YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                   Attach a one page curriculum vitae (Appendix B) for each of the faculty listed above (use Appendix B form). CVs using the NIH format Biographical Sketch format will be accepted as long as they provide current hospital staff privileges. If additional rows are needed to list more than 18 faculty, please e-mail applications@ucns.org. *Indicate certification by ABMS or RCPSC and the specialties in which certified. Indicate certification by UCNS and the subspecialty in which certified. UCNS Program Accreditation Application Page 11 of 21 Neuro-Oncology 2008
  • 12. C. Other Teaching Faculty List other teaching faculty regularly involved in teaching fellows, including consultants and basic science faculty. Note their department, title and certifying credentials, and supervisory responsibilities to the program. See Section 2 for institution numbers. Name, Degree, Title and Position Role in Curriculum Privileges at Institution #1,2,3,4 Full-Time If Part-time, State Current Certification*Wks/ Yr Hrs/ Wk                   YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                                     YES NO                   Attach one page curriculum vitae (Appendix B) for members with major teaching responsibilities (use Appendix B form). CVs using the NIH Biographical Sketch format will be accepted. If additional rows are needed to list more than 18 faculty, please e-mail applications@ucns.org. *Indicate certification by ABMS or RCPSC and the specialties in which certified. Indicate certification by UCNS and the subspecialty in which certified. UCNS Program Accreditation Application Page 12 of 21 Neuro-Oncology 2008
  • 13. SECTION 5. PROGRAM RESOURCES AND FACILITIES (Program Requirements V, F) A. Facilities 1. Facilities and resources for training See Section 2 for institution numbers. Are the following office space and resources available? Faculty and Resources Inst 1 Inst 2 Inst 3 Inst 4 a. Neuro-Oncology Faculty Offices and Facilities YES NO YES NO YES NO YES NO Is there administrative support for the Fellowship & Program Director? YES NO YES NO YES NO YES NO Is a clinical and/or research nurse a member of the program faculty? YES NO YES NO YES NO YES NO b. Fellow Offices and Resources Does each fellow have his/her own office? YES NO YES NO YES NO YES NO Are the offices for groups of fellows? YES NO YES NO YES NO YES NO Is there dedicated administrative support for fellows? YES NO YES NO YES NO YES NO Does the fellow have access to other office equipment such as copiers, slide projectors, PowerPoint, video projection equipment or services for slides presentations, illustration services? YES NO YES NO YES NO YES NO c. Laboratory Facilities YES NO YES NO YES NO YES NO d. Imaging Facilities YES NO YES NO YES NO YES NO e. Psychiatric Consultation YES NO YES NO YES NO YES NO f. Psychological Services YES NO YES NO YES NO YES NO g. Pain Services YES NO YES NO YES NO YES NO h. Chemotherapy YES NO YES NO YES NO YES NO i. Radiation Oncology YES NO YES NO YES NO YES NO j. Neuropathology YES NO YES NO YES NO YES NO k. Social Work and Case Management Including Palliative Care and Hospice YES NO YES NO YES NO YES NO 2. Briefly describe conference facilities at each institution that will be used for neuro-oncology conferences.       3. Briefly describe the space provided for neuro-oncology program faculty and fellow research at each institution. (Program Requirements V, F)       UCNS Program Accreditation Application Page 13 of 21 Neuro-Oncology 2008
  • 14. B. Library Facilities Use the table below to describe the institutional and departmental library holdings and other reference resources at each institution. See Section 2 for institution numbers. Are the following facilities and resources available? Library Facilities Inst 1 Inst 2 Inst 3 Inst 4 a. Journals Access to Medline YES NO YES NO YES NO YES NO b. Computer databases available YES NO YES NO YES NO YES NO Access in hospital YES NO YES NO YES NO YES NO Access in library YES NO YES NO YES NO YES NO 24 hour access YES NO YES NO YES NO YES NO Access to major texts and full text journals YES NO YES NO YES NO YES NO Internet search capabilities YES NO YES NO YES NO YES NO c. Library available on site YES NO YES NO YES NO YES NO Library with major texts in all areas of medicine on site or nearby YES NO YES NO YES NO YES NO Interlibrary loan capability YES NO YES NO YES NO YES NO Textbook availability YES NO YES NO YES NO YES NO Major Neuro-oncology texts on wards YES NO YES NO YES NO YES NO Major Neuro-oncology texts in clinic YES NO YES NO YES NO YES NO Teleconference capability YES NO YES NO YES NO YES NO UCNS Program Accreditation Application Page 14 of 21 Neuro-Oncology 2008
