Suggested ADULT PIF Changes s1

NEUROCRITICAL CARE PROGRAM ACCREDITATION APPLICATION PROGRAM INFORMATION FORM (PIF)

FOR NEW APPLICATIONS ONLY

Revised: 10-08-2007

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 PIF form. 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.

NAME OF PRIMARY INSTITUTION:

For Programs that currently have fellows: Please continue with the application instructions. For Programs that currently do not have fellows, the following instructions apply: Newly established fellowship programs or programs without existing fellows, with minor exceptions, must meet the same standards and provide the same information as programs that have currently enrolled fellows. The entire PIF should be completed. It is assumed that new programs will have developed the required policies and plans to train fellows to a standard defined by the requirements. In sections related to policy, the specific language should be included. In sections related to planned activities such as the didactic curriculum, rotations, etc., the specific details of those activities should be described to a level that would allow the AC to evaluate their probable success. In the limited areas where information is simply not available, e.g., number of graduates, you should mark that section as "N/A" (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 [email protected]. 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.

UCNS Program Accreditation Application Page 1 of 20 Neurocritical Care September 2007 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(s) from Department Chair(s) of the participating institution(s) (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 areas; list of other lectures Appendix E: list of neurocritical care 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. 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. QUESTIONS

Contact the UCNS Executive Office with questions: UCNS Executive Office, 1080 Montreal Ave., St. Paul, MN 55116 Tel: 651-695-2750 Fax: 651-361-4850 E-mail: [email protected].

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/accreditation/application/. UCNS Program Accreditation Application Page 2 of 20 Neurocritical Care September 2007 I. TABLE OF CONTENTS

Section 1 General Program Information 1.A Accreditation Information 1.B Program Director Information 2 Institutions 3 Fellows 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 3.F Scholarly Activity 4 Personnel 4.A Program Director 4.B Program Teaching Staff—Neurocritical Care 4.C Other Teaching Staff 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 8 Evaluation 8.A Fellow Evaluation 8.B Program Evaluation 8.C Curriculum Development 8.D Curriculum Evaluation 9 Signatures 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 Neurocritical Care meetings attended by fellows Appendix F: list of research projects by fellows Appendix G: list of publications by fellows

PROGRAM INFORMATION FORM (PIF)

UCNS Program Accreditation Application Page 3 of 20 Neurocritical Care September 2007 SECTION 1. GENERAL PROGRAM INFORMATION

A. Accreditation Information

Date: Name of Primary Institution: Title of Program: Does your program currently have fellows? 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 staff member of the sponsoring institution? YES NO Does the Program Director hold a current license to practice medicine in the state of YES NO the sponsoring institution? PD based at primary teaching institution? YES NO Number of hours per week PD spends in: (Do NOT use percentages) Clinical Administration: Research: Didactics/Teaching: Supervision: Is PD also Department Chair? YES NO If No, Chair Name:

UCNS Program Accreditation Application Page 4 of 20 Neurocritical Care September 2007 SECTION 2. INSTITUTIONS (Program Requirements II, A, B)

SPONSORING INSTITUTION: (Institution #1) (The university, hospital, or foundation that has ultimate responsibility for this program and must meet the current ACGME Institutional Requirements.) 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):

Name of Individual Responsible for Oversight of Training at this Institution (Program Director): Does SPONSOR have an affiliation with a medical school (could be the sponsoring YES NO institution)? 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: Type of Institution: (e.g., Teaching Hospital, General Hospital, Medical School): Ownership Type: (e.g., State, Corporation, Church):

PARTICIPATING INSTITUTION (Institution #3) If more than one participating institution, e-mail [email protected]. Name: Address: City, State, Zip Code: Distance between Miles: Minutes: Institutions 1 & 2: Type of Rotation Elective Required Both (select one) Length of Fellows Rotation (in months) Year 1: Year 2: Name of Individual Responsible for Oversight of Training at This Institution (Program Director): Type of Institution: (e.g., Teaching Hospital, General Hospital, Medical School): Ownership Type: (e.g., State, Corporation, Church): Brief Educational Rationale for Use of This Institution:

UCNS Program Accreditation Application Page 5 of 20 Neurocritical Care September 2007 RELATED CORE PROGRAM IN 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:

SECTION 3. FELLOWS

A. Number of Positions (For the current academic year)

Positions Year 1 Year 2 Total Number of Requested Positions Number of Filled Positions*

Date Last Fellow Completed this Program (if total Number of Filled Positions = 0)*: *Not applicable to programs with no fellows on duty.

