Residency Training Program Application Packet

Revised Sept 2014 Residency Training Program Application Packet

GENERAL: In order to begin residency or fellowship training in emergency and critical care, each Mentor must have in place an approved Residency Training Program for his or her applicants. Approved Residency Training Programs are comprised of a: 1. Mentor 2. Residency Training Plan 3. Residency Training Facility For each Mentor, up to 3 residents/fellows may be trained at any time under a single, approved Residency Training Program, as long as all trainees are using the same approved Residency Training Facility and Residency Training Plan. In addition, Mentors who work together in the same facility may use the same Residency Training Plan and Residency Training Facility applications for their respective Programs. However, if flexibility is needed for the applicant’s training, each of the Mentor’s trainees may have a separate Residency Training Plan. In this case, the Mentor may have up to three approved Residency Training Programs (but may only have a total of 3 active residents at any time). A new Residency Training Program Application Packet must be submitted for the following situations: (a.) If a Residency Training Plan for a potential applicant will differ from the Mentor’s previously approved Residency Training Plan (b.) All new Programs Approval of the Residency Training Program (Plan, Mentor, & Facility) is required before an applicant may commence training or register with the ACVECC Executive Secretary as an emergency/critical care resident or fellow. Documents required for a Residency Training Program Application include:  Signed Mentor Agreement form  Residency Training Plan Application  Residency Training Facility Application

If the trainee is entering into a Mentor’s pre-approved Residency Training Program, only a Registration Form must be submitted. All new Residents, Fellows, and Mentors must submit the Registration form to the Executive Secretary; by or before February 1st for programs starting in January; by or before August 1st for programs starting in July.

Annual updates of the Residency Training Program and Residency Training Facility must be completed to maintain ACVECC approval. Any major changes to the Program or Facility need to be submitted immediately to the Executive Secretary. Included in this Residency Training Program Application packet are the following documents:  Application for Residency Training Plan  Application for Residency Training Facility  Mentor Agreement form  Guidelines for Veterinary Emergency and Critical Care Facilities In addition, the following documents will be needed after approval of the Residency Training Program:  Annual Update for Residency Training Program & Residency Training Facility  Major Change to Residency Training Program Form Application for Residency Training Plan

This Proposal is for a Residency or Fellowship Training Plan. (Circle or Bold)

Is the Residency Training Program for which this Plan is proposed combined with residency training in another specialty (e.g., ACVIM, ACVA)? Yes No (Circle or Bold)

If Yes, which specialty?

The proposed duration of Training Program (minimum 3 years for Residency, 2 years for Fellowship; maximum 6 years) is: Years

Proposed Resident/Fellow start date (month, day, year):*

Proposed Resident/Fellow end date (month, day, year):

Note: Standard start date is either January 15 or July 15; however, alternate start dates will be considered by the Residency Training Committee: Alternative Requested Residency Training Plan inception date (month, day, year):

*Residents/Fellows cannot be recruited until the Residency Training Program (Facility and Plan) has been approved and the Mentorship Agreement received by the Residency Training Committee.

Residents may receive Emergency and Critical Care Immersion with ACVECC diplomate supervision at any approved Residency Training Facility. For each approved Residency Training Facility in which the Program will provide E/CC Immersion, list the affiliated Residency Training Facility Administrator (see page 19 of the 2014 Standards). Also indicate the approximate percentage time or number of weeks the Resident(s)/Fellow(s) will spend in E/CC Immersion at the facility. Primary Approved Facility for Administrator e-mail % time or # weeks Program

Additional Approved Administrator e-mail % time or # weeks Facilities

Revised Sept 2014 At least one Mentor must be named for the Plan and Program. Mentor(s) associated with this Residency Training Plan at the Primary Approved Residency Training Facility include:

If any of the above Mentors will not participate as a Supervisor for Immersion in Emergency and Critical Care for at least 8 weeks of Residency Training annually, place an asterisk by the name(s), and please attach a document proposing how this/these Mentor(s) will contribute to the Residency Training Program.