  • 15. SECTION 6. EDUCATIONAL PROGRAM A. Curriculum Describe in block form the typical curriculum for fellows by months (or four-week stints), not weeks, including the institution (#1, 2, 3, 4) as listed in Section 2. If you require an extended table, please email a request to applications@ucns.org. Please refer to Program Requirements V.D. for a required triad of clinical experiences in neuro-oncology. Curricular components may be offered in blocks or longitudinally. An example of the latter is a regularly scheduled clinic attended over a period of time while assigned to other rotations. Those components offered in block assignments each year should be recorded in the block template. Those clinical experiences offered longitudinally should be recorded separately in the longitudinal templates by year. You should not include conferences, lectures or other didactic experiences in the longitudinal template. Include the goals and objectives for each of these curricular assignments and the programs overall goals and objectives as Appendix C. 1. Have these goals and objectives been provided to the fellows? YES NO BLOCK ROTATIONS –YEAR 1 July August September October November December January February March April May June                                                                         LONGITUDINAL EXPERIENCES - YEAR 1 Type Of Experience Time Commitment/Weekly Structured Number Of Weeks/Year Amount Of Time in Months (e.g. 40 Half Days=1 Month)                                                                         UCNS Program Accreditation Application Page 15 of 21 Neuro-Oncology 2008
  • 16. Include the goals and objectives for each of these curricular assignments and the program’s overall goals and objectives as Appendix C. 2. Have these goals and objectives been provided to the fellows? YES NO BLOCK ROTATIONS - YEAR 2 July August September October November December January February March April May June                                                                         LONGITUDINAL EXPERIENCES – YEAR 2 Type Of Experience Weekly Structured Number Of Weeks Amount Of Time in Months (e.g. 40 Half Days=1 Month)                                                                         UCNS Program Accreditation Application Page 16 of 21 Neuro-Oncology 2008
  • 17. B. Seminars and Conferences (Program Requirements V, C) 1. Attach a schedule of clinical conferences for fellows in each institution (Appendix D). Name the faculty member assigned to each conference. Indicate which conferences are mandatory for fellows. 2. Attach a list of required lectures (>50 in total) comprising the formal didactic component of the fellowship (see Program Requirements V.C.1). (Appendix D) 3. Attach a list of the courses, conferences and/or lectures given in each of the other areas required in the program (Appendix D). 4. Attach a list of lectures not already supplied, such as lectures by visiting neuroscientists (Appendix D). 5. Is there a journal club? YES NO Specify attendance by fellow and faculty, the frequency of meeting, and the organization of the club. If there is no journal club, what substitutes for it?       C. Educational Program 1. What teaching responsibilities do fellows have?       2. Describe how the program has integrated the six Accreditation Council for Graduate Medical Education (ACGME) core competencies (www.acgme.org) listed below into the didactic and clinical curriculum. Describe the method(s) used to evaluate fellow performance in each area (e.g. fellow, director, and faculty evaluation also known as 360 degree evaluation; patient surveys; portfolios; record review; simulations; standardized oral exams; standardized patients; written examinations; etc.) a. Patient care       b. Medical knowledge       c. Practice-based learning and improvement       d. Interpersonal and communication skills       e. Professionalism       f. Systems-based practice       UCNS Program Accreditation Application Page 17 of 21 Neuro-Oncology 2008
  • 18. 3. Required Clinical Components (Program Requirements V, D). Provide the amount of time in months spent in each setting. Also, please indicate whether the curriculum includes at least four months experience in each of the three required areas: neuro-oncologic issues in systemic cancers; neuro- oncologic issues in primary nervous system cancer, ancillary and palliative care issues. TYPE OF EXPERIENCE TIMING IN PROGRAM FORMAT (block vs. longitudinal) TOTAL AMOUNT OF TIME Outpatient, including both consultation and continuity clinics                   Inpatient (ward-service) experiences                   Inpatient consultation                   Emergency room experiences                   neuro-oncology consultation in patients with systemic cancer                   Care of patients with primary nervous system neoplasms                   Experience with supportive and ancillary care                   4. Document how fellows are provided with direct experience in progressive responsibility for patient management.       