December 2008 Annual Update for Residency Training Programs

Transcription

1 Annual Update for Residency Training Programs This Update is for a Residency or Fellowship Training Plan. (Circle or Bold) Is the Residency Training Program combined with residency training in another specialty (e.g., ACVIM, ACVA)? Yes No (Circle or Bold) If Yes, which specialty? What is the duration of Training Program (minimum 3 years for Residency, 2 years for Fellowship; maximum 6 years): Years Resident/Fellow annual start date (month, day): Resident/Fellow annual end date (month, day): Note: Standard start date is either January 15 or July 15; however, alternate start dates will be considered by the Residency Training Committee: Residents may receive Emergency and Critical Care Immersion with ACVECC diplomate supervision at any approved Residency Training Facility approved under this Program. 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 Program Administrator % time or # weeks Alternate Approved Facilities Administrator % time or # weeks

2 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 do 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 explaining how this/these Mentor(s) contribute to the Residency Training Program. Additional Supervisor(s) for Emergency and Critical Care Supervision 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 the Mentor(s) and/or Supervisor(s) listed above.

3 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. Requirements vary based on whether Resident or Fellow is under Guidelines (started prior to 2008) or Standards (started 2008 or later). o Fellows are exempt from weeks in their area(s) of specialty (See the Standards) Specialty Specialist(s) already agreed to provide supervision Site / Location Internal Medicine Surgery Anesthesia Cardiology Diagnostic Imaging Neurology Ophthalmology* Others in Plan: * See November 2007 Standards & Guidelines p. 17 for alternate option for Large Animal Residents/Fellows who started in 2008 or later

4 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 Seminars This Plan includes a minimum of 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 Additional Requirements. D. Plan 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 Outline 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)

5 Update for Residency Training Facility December 2008 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. 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: 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 provide E/CC Immersion Supervision at this Facility

6 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 Please indicate the number of Diplomates in each of the following specialties who are 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. *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.

7 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 receives Supervised E/CC Immersion at this Facility: # of weeks: Please check one of the following two boxes regarding the 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, including a timeline. I will confirm compliance with the Guidelines with the Residency Training Committee within 30 days of the date of this application. Textbooks: The Resident or Fellow should have access on a 24-hour basis to textbooks published within the past 10 years (or the most recent edition if an older, classic physiology text). Available resources should include information on basic physiology, surgery, critical care, internal medicine, endocrinology, emergency procedures, anesthesia, fluid therapy, anatomy, hematology, radiology, nutrition, cardiology, neurology, oncology, ophthalmology, and infectious diseases. The reading list published annually by the Exam Committee may be used as a resource for the resident library. Please indicate which of the following texts are available: Textbook of Critical Care Medicine, Fink et. al. Critical Care Medicine, Parrillo and Dellinger (3rd ed). The ICU Book, Marino et al. The Veterinary ICU Book, Wingfield and Raffe Small Animal Critical Care Medicine, Silverstein and Hopper Manual of Small Animal Emergency and Critical Care, Macintire et al. Handbook of Veterinary Procedures and Emergency Treatment, Kirk and Bistner Textbook of Critical Care, Shoemaker, et al (4th ed). Current Veterinary Therapy XII, XIII, Kirk ed. Plumb s Veterinary Drug Handbook The Pharmacologic Approach to the Critically Ill Patient, Chernow Lumb and Jones Veterinary Anesthesia, Thurmon et. al. Fluid Therapy in Small Animal Practice, DiBartola Clinical Physiology of Acid-Base and Electrolyte Disorders, Rose

8 Applied Respiratory Physiology, Nunn Principles and Practice of Mechanical Ventilation, Tobin Textbook of Small Animal Surgery, Slatter or Fossum Small Animal Surgery Fossum Complications in Small Animal Surgery - Lipowitz; Caywood, et al Disease Mechanisms in Small Animal Surgery, Bojrab Decision Making in Small Animal Radiology, Farrow Textbook of Diagnostic Radiology, Thrall Textbook of Veterinary Internal Medicine, Ettinger and Feldman Textbook of Respiratory Diseases in Dogs and Cats, King Canine and Feline Endocrinology and Reproduction, Feldman and Nelson Canine and Feline Cardiology, Fox or Kittleson Canine and Feline Electrocardiography, Tilley Small Animal Gastroenterology, Strombeck Veterinary Pediatrics, Hoskins Small Animal Toxicology Peterson Infectious Diseases of the Dog and Cat, Greene Textbook of Veterinary Anatomy, Dyce, et al Small Animal Clinical Diagnosis by Laboratory Methods, Willard, et al December 2008 List other available, relevant textbooks and their publication dates: Text Author Date