Note: the total number of fellows in years 1 and 2 should not exceed the total number of full-time faculty for the fellowship program.

B. Actively Enrolled Fellows (if applicable) (Program Requirements III)

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 *UCNS Board Prior GME Name Medical School *ABPN Certified? Eligible upon training graduation? YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO

*Completed ACGME-approved residency in Neurology, Neurological Surgery, Internal Medicine, Anesthesiology, Surgery, or Emergency Medicine.

UCNS Program Accreditation Application Page 6 of 20 Neurocritical Care September 2007 YEAR TWO *UCNS Board Name Medical School Medical School *ABPN Certified? Eligible upon graduation? YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO

C. Aggregate Data on Fellows Completing or Leaving the Program for the Last Three (3) Years (if applicable)

June 30, June 30, June 30, Based in academic year ending: (indicate year) (indicate year) (indicate year) Number of Graduates Number of Fellows Who Withdrew from the Program* Number of Fellows Who Transferred Out of the Program Number of Fellows on Leave of Absence from the

Program Number of Fellows Dismissed from the Program

*Please provide reason(s) for fellows who left the program in the last three years (e.g., withdrawn, transferred, leave of absence, or dismissed).

UCNS Program Accreditation Application Page 7 of 20 Neurocritical Care September 2007 D. Fellows Completing Program in the Last Three Years (if applicable). List fellows who have 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 Certified? YES NO YES NO YES NO

List fellows who have completed all training for this subspecialty based on the academic year ending June 30, .

E. Scholarly Activity (if applicable)

Based on Academic Year Ending June 30, . June 30, . June 30, . Number of Nationally Peer-Reviewed Published Articles

Authored or Co-Authored by Fellows during the Year Number of Fellow Presentations at Regional or National

Meetings in the Year

SECTION 4. FACULTY AND PERSONNEL

A. Program Director (Program Requirements IV, A, B)

1. Describe the Program Director’s qualifications in Neurocritical Care

Indicate appropriate qualifications, including a description of the Program Director’s clinical on-service time in an ICU environment. This should include the number of years of experience in caring for a neurocritical care patient population, the average number of weeks on-service per year, the average number of patients seen per day, how the ICU team is organized (i.e. residents, NPs, nurses, pharmacists), and a description of how evening and weekend coverage is arranged.

2. List the Program Director’s educational experience and abilities

Examples should be submitted documenting the Program Director’s prior and ongoing experience teaching, lecturing, or writing on topics related to neurocritical care as well as experience in administration of educational

UCNS Program Accreditation Application Page 8 of 20 Neurocritical Care September 2007 programs.

3. List the Program Director’s CME activities related to neurocritical care or critical care medicine in general in past three years

4. Is the Program Director ABMS or RCPSC certified in his/her primary specialty? YES NO If not, please indicate appropriate educational qualifications.

5. Is the Program Director certified by the UCNS in neurocritical care or possess appropriate equivalent qualifications? YES NO

6. List the Program Director’s research projects and innovation related to neurocritical care.

Examples may include research that he/she has participated in, meetings attended or journals regularly read, or ICU based management protocols that he/she has developed or implemented.

7. Is the Program Director a full-time staff member of the sponsoring institution? YES NO

8. Is the Program Director licensed to practice in the state where the institution that sponsors the program is located? YES NO

9. 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.

UCNS Program Accreditation Application Page 9 of 20 Neurocritical Care September 2007 B. Program Teaching Staff—Neurocritical Care (Program Requirements IV, C, D, E, F

List all members of the program responsible for training in the ICU setting. Program teaching staff refers to faculty intensivists who supervise fellows in the daily practice of neurocritical care. For those with dual appointments, identify primary appointment (neurology or other department) in parentheses.

See Section 2 for institution numbers.

Privileges If Part-Time Name, Degree, Title and Position at State Current Full-Time* and Role in Curriculum Institution Wks/ Hrs/ Certification** #1,2,3,4 Yr 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 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.

If additional rows are needed to list more than 20 faculty, please e-mail [email protected].

*Full-time member of the staff of the institution

**Indicate if certified by ABMS or RCPSC and the specialties in which certified.

UCNS Program Accreditation Application Page 10 of 20 Neurocritical Care September 2007 C. Other Teaching Staff

List other teaching staff (non-intensivists) regularly involved in teaching fellows, including consultants and basic science faculty. Examples of other teaching staff may include neurosurgeons or anesthesiologists who train fellows for specific procedural competencies, or neurological subspecialists (i.e., stroke, epilepsy, or neuromuscular diseases) who provide training for specific aspects of the Neurocritical Care Core Curriculum. Note their department, title and certifying credentials, and supervisory responsibilities to the program.