5. Core Content Document how the program will teach the following areas of study. a. Adult Primary Nervous System Tumors       b. Pediatric Nervous System Tumors       c. Treatment of Metastatic Cancer to the Nervous System       d. Systemic Cancer-Related Neurological Disorders       e. Interdisciplinary Management of neuro-oncology Patients       D. Educational Policies (Program Requirements V, F) 1. Describe the Program Director’s supervision of fellows in each clinical setting.       2. Describe how compliance with ACGME duty hours is maintained (www.acgme.org). Please submit a copy of the policy on duty hours and a call schedule.       UCNS Program Accreditation Application Page 18 of 21 Neuro-Oncology 2008
  • 19. SECTION 7. RESEARCH AND SCHOLARLY ACTIVITY A. Fellow Meeting Attendance Comment on how many and how often fellows attend local, regional, and national neuro-oncology meetings. You should provide a list of meetings that fellows have attended over the past three years, showing the fellows by name, as Appendix E. B. List of Research Projects by Fellows List the research projects by fellows from the section/division during the past 3 years as Appendix F. C. List of Publications by Fellows List the publications by fellows from the section/division during the past 3 years as Appendix G (not manuscripts submitted or in preparation) D. Scholarly Activity Summary Academic Year Ending June 30,       June 30,       June 30       Number of Nationally Peer-Reviewed Published Articles Authored or Co-Authored by Fellows in the Past Year                   Number of Fellow Presentations at Regional or National Meetings in the Past Year                   SECTION 8. EVALUATION (Program Requirements VI, A) A. Fellow Evaluation 1. Describe the methods & frequency for fellow evaluation used in the program.       2. Fellow Feedback and Records Describe how and by whom feedback to fellows is provided and what remedial actions are taken in cases of deficiency. What kind of records of fellow evaluations does the program maintain?       3. Final Evaluation Please provide a copy of a final evaluation used for fellows who complete the program.       4. Impaired Fellows What policies are in place for dealing with impaired fellows?       5. Fellow Stress How does the program monitor fellow stress, provide counseling and support services to fellows?       B. Faculty Evaluation (Program Requirements VI, B) Describe the system by which the faculty is evaluated. Are written evaluations by fellows used in this process? If not, please explain. YES NO       UCNS Program Accreditation Application Page 19 of 21 Neuro-Oncology 2008
  • 20. C. Program Evaluation (Program Requirements VI, C) Describe the system by which the program is evaluated.       D. Curriculum Development 1. Describe how written evaluations by fellows are used in the curriculum development process.       2. Describe the participation by fellows in the curriculum development and evaluation process.       3. Describe who participated in the development of written goals and objectives for the required experiences and state the time of most recent revision.       E. Curriculum Evaluation 1. Describe the criteria used in assessing the extent to which goals and objectives (Appendix C) are met.       2. Explain how often the goals and objectives are reviewed and how they are evaluated.       3. Describe how the performance by graduates on the certifying examinations is used to evaluate the effectiveness of the program and to modify the goals and objectives.       UCNS Program Accreditation Application Page 20 of 21 Neuro-Oncology 2008
  • 21. SECTION 9. SIGNATURES If this form was completed by the Program Coordinator, please provide the following information: Program Coordinator Name:       Telephone Number:       E-mail:      The signatures below attest to the completeness and accuracy of the information provided. Please insert an electronic signature, or sign and fax this page to the UCNS Executive Office at 651-361-4916. Insertion of an electronic signature: By typing your name in the space provided, you are submitting the electronic equivalent of a legal signature. You are also asserting that you completed the application. To verify the contents of the application, the signatory must enter his/her name in the space provided. Acceptable “signatures” should be preceded and followed by the forward slash (/) symbol. Acceptable “signature” should be as follows: /John Doe/. Neuro-Oncology Program Director Name:       Signature:       Date:       Department Chair Name:       Signature:       Date:       Please use the Appendices A-G template for submitting Appendices A-G. UCNS Program Accreditation Application Page 21 of 21 Neuro-Oncology 2008