Additional Supervisor(s) for Immersion in Emergency and Critical Care associated with this Residency Training Plan who are not listed above as Mentor(s) for the Program:

Additional ACVECC Supervisors Approved Residency Training Facility

PLAN OVERVIEW

Each Residency Training Plan must consist of the following components for residents/fellows: 1. ACVECC Immersion  72 weeks/60 weeks 2. Specialty Immersion  22 weeks/variable (fellows waive weeks of their specialty) 3. Independent Study  35 weeks/12 weeks

A. Plan for Emergency and Critical Care Immersion Weeks  All weeks will be 40 hours minimum, and will be supervised for 20 hours minimum as detailed in the Standards and Guidelines.  All weeks will occur at a Residency Training Facility approved in advance by the Residency Training Committee.  Minimum 72 weeks for Residents, 60 weeks for Fellows.

 Yes − 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.

Revised Sept 2014 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 2014 Standards.  When a Supervisor is board certified in more that one specialty, it is expected that s/he will practice primarily the one specialty for which the Resident or Fellow is receiving credit during that training week.  Supervisors must be legally and locally authorized to practice in the facility where supervision takes place.  22 weeks for Residents; variable for Fellows o Fellows are exempt from weeks in their area(s) of specialty (See the 2014 Standards)

Requirement (# weeks) Specialist(s) already agreed to provide supervision Site / Location Internal Medicine (6)

Surgery (6)*

Anesthesia (2)

Cardiology (2)

Diagnostic Imaging (2)

Neurology (2)**

Ophthalmology (2)

* See September 2014 Standards p. 9 for alternate option for 2 weeks of Surgery ** See September 2014 Standards p. 9 for alternate option for Large Animal Residents/Fellows

C. Plans for Completing Additional Requirements  Seminars, Continuing Education, & Coursework (p. 10 of Sept 2014 Standards)  Fellowships require the first two requirements, while residencies may combine any two out of the three. Please check the appropriate boxes:  This Plan includes a minimum of 200 hours (fellows 100 hours) Seminars  This Plan includes a minimum of 16 hours per year (fellows 16 hrs/yr) Continuing Education  This Plan includes a minimum of 50 hours Coursework

Revised Sept 2014 Attach an addendum (not to exceed one page total) detailing the plan for completion of Additional Requirements.

D. Plans for Completing Teaching and Lecture Requirements

Attach an addendum (not to exceed one page total) detailing the plan for completion of the Teaching and Lecture Requirements (p. 11 of Sept. 2014 Residency Training Standards)

E. Year-by-Year Plan

Requirement Year 1 Year 2 Year 3 Year 4 Year 5

E/CC Immersion (weeks)

Independent Study (weeks)

Internal Medicine (weeks)

Surgery (weeks)

Anesthesia (weeks)

Cardiology (weeks)

Diagnostic Imaging (weeks)

Neurology (weeks)

Ophthalmology (weeks)

Other rotations or vacation (weeks)

Total Weeks for each year

Seminars (hours)

Continuing Education (hours)

-or- Coursework (hours)

Didactic Teaching (hours)

Laboratory Teaching (hours)

Revised Sept 2014 Application for Residency Training Facility

 Please read the Residency Training Standards (published September 2014) and refer to the attached “Guidelines for Veterinary Emergency and Critical Care Facilities” for assistance with completion of this Application.

Name of Facility:

Name of Facility Administrator (see 9/14 Standards p. 19):

Physical Address of Facility:

Mailing Address of Facility, if different than above:

Phone number: Fax number: Administrator: e-mail address:

All Approved Residency Training Facilities must be affiliated with at least one ACVECC Diplomate who is licensed and authorized to practice in the facility as a staff specialist. This individual must be in attendance ‘full time.’ Full time for this purpose is defined as a minimum of 40 weeks per year. Who is the affiliated diplomate for this facility?

List the name(s) of all ACVECC Diplomates employed primarily at this facility who will provide E/CC Immersion Supervision at this Facility.

1. 2. 3. 4. 5. 6. 7. 8.