See Section 2 for institution numbers. Privileges If Part-time, Title and Position at State Current Name, Degree and Role in Full-Time Institution Wks/ Hrs/ Certification* Curriculum #1,2,3,4 Yr 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

Attach a 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 [email protected].

UCNS Program Accreditation Application Page 11 of 20 Neurocritical Care September 2007 SECTION 5. FACILITIES AND RESOURCES (Program Requirements V, G)

A. Facilities

1. Facilities and resources for training

See Section 2 for institution numbers. Are the following office space and resources available?

Inst Inst Inst Inst Faculty and Resources 1 2 3 4 YES YES YES YES a. Neurocritical Care Faculty Offices and Facilities NO NO NO NO b. Fellow Offices and Resources YES YES YES YES Does each fellow have his/her own office? NO NO NO NO YES YES YES YES Are the offices for groups of fellows? NO NO NO NO Do the fellows have access to administrative YES YES YES YES support? NO NO NO NO Does the fellow have access to other office YES YES YES YES equipment such as copiers, slide projectors, NO NO NO NO PowerPoint, video projector equipment or technology services for slide presentations, illustration services? YES YES YES YES c. Dedicated Neuro-ICU Facilities NO NO NO NO YES YES YES YES d. General Medical-Surgical ICU Facilities NO NO NO NO YES YES YES YES e. Emergency Room Facilities NO NO NO NO YES YES YES YES f. TCD/Doppler Laboratory NO NO NO NO YES YES YES YES g. 24-Hour CT NO NO NO NO YES YES YES YES h. MRI Scanner NO NO NO NO YES YES YES YES i. Parenchymal ICP Monitors NO NO NO NO YES YES YES YES i. Continuous EEG monitoring NO NO NO NO

2. Briefly describe conference facilities at each institution that will be used for Neurocritical Care conferences.

3. Briefly describe the space provided for Neurocritical Care program faculty and fellow research at each institution. (Program Requirements V, F)

UCNS Program Accreditation Application Page 12 of 20 Neurocritical Care September 2007 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?

Inst Inst Inst Inst Library Facilities 1 2 3 4 a. Journals YES YES YES YES Access to Medline NO NO NO NO YES YES YES YES b. Computer databases available NO NO NO NO YES YES YES YES Access in hospital NO NO NO NO YES YES YES YES Access in library NO NO NO NO YES YES YES YES 24 hour access NO NO NO NO YES YES YES YES Access to major texts and full text journals NO NO NO NO YES YES YES YES Internet search capabilities NO NO NO NO YES YES YES YES c. Library available on site NO NO NO NO Library with major texts in all areas of medicine YES YES YES YES on site or nearby NO NO NO NO YES YES YES YES Interlibrary loan capability NO NO NO NO YES YES YES YES Textbook availability NO NO NO NO YES YES YES YES Major neurocritical care texts on wards NO NO NO NO YES YES YES YES Major neurocritical care texts in clinic NO NO NO NO YES YES YES YES Teleconference capability NO NO NO NO

UCNS Program Accreditation Application Page 13 of 20 Neurocritical Care September 2007 SECTION 6. EDUCATIONAL PROGRAM

A. Curriculum

Describe in block form the typical curriculum for fellows by months, not weeks, including the institution (#1, 2, 3, 4) as listed in Section 2. If your program uses another interval (e.g. 4 week blocks rather than calendar months) for block rotations you should adjust the table accordingly to show 13 columns.

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.

Note that a minimum of 12 months’ experience as a member of a team providing primary ICU or appropriate room/OR/PACU care is a requirement for UCNS accreditation.

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 Time Commitment/Week in Half Amount Of Time in Months (e.g. 40 Type Of Experience Number Of Weeks/Year Days Half Days=1 Month)*

*Longitudinal amount of time MUST equal 100%.

UCNS Program Accreditation Application Page 14 of 20 Neurocritical Care September 2007 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 Amount Of Time in Months (e.g. 40 Type Of Experience Time Commitment/Week in Half Days Number Of Weeks/Year Half Days=1 Month)*

*Longitudinal amount of time MUST equal 100%.

UCNS Program Accreditation Application Page 15 of 20 Neurocritical Care September 2007 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 the conference. Indicate which conferences are mandatory for fellows.

2. Attach a list of the courses, conferences and/or lectures given in each of the other areas required in the program (Appendix D).