9 Periodicals: At least the previous 5 years should be available in hard or electronic copy form, 24 hours a day. Check such available resources: Journal of Veterinary Emergency and Critical Care Journal of the American Veterinary Medical Association American Journal of Veterinary Research Veterinary Surgery Journal of Veterinary Internal Medicine Veterinary Anesthesia and Analgesia Veterinary Clinics of North America (small or large animal as pertains to the practice) Compendium of Continuing Education for Veterinarians Journal of the American Animal Hospital Association Critical Care Medicine New England Journal of Medicine Intensive Care Medicine American Journal of Respiratory and Critical Care Medicine (The Blue Journal) Annals of Emergency Medicine Journal of Trauma Other pertinent journals available 24 hours a day: List other 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 December 2008 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: Approved by: Date: 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 To avoid confusion on the part of the general public and to provide guidelines for consistency in the designation of Veterinary Emergency Facilities, the following nomenclature is suggested which is consistent with the AVMA guidelines. The veterinary Emergency and Critical Care Society (VECCS) recommends that the following terminology be used when referring to emergency service and facilities. Emergency Service: The category of service provided should be clearly evident to the public. Veterinary Emergency Service - A veterinary service with a veterinarian on the premises during all hours of operation receiving and managing emergency cases. On-Call Veterinary Emergency Service - A veterinary service on-call or available to receive and manage emergency cases as requested if veterinarian is available. Does not have constant coverage by a veterinarian during all hours of operation. Emergency Facility: A veterinary facility with the primary and dedicated function of receiving and managing emergency patients during its specified hours of operation. Emergency Clinic -A facility that is specifically operated, staffed and equipped to provide emergency service. Most patients are treated on an outpatient basis. The specified hours of operation are expected to be other than the normal business hours of general veterinary practices. Patients are transferred to the primary care veterinarian the next workday. Emergency Hospital - Emergency facility similar to an Emergency Clinic but with more advanced capabilities enabling hospitalization and management of multiple critical patients. Emergency/Critical Care Center - A facility specifically designated to be operated, staffed and equipped (in accordance with Parts 1 and 2 of these guidelines) 24 hours a day to provide a broad range of veterinary emergency and critical care service. It is suggested that professional staff include board certified specialists and veterinary technician specialists (AVECCT). Centers that share a facility with a specialty practice or primary care practice must provide staffing and equipment to ensure appropriate emergency and critical patient care. PART 1: MINIMUM GUIDELINES FOR A VETERINARY EMERGENCY FACILITY Staffing During the specified hours of operation a licensed veterinarian should be on the premises at all times and sufficient staff must be available to provide expedient patient care. Staffing should be sufficient to allow: Processing multiple patients Performance of a wide range of life-saving procedures to include but not be limited to cardiopulmonary resuscitation and emergency surgery. This requires at least three people, including one veterinarian and one veterinary technician. Appropriate and timely consultation with veterinary specialists. A close association with a Diplomate of the American College of Veterinary Emergency and Critical Care, or other veterinary diplomates with a special interest and experience in emergency and critical care is recommended to optimize patient care and facilitate patient referral if necessary. Communications Good communications must be maintained to allow efficient transfer of patient information between the emergency facility and primary care veterinarians. It is highly recommended that the emergency facility have all the clinic and home telephone numbers of primary care veterinarians. A report should be sent to the primary care veterinarian in a timely manner to ensure immediate continuity of care and for inclusion in the patient's permanent record. Medical Records A complete and thorough medical record on file for each patient should be kept at the emergency facility. The Medical record must follow AVMA guidelines for the POMR and must include: 1. Client identification 2. Patient signalment 3. Presenting complaint(s) 4. History 5. Physical examination 6. Clinical pathology tests performed and results 7. Diagnostic imaging procedures and interpretation 8. Tentative diagnosis or rule/outs 9. All treatments including anesthesia records and surgical procedures 10. Progress notes 11. Medications administered 12. Client instructions and other client communications including release forms 13. Client and referring veterinarian communications 14. All entries in the medical record should clearly identify the individual(s) responsible for administering care and entering data. Continuing Education Continuing education must be provided for professional and technical staff and must allow: veterinarians and technicians to comply with CE requirements for state licensure. veterinarians to meet specialty board CE requirements to maintain certification technicians to meet CE requirements of their respective certification and licensing boards All veterinarians should obtain at least 30 hours of accredited 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 of emergency and critical care medicine. Technicians should receive at least 24 hours of continuing education in the field of emergency and critical care medicine every two years. A system of ongoing, inservice training should be provided for veterinarians and technical staff to assure teamwork and familiarity with current procedures and guidelines. All facilities should maintain a library containing current textbooks, periodicals and, ideally, electronic data sources and Internet access. Emergency Capabilities The level of care and maintenance provided in areas of laboratory, pharmacy, medicine, surgery,