Revised Sept 2014 List the name(s) of any ACVECC Diplomates who will provide E/CC Immersion Supervision at this Facility who are not employed primarily at this Facility:

ACVECC Diplomate Supervisor Place of primary employment 1 . 2. 3.

Please indicate the number of Diplomates in each of the following specialties who will be available for Resident or Fellow interaction and/or supervision at the Facility. Individuals with multiple board certifications may be counted twice, as long as they actively practice all the specialties for which they’re counted. However, each immersion week for residents may only be counted towards one requirement, even if the supervisor has multiple board certifications.

ACVA or ECVAA (Anesthesiology) ACVIM (or ECVIM) – Cardiology ACVIM (or ECVIM) – Internal Medicine* ACVIM (or ECVN) – Neurology ACVIM (or ECVIM) – Oncology ACVN - Nutrition ACVO (or ECVO) - Ophthalmology ACVR (or ECVDI) - Diagnostic Imaging ACVR - Radiation Oncology ACVS (or ECVS) - Surgery

Other specialties pertinent to the Residency Training Plan(s) associated with this Facility.

*Facilities for training small animal E/CC Residents and Fellows should list only small animal internists, and those training large animal E/CC Residents and Fellows should list only large animal internists. If this Application is for a combined small and large animal Facility, please indicate the number of large animal internists and small animal internists under “Other.”

Does this Facility remain open for emergency appointments and hospitalize inpatients 24 hours a day, 7 days a week?

Yes No (Circle or Bold)

Revised Sept 2014 Please check one of the following two boxes regarding the Proposed Residency Training Facility, in reference to the Guidelines for Veterinary Emergency and Critical Care Facilities:

 This Facility meets or exceeds the Minimum Guidelines for a “Veterinary Emergency and Critical Care Center” (Part 2).

 This Facility does not meet the Minimum Guidelines for a “Veterinary Emergency and Critical Care Center” (Part 2). I have attached a document (not to exceed one page) listing the Facility’s deficits and the exact plans to bring the Facility up to Guideline standards prior to the initiation of training, including a timeline. I will confirm compliance with the Guidelines in writing to the Residency Training Committee within 30 days of the date of this application.

Required References

Each Residency Training Facility is required to provide the Required References listed in the Knowledge Requirements on-site, and to make all Required References available to trainees 24 hours a day, 7 days a week. The most recent version of the Knowledge Requirements is available at www.acvecc.org under the Training Guidelines section.

Please check one of the following two boxes regarding availability of Required References at the Proposed Residency Training Facility:

 This Facility has available to trainees at all times at least the minimum Required References as detailed in the most recent version of the Knowledge Requirements.

 This Facility does not have available to trainees at all times at least the minimum Required References as detailed in the most recent version of the Knowledge Requirements. I have attached a document (not to exceed one page) listing the Facility’s deficits and the exact plans to acquire the missing Required References prior to the initiation of training, including a timeline. I will confirm compliance in writing to the Residency Training Committee within 30 days of the date of this application.

Revised Sept 2014 Each Residency Training Facility is required to provide on site internet access to the common veterinary and human medical databases to trainees 24 hours a day, 7 days a week.

List internet resources available to trainees 24 hours a day:

List other medical Facilities or resources available to trainees (human medical schools or centers, medical libraries, etc.) – List only those resources to which the trainee(s) actually have access, not just to those geographically nearby the Facility:

