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Oncology RT Registration Form 1-14-09.doc

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    Oncology RT Registration Form 1-14-09.doc Oncology RT Registration Form 1-14-09.doc Document Transcript

    • RESIDENCY TRAINING PROGRAM REGISTRATION 2009-2010 ONCOLOGY New applications for ACVIM Residency Training Programs must be received by the Residency Training Committee 90 days prior to any residents beginning training. Before completing this form, please review the general and specific requirements for oncology residency training programs in the ACVIM General Information Guide (GIG). The most current version of the GIG is available on the ACVIM website at www.ACVIM.org. If there is a discrepancy between this form and the GIG, the GIG will be considered correct, however, please contact the ACVIM office or the Residency Training Committee Chairperson for clarification. Prior to making significant changes in a residency training program, approval of the ACVIM and Oncology Resident Training Committee must be obtained. The candidate and/or program director must notify ACVIM, in writing. Significant changes could include, but are not limited to: changes in program director or any mentors, transferring from one program to another, alterations in program duration, switching to a ‘dual board’ program, or enrolling in an institutional graduate program. Notice: Some questions in this form are included for data collection purposes. The inclusion of an item does not imply that the item is a program requirement for ACVIM. For multi-site residency programs: To ensure uniformity of training and compliance with current GIG requirements, training programs which include multiple sites must provide detailed information as to which Diplomates in the specialty of Oncology, as well as other Specialties, will be supervising the resident(s) at each site. In this updated program registration form, the program director must provide specific, detailed information regarding supervision and facilities available at each specific site(s). Check box if this is a renewal application with unaltered information from the previous year: Part 1 Date: Program Director: (Must be a Diplomate of ACVIM in the Specialty of Oncology) Program Director’s Contact Information: Work Phone: Fax: E-mail: Mailing Address: 1. Location of Training Program: Primary Site: © 2009 American College of Veterinary Internal Medicine
    • Secondary Site (if applicable): (Please attach specific information regarding the percentage of time scheduled at each site and which rotation requirement shall be met at each site). Outside Rotations/Other Sites (if applicable): (Please attach signed Letters of Support from all individuals providing off-site training of oncology residents to this registration form. Each Letter of Support should contain specific information regarding the percentage of time schedule at each site and which rotation requirement shall be met at each site. Letters of Support must be submitted annually WITH program renewal forms and WITH each new program request. 2. Length of Training Program: Yes 2 years 3 years Other -provide details 3. Advanced Degree: Yes No Optional Masters: PhD: Comments: 4. Resident Advisor(s): (Must be ACVIM Diplomate(s) in Oncology.) 5. Supervising Diplomates: (Must be ACVIM Diplomates in Oncology.) 6. It is essential that the candidate have direct face to face contact with the supervising Diplomate(s) in the Specialty of Oncology. The minimum 104 week intensive training must be structured in the following way (GIG H1.a.3.f): a. Indirect Supervision: For a minimum of 24 weeks of the residency, the supervising Diplomate(s) must be available for face-to-face contact at least one hour per day for four days per week. b. Direct Supervision: The supervising Diplomate(s) must be actively receiving patients with the resident for a minimum of 50 training weeks (as defined in the GIG, section D.2.d.) during the residency. This is in addition to the 24 weeks listed in 1 above. Affiliated Rotations: In addition to the 74 weeks outlined in 1 and 2 above, a minimum of 24 weeks must be spent actively receiving (direct supervision) patients in affiliated rotations as outlined in the GIG H1.a.3.f. c. Supervising Diplomate(s) Choice of Additional Rotations: In addition to the weeks outlined in 1, 2, and 3 above, 6 weeks of the residency may be unsupervised; this includes any time used for conferences, research, studying for boards or similar activities. Does your residency program comply with the guidelines outlined in a – c above? Yes No © 2009 American College of Veterinary Internal Medicine