3. Attach a list of lectures not already supplied, such as lectures by visiting neuroscientists (Appendix D).

4. 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 the organizational features of the ICU itself, including whether the practice environment is a dedicated neurological or multi-specialty unit, whether the admission and coverage model is open or closed, a description of the patient population that is cared for (i.e. stroke, trauma), and the role of consulting services from other specialties.

3. 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 16 of 20 Neurocritical Care September 2007 4. Clinical Components (Program Requirements V, D)

How are experiences structured? Provide the amount of time required.

TYPE OF EXPERIENCE LOCATION IN AMOUNT OF THE PROGRAM TIME ICU (primary team) ICU (consultative) Inpatient step-down or intermediate care unit (primary team) Inpatient floor service (primary team) Inpatient consultation (including rapid response teams) Emergency room experiences Operating room or post-anesthesia recovery room Outpatient clinic Other

Tally block rotations by months (or 4 week blocks, if applicable) without subtracting imbedded longitudinal experiences. Count longitudinal experiences by converting to months (see above). Grand total may exceed 12 months.

5. Identify for each fellow if he/she has provider and/or instructor experience for each of the certifications listed.

FELLOW TYPE OF SUPPORT* PROVIDER INSTRUCTOR ACLS YES NO YES NO ATLS YES NO YES NO PALS YES NO YES NO FCCS YES NO YES NO ACLS YES NO YES NO ATLS YES NO YES NO PALS YES NO YES NO FCCS YES NO YES NO ACLS YES NO YES NO ATLS YES NO YES NO PALS YES NO YES NO FCCS YES NO YES NO ACLS YES NO YES NO ATLS YES NO YES NO PALS YES NO YES NO FCCS YES NO YES NO ACLS YES NO YES NO ATLS YES NO YES NO PALS YES NO YES NO FCCS YES NO YES NO ACLS YES NO YES NO ATLS YES NO YES NO PALS YES NO YES NO FCCS YES NO YES NO ACLS YES NO YES NO ATLS YES NO YES NO PALS YES NO YES NO FCCS YES NO YES NO

* Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS), Pediatric Advanced Life Support (PALS), Fundamental Critical Care Support (FCCS)

UCNS Program Accreditation Application Page 17 of 20 Neurocritical Care September 2007 6. Document how fellows are provided with direct experience in progressive responsibility for patient management.

7. Core Content

Document how the program addresses the following areas of study. Please refer to the Core Curriculum for Neurocritical Care document for details regarding the content of each section. Educational methods may include didactic teaching sessions, small group seminars, assigned reading, journal clubs, attendance at weekly conferences, bedside teaching, rotations through other subspecialty ICUs, attendance at national meetings and CME events, and other approaches. Please describe how fund of knowledge and competence with procedures are evaluated throughout the course of training.

a. Neurological disease states: pathology, pathophysiology, and therapy

b. General medical disease states: pathology, pathophysiology, and therapy

c. General aspects of critical care (i.e. administration and management principles, ethical and legal aspects of critical care medicine, fundamentals of research methodology)

d. Procedural competencies (please include policies for bedside teaching, number of observed procedures required, and mechanism for faculty sign-off)

D. Educational Policies (Program Requirements V, G)

1. Describe the Program Director’s supervision of fellows at all times.

2. Describe how compliance with ACGME duty hours is maintained. Please submit a copy of the policy on duty hours and a call schedule.

SECTION 7. RESEARCH AND SCHOLARLY ACTIVITY

A. Fellow Meeting Attendance

Comment on how many and how often fellows attend local, regional, and national neurocritical care 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.

UCNS Program Accreditation Application Page 18 of 20 Neurocritical Care September 2007 (not manuscripts submitted or in preparation)

SECTION 8. EVALUATION (Program Requirements VI, A)

A. Fellow Evaluation

1. Describe the methods 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 forms for fellows who have completed the Program. If this is not available, please explain.

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?

6. 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

B. Program Evaluation (Program Requirements VI, C)

Describe the system by which the program is evaluated.

C. Curriculum Development

1. Are written evaluations by fellows used in this process? If not, please explain. YES NO

2. Describe the participation by fellows in this 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.

UCNS Program Accreditation Application Page 19 of 20 Neurocritical Care September 2007 D. 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?

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 651-361-4819. 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.

Neurocritical Care Program Director

Signature: Date:

Department Chair

Signature: Date:

Please use the Appendices A-G template for submitting Appendices A-G.

UCNS Program Accreditation Application Page 20 of 20 Neurocritical Care September 2007