Revised Sept 2014 Mentorship Agreement

I agree that for all of my residents and/or fellows, as Program Mentor, I:  and the registering resident must complete and submit the ACVECC Resident/Fellow registration form and required registration fee to the executive secretary within 30 days of initiation of training.  will ensure that the resident or fellow’s schedule is consistent with the Residency Training Plan approved for this Residency Training Program.  will be available to the resident or fellow on a continuing basis.  must remain an ACVECC member in good standing for the duration of my resident or fellow’s training in order to remain his/her Mentor.  will directly oversee the approved Residency Training Plan, monitor my resident or fellow’s progress, and ensure that both the Core Curriculum and Spirit (high standards) are accomplished.  will meet with the resident or fellow at least once every 3 months to evaluate his/her progress through the Program.  will accept ultimate responsibility for the quality and educational experiences of the residency or fellowship, including the quality of supervision by other Diplomates.  will review and critique the resident or fellow’s annual progress report, knowledge & experience requirements, skills log, and training benchmarks (as required).  will report any major change in the Residency Training Program or Facility immediately to the Residency Training Committee.  am responsible for informing the Credentials Committee of the resident or fellow’s progress on an annual basis.  am responsible for signing a letter at the time of credential application verifying the resident or fellow’s successful completion of all aspects of the program.  will act as (or ensure that another individual acts as) the Residency Training Facility Administrator to ensure that all administrative tasks and communication with ACVECC are completed in a correct and timely manner.  will continue to work with the candidate until s/he is successful in passing the certifying examination and achieves Diplomate status, or for as long as is mutually agreeable.

Mentor Name: ______

Mentor Signature: ______Date

For ACVECC Use:

Received by: ______Date: ______

Approved by: ______Date: ______

Revised Sept 2014 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 patient referral if necessary. To avoid confusion on the part of the general public and to provide guidelines for consistency in the designation of Veterinary Communications Emergency Facilities, the following nomenclature is suggested Good communications must be maintained to allow efficient which is consistent with the AVMA guidelines. The veterinary transfer Emergency and Critical Care Society (VECCS) recommends that of patient information between the emergency facility and primary the following terminology be used when referring to emergency care veterinarians. It is highly recommended that the emergency service and facilities. facility have all the clinic and home telephone numbers of primary care veterinarians. A report should be sent to the primary care Emergency Service: The category of service provided should be veterinarian in a timely manner to ensure immediate continuity of clearly evident to the public. care and for inclusion in the patient's permanent record. Veterinary Emergency Service - A veterinary service with a veterinarian on the premises during all hours of Medical Records A complete and thorough medical record on file operation receiving and managing emergency cases. for each patient should be kept at the emergency facility. The Medical record must follow AVMA guidelines for the POMR On-Call Veterinary Emergency Service - A veterinary and must include: service on-call or available to receive and manage 1. Client identification emergency cases as requested if veterinarian is available. 2. Patient signalment Does not have constant coverage by a veterinarian 3. Presenting complaint(s) during all hours of operation. 4. History 5. Physical examination Emergency Facility: A veterinary facility with the primary and 6. Clinical pathology tests performed and results dedicated function of receiving and managing emergency patients 7. Diagnostic imaging procedures and interpretation during its specified hours of operation. 8. Tentative diagnosis or rule/outs Emergency Clinic -A facility that is specifically 9. All treatments including anesthesia records and surgical operated, staffed and equipped to provide emergency procedures service. Most patients are treated on an outpatient 10. Progress notes basis. The specified hours of operation are expected to 11. Medications administered be other than the normal business hours of general 12. Client instructions and other client communications veterinary practices. Patients are transferred to the including release forms primary care veterinarian the next workday. 13. Client and referring veterinarian communications Emergency Hospital - Emergency facility similar to an 14. All entries in the medical record should clearly identify the individual(s) responsible for administering care and Emergency Clinic but with more advanced capabilities entering data. enabling hospitalization and management of multiple critical patients. Continuing Education Continuing education must be provided for Emergency/Critical Care Center - A facility professional and technical staff and must allow: specifically designated to be operated, staffed and veterinarians and technicians to comply with CE equipped (in accordance with Parts 1 and 2 of these requirements for state licensure. guidelines) 24 hours a day to provide a broad range of veterinary emergency and critical care service. It is veterinarians to meet specialty board CE requirements suggested that professional staff include board certified to maintain certification specialists and veterinary technician specialists technicians to meet CE requirements of their respective (AVECCT). Centers that share a facility with a certification and licensing boards specialty practice or primary care practice must provide All veterinarians should obtain at least 30 hours of accredited staffing and equipment to ensure appropriate emergency continuing education every two years in the field of emergency and and critical patient care. 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 PART 1: MINIMUM GUIDELINES FOR A VETERINARY receive at least 24 hours of continuing education in the field of EMERGENCY FACILITY emergency and critical care medicine every two years. A system of Staffing ongoing, in service training should be provided for veterinarians During the specified hours of operation a licensed veterinarian and technical staff to assure teamwork and familiarity with current should be on the premises at all times and sufficient staff must be procedures and guidelines. All facilities should maintain a library available to provide expedient patient care. Staffing should be containing current textbooks, periodicals and, ideally, electronic sufficient to allow: data sources and Internet access. Processing multiple patients Performance of a wide range of life-saving procedures to Emergency Capabilities The level of care and maintenance provided in areas of laboratory, pharmacy, medicine, surgery, include but not be limited to cardiopulmonary radiology, diagnostic imaging, anesthesiology, infectious diseases resuscitation and emergency surgery. This requires at control, and housekeeping should be consistent with currently least three people, including one veterinarian and one accepted practice and procedures for a veterinary emergency and veterinary technician. critical care facilities and comply with state, federal, and provincial Appropriate and timely consultation with veterinary directives. Instrumentation, pharmaceuticals, and supplies should specialists. A close association with a Diplomate of the be sufficient for the practice of medicine and surgery at a level of American College of Veterinary Emergency and Critical care Care, or other veterinary diplomates with a special consistent with that expected in the practice of veterinary medicine interest and experience in emergency and critical care is as directed by the individual country, state or province practice recommended to optimize patient care and facilitate acts. Revised Sept 2014 Emergency facilities should have procedures in-place to quickly 6. Laboratory functions: Perform in a timely manner a) a obtain specialist consults and to refer cases as appropriate. complete blood count, BUN, refractometric total solids, All emergency facilities should have the capacity to perform the blood glucose, urinalysis, b) activated clotting time, c), following: electrolyte measurements (Na, K, Cl), d) FIV/FeLV 1. Diagnosis and management of life-threatening serology, e) cytology, f) heartworm testing, and g) fecal emergencies including cardiovascular, respiratory, and examination (flotation, cytology and parvovirus antigen neurological problems to include: a) cardiopulmonary test). Additionally, an emergency facility must have resuscitation including electrical defibrillation b) laboratory supplies to collect, prepare, and preserve placement and maintenance of thoracostomy tubes, c) samples for a complete serum biochemical profile, emergency tracheostomy and tracheostomy tube care, d) blood gas analysis, full coagulation profiles, oxygen supplementation, e) assisted ventilation. microbiological culture, and histopathology. 2. Monitoring capabilities should include: a) 7. Imaging: a) Produce good quality radiographs while electrocardiogram, b) arterial blood pressure, c) central ensuring the safety of patient and staff. A radiographic venous pressure, d) pulse oximetry, e) esophageal machine of at least 300 mA and an automatic film stethoscope. processor are highly recommended. b) On-site 3. Emergency surgery including: a) surgical hemostasis, ultrasonography capability is highly recommended wound debridement and application of wound 8. Have or have ready access to endoscopy. 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 PART 2: MINIMUM GUIDELINES FOR A VETERINARY procedures in a timely manner. EMERGENCY AND CRITICAL CARE CENTER 4. Treatment of circulatory shock using crystalloids, Emergency and Critical Care Centers must meet all the previous colloids and blood products and equipment such as requirements as well as the following: calibrated burettes or infusion pumps to allow accurate 1. Be able to serially monitor a CBC, full serum delivery of fluids. Facilities should have natural and/or biochemical profile, coagulation screen and blood gases artificial blood products and the capacity to type and on site. cross match donor and patient blood. 2. Monitor direct arterial blood pressure and end tidal 5. Anesthetic and analgesic therapy to include opiates, carbon dioxide concentration. non-steroidal medication, and inhalational anesthesia. 3. Perform peritoneal or pleural dialysis. Intra-operative monitoring should include an 4. Have the ability to provide enteral and parenteral electrocardiogram, esophageal stethoscope, blood nutrition. pressure monitor and pulse oximetry when appropriate. 5. Perform long-term mechanical assisted ventilation.

Revised Sept 2014