    • 7. Have the supervising Diplomate(s) and residency candidate read the objectives for an oncology residency as outlined in the General Information Guide, Specialty of Oncology? Yes No While it may have no bearing on your program, we recommend that the supervising Diplomat(s) and the residency candidate review the GIG yearly. You may obtain a copy of the GIG from the ACVIM website at www.ACVIM.org. 8. Does your training program consist of a minimum of 104 weeks? Yes No 9. The supervising Diplomate(s) should also periodically evaluate the resident (a minimum of once every 6 months) and should discuss the results of those evaluations with the candidate and be able to provide the Residency Training Committee with written summaries of those evaluations if required. A more formal yearly evaluation is required by this Committee every year, and should be sent to the ACVIM Office by August 31st. This evaluation consists of a. the candidate’s updated Oncology Resident weekly schedule log available from the ACVIM Office. b. an evaluation of the resident candidate using the Yearly Update Resident Evaluation form available from the ACVIM Office. Does your program comply with these standards of resident evaluation? Yes No 10. Please list the residents who have completed the training program within the last five years, including the year that each individual’s training program ended. If possible, please indicate whether the individual has completed the board certification process. Name Program End Date Board-certified? 11. Please list all residents currently enrolled in the training program in addition to their actual program start and end dates. Name Program Start Date Program End Date 12. Please list all Diplomates of ACVIM responsible for supervision of clinical training who specialize in areas other than the program being registered. For multisite programs, please use the comments section to give detail pertaining to the method of providing direct (in person, not videoconference) contact with the resident and at which site. Specifically, list the number of contact hours (direct and indirect; see GIG H1.a.2) each diplomate will spend with the resident per month. Name and degree Specialty Site Number of hours © 2009 American College of Veterinary Internal Medicine
    • 13. Please list all Diplomates of the American College of Veterinary Pathology in the areas of clinical pathology or gross/histopathology associated with residency training. For multisite programs, please use the comments section to give detail pertaining to the method of providing direct (in person, not videoconference) contact with the resident and at which site. Specifically, list the number of contact hours each diplomate will spend with the resident per month. Name Clinical or Anatomic Site How contact provided Pathology A board certified veterinary pathologist with training in clinical pathology and a fully equipped laboratory facility should be routinely available. In addition, there should be at least 40 hours of direct contact with a clinical pathologist to facilitate training in diagnostic clinical cytology. A board-certified pathologist should be routinely available for evaluation of clinical material. A minimum of 40 hours of direct contact exploring surgical histopathology is required during the residency. Does your program meet these requirements for clinical/surgery pathology training in your residents? Yes No 14. Please list all Diplomates of the American College of Veterinary Radiology (not including radiation oncology) associated with residency training. For multisite programs, please use the comments section to give detail pertaining to the method of providing direct (in person, not videoconference) contact with the resident and at which site. Name Site How contact provided 15. Please list all Diplomates of the American College of Veterinary Radiology responsible for training in Radiation Oncology. For multisite programs, please use the comments section to give detail pertaining to the site (if off site) and method of providing direct (in person, not videoconference) contact with the resident and how the 4 weeks of GIG-mandated radiation oncology training will be fulfilled. Please attach a letter of support if this training is provided by an off-site ACVR-RO diplomate. Name Comments The resident should have access to radiation therapy and a board certified veterinary radiation oncologist. The oncology resident should have a minimum of one month of direct contact with a board certified veterinary radiation oncologist to discuss clinical management of patients receiving radiation therapy, radiation planning, dosimetry, and physics related to clinical radiation therapy. Does your program meet this requirement for radiation oncology training of your residents? Yes No © 2009 American College of Veterinary Internal Medicine
    • 16. Please list the non-ACVIM Diplomates available for consultation in the areas of dermatology, surgery, ophthalmology, anesthesiology, emergency/critical care, clinical nutrition, clinical pharmacology, and/or theriogenology. For multisite programs, please use the comments section to give detail pertaining to the method of providing direct (in person, not videoconference) contact with the resident and at which site. Specifically, list the number of contact hours (direct and indirect; see GIG H1.a.2) each diplomate will spend with the resident per month. Name Site How contact provided 17. In addition to directly supervised patient care, the candidate should also be involved in patient-oriented teaching rounds and formal teaching conferences such as clinical pathologic conferences, resident seminars, and grand rounds sessions. The candidate must participate in these teaching exposures a minimum of several times each week during the residency training program. Please provide a description of the conferences, etc., which directly pertain to training in Oncology and attach a schedule that gives specific details for rounds, seminars, and journal clubs given on a daily, weekly or monthly basis. 