RESIDENCY TRAINING PROGRAM REGISTRATION
PART A: GENERAL PROGRAM INFORMATION
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Date: |
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Program Leader: |
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Program
Leader’s Contact Information:
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Work Phone: |
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Fax: |
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E-mail: |
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Mailing Address: |
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Please
list the residents currently participating in your training program, along with
the beginning date of the program, and expected ending date of the program.
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Resident Name |
Length of Program |
Start date (mm/dd/yyyy) |
End Date (mm/dd/yyyy) |
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Location of Training Program:
Primary Site:
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Secondary Site
(If applicable):
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Other Sites
(Off-site, if applicable):
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Does your training program
consist of a minimum of 156 weeks?
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Yes |
No |
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Comments: |
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Is this registration for a
standard __________ or alternative
________ program?
PART B: PROGRAM PERSONNEL
Resident Supervisor(s) at Primary Site:
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name |
weeks of clinical anesthesia/year |
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Are each of the Resident Advisors listed above familiar with current Residency Training Program requirements as outlined in the General Information Guide?
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Yes |
No |
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Comments: |
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Does your training program provide on-site residency
training by the required number of supervisors per residency candidate? Preferably, two ACVA or ECVAA Diplomates for one resident;
three ACVA/ECVAA Diplomates for two residents or four ACVA/ECVAA Diplomates for
three residents but acceptable 2, 3 or 4 diplomates for 2, 3 or 4 residents if
100% of all residents’ clinical time will be supervised by a diplomate. If no,
please provide a detailed explanation of the qualifications of other
supervising anesthesiologists.
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Yes |
No |
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Comments: |
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Supervisors at secondary sites:
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NOTE: A Supervising
Diplomate must spend a minimum of 9 weeks of their full
time effort committed to clinical anesthesia responsibilities within the
institution’s veterinary health care facility.
NOTE:
Time spent at a secondary site must not exceed 12 weeks for a program to be
considered a standard residency training program.
PART C:
FACILITY AND RESOURCES
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.)
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Available? |
Location of equipment? |
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Yes |
No |
(On-site or list site name) |
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Anesthetic
delivery systems |
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-small
animals |
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-large
animals |
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Monitoring
equipment |
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-EKG |
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-direct
blood pressure |
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-doppler
blood pressure monitor |
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-oscillometric
blood pressure monitor |
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-capnography |
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-inhalant
agent analyzer |
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-pulse
oximetry |
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-cardiac
output monitor(Thermodilution, lithium dilution) |
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-CVP
measuring capacity |
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-EEG |
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-Neuromuscular
blocking monitoring equipment |
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Fluid
administration devices (fluid pumps, syringe pumps) |
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Ventilators |
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-small
animal anesthesia ventilators |
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-large
animal anesthesia ventilators |
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-Critical
care ventilator |
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Tracheostomy
kits (large and small animals) |
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Defibrillator |
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Ultrasonographic
equipment |
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Color
flow/Doppler equipment |
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Cardiac
catheterization capability |
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Endoscopy
equipment |
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GI equipment |
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Bronchoscopy |
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Clinical
Pathology capabilities: (includes CBC, serum chemistries, blood gases,
urinalysis, cytology, parasitology,
microbiology, and endocrinology) |
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Serum
osmolality measurement |
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Colloid
oncotic pressure measurement |
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Computed
Tomography |
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Magnetic
Resonance Imaging |
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Computerized
Medical Records w/Searching Capabilities |
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Veterinary
Library w/Literature Searching Capabilities |
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Medical
Library w/Literature Searching Capabilities |
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Intensive
Care Facility – 24 hours |
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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.
PART D: EDUCATIONAL PROGRAM
Does each resident in your program spend a minimum of 94 weeks on
anesthesia clinical rotations?
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Yes |
No |
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Comments: |
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Are formal
conferences/seminars/rounds, such as journal club, morbidity/mortality rounds,
or seminars held on a weekly basis?
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Yes |
No |
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Comments: |
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Please provide a brief description of the standard
rounds/meetings/conferences, etc., that are provided and the typical schedule.
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Is
each resident able to or expected to attend an anesthesia related conference
during his/her training program?
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Yes |
No |
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Comments: |
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Is each resident able to participate in an investigation suitable
for publication in the field of anesthesia, pain management or critical care?
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Yes |
No |
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Comments: |
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Signature of Program Leader
_________________________________
Date _______
Signatures of Supervising Faculty:
_____________________________________ Date __________
_____________________________________
Date ___________
_____________________________________
Date ___________