12 radiology, diagnostic imaging, anesthesiology, infectious diseases control, and housekeeping should be consistent with currently accepted practice and procedures for a veterinary emergency and critical care facilities and comply with state, federal, and provincial directives. Instrumentation, pharmaceuticals, and supplies should be sufficient for the practice of medicine and surgery at a level of care consistent with that expected in the practice of veterinary medicine as directed by the individual country, state or province practice acts. Emergency facilities should have procedures in-place to quickly obtain specialist consults and to refer cases as appropriate. All emergency facilities should have the capacity to perform the following: 1. Diagnosis and management of life-threatening emergencies including cardiovascular, respiratory, and neurological problems to include: a) cardiopulmonary resuscitation including electrical defibrillation b) placement and maintenance of thoracostomy tubes, c) emergency tracheostomy and tracheostomy tube care, d) oxygen supplementation, e) assisted ventilation. 2. Monitoring capabilities should include: a) electrocardiogram, b) arterial blood pressure, c) central venous pressure, d) pulse oximetry, e) esophageal stethoscope. 3. Emergency surgery including: a) surgical hemostasis, wound debridement and application of wound dressings, b) stabilization of musculo-skeletal injuries, c) aseptic thoracic, abdominal, and neurosurgery, or d) be able to refer to a facility that can perform these procedures in a timely manner. 4. Treatment of circulatory shock using crystalloids, colloids and blood products and equipment such as calibrated burettes or infusion pumps to allow accurate delivery of fluids. Facilities should have natural and/or artificial blood products and the capacity to type and cross match donor and patient blood. 5. Anesthetic and analgesic therapy to include opiates, non-steroidal medication, and inhalational anesthesia. Intra-operative monitoring should include an electrocardiogram, esophageal stethoscope, blood pressure monitor and pulse oximetry when appropriate. 6. Laboratory functions: Perform in a timely manner a) a complete blood count, BUN, refractometric total solids, blood glucose, urinalysis, b) activated clotting time, c), electrolyte measurements (Na, K, Cl), d) FIV/FeLV serology, e) cytology, f) heartworm testing, and g) fecal examination (flotation, cytology and parvovirus antigen test). Additionally, an emergency facility must have laboratory supplies to collect, prepare, and preserve samples for a complete serum biochemical profile, blood gas analysis, full coagulation profiles, microbiological culture, and histopathology. 7. Imaging: a) Produce good quality radiographs while ensuring the safety of patient and staff. A radiographic machine of at least 300 ma and an automatic film processor are highly recommended. b) On-site ultrasonography capability is highly recommended 8. Have or have ready access to endoscopy. PART 2: MINIMUM GUIDELINES FOR A VETERINARY EMERGENCY AND CRITICAL CARE CENTER Emergency and Critical Care Centers must meet all the previous requirements as well as the following: 1. Be able to serially monitor a CBC, full serum biochemical profile, coagulation screen and blood gases on site. 2. Monitor direct arterial blood pressure and end tidal carbon dioxide concentration. 3. Perform peritoneal or pleural dialysis. 4. Have the ability to provide enteral and parenteral nutrition. 5. Perform long-term mechanical assisted ventilation.