18. Please list all opportunities offered to and/or required of the resident for attendance and/or giving formal presentations at local, regional, state or national meetings. Indicate whether the resident will attend or present at these meetings. 19. For board-certification in oncology, the resident must have a minimum of one major publication in the field of oncology in print or accepted for publication in a refereed scientific journal. A literature review or case report is not acceptable. Please describe how this program supports this requirement for publication. 20. Please indicate the availability of the following facilities or equipment. Indicate if these are available at the primary training site, or at a different location. (In the Location column, indicate on-site for primary location or the name of the facility where the equipment is located if off-site.) For facilities that are not on-site, please describe the situation and availability in the space at the end of this section. Available? Location of equipment? (Y or N) (On-site or list site name) a) Standard radiological equipment b) Ultrasonographic equipment c) Color flow/Doppler equipment d) Endoscopy equipment GI equipment Bronchoscopy Cystoscopy Rhinoscopy Laparoscopy e) Clinical Pathology capabilities: (includes CBC, serum chemistries, blood gases, urinalysis, cytology, parasitology, microbiology, and endocrinology) © 2009 American College of Veterinary Internal Medicine
    • f) Electrocardiography g) Blood Pressure Measurement h) Nuclear Medicine i) Computed Tomography j) Magnetic Resonance Imaging k) Radiation Therapy Facility l) Intensive Care Facility – 24 hours m) Total parenteral nutrition capability n) Computerized Medical Records w/Searching Capabilities If any of the above equipment or facilities are available off-site, please explain how the resident can access them for case management, research, or study. 21. The resident should have access to a human or veterinary medical library with on-line searching capacity and at a minimum have access to all textbooks (current editions) and full text access to all journals on the current examination committee reading list (See item 21. to be completed by Program Director. Note that on-line access to texts must be full-text not abstracts only). This library should be available on-site or within a reasonable commuting distance (defined as within a 15 mile radius of the primary training site). Please indicate how your resident can obtain access to the following textbooks/journals. Available Available Hard copy or subscription available on through pub- through CD- site, or Medical/Veterinary Library (insert med only Not Text or journal ROM name) (free or will available or online purchase subscription articles) DeVita: Cancer: Principles and Practice of Oncology, 7th ed. (2005) Withrow: Veterinary Clinical Oncology, 4th Ed. (2007) Chabner: Cancer Chemotherapy, 4th Ed. (2006) Tannock&Hill: Basic Science of Oncology, 4th Ed. (2005) Abbas: Cellular and Molecular Immunology, 5th Ed. (2005) Meuten: Tumors in Domestic Animals, 4th ed. (2002) Morrison: Cancer in Dogs and Cats, 2nd Ed. (2002) Ettinger: Textbook of Veterinary Internal Medicine, 6th Ed. (2005) Kirk: Current Veterinary Therapy XI, XII, XIII, XIV Feldman & Nelson: Canine and Feline Endocrinology and Reproduction, 3rd Ed. (2003) Cowell: Diagnostic Cytology, 3rd Ed. (2007) Hall: Radiobiology for the Radiologist, 6th Ed. (2006) Ogilvie & Moore: Feline Oncology (2001) Ogilvie & Moore: Managing the Canine Cancer Patient (2006) Veterinary Clinics of North America- oncology-related issues (2000- present) Duncan: Veterinary Laboratory Medicine: Clinical Pathology, 4th Ed. (2003) © 2009 American College of Veterinary Internal Medicine
    • Feldman: Schalm’s Veterinary Hematology, 5th Ed. (2000) Norman and Streiner: Biostatistics- the Bare Essentials, 2nd Ed. (2000) Journal of Veterinary Internal Medicine Journal of the American Veterinary Medical Association American Journal of Veterinary Research Compendium for Continuing Education Journal of the American Animal Hospital Association Veterinary Clinical Pathology Veterinary and Comparative Oncology Veterinary Pathology Veterinary Surgery Veterinary Radiology and Ultrasound Journal of Small Animal Practice Research in Veterinary Science Cancer New England Journal of Medicine Clinical Cancer Research Nature Reviews: Cancer Comments: Does your program meet these library requirements? Yes No **Please note, any candidate that significantly changes or alters their residency training program before completion must notify ACVIM, in writing, before the changes are made to ensure that the proposed changes are approved. Significant changes could include, but are not limited to: - transferring from one program to another - alterations in program duration - switching to a ‘dual board’ program - enrolling in an institutional graduate program - change of Program Director © 2009 American College of Veterinary Internal Medicine