1

ACGME • Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29104/0verview/Overview

Sponsored Programs Slte Visit• Reports

Application Overview Program v Faculty v Residents v Sites

Program Application

Your program appllcation has been Initiated.

You are now viewing the program application overview page. This page lists the steps that the program

director will be required to complete In order to submit the application.

As the 010, you are now required to complete application steps 1 (participating altos) end 2 (program

director).

Onoe you have completed step 2, an email w ill be sent to the program director with a username and

password for this program. The program director is then responsible for completing the remain ing steps of

the application. You will be able to monit0< the progress of this application by ciiciling Sponsored Programs

and searching for applications within your institution.

Program Appllcatlon Instructions

DIO f Program Director Steps Not Submitted

Step 1: Select the Participating Sites (to be COff!pleted by the DIO): ~

1 slte(s) have been added to this program.

s been selected but needs to review his or her personal information through ADS.

Vlow

View

Program Director Steps Not SUbmltted

Step 3: Update Program Details: A Be sure to update the basic program information including the address.

Step 4: Add Other Program Personnel A You are required to add et least one program coordinator {max 2) You may also add a Co-Program

Direct0< and a Department Chair.

View

View

The following personnel are available to add: Program Coordinator, Department Chair, Co-Program Director

Step 5: Update ACGME Requested/Filled Resident Positions A Enter the number of resident positions being requested by year a.s well as the number of currently

filled poslhons.

Step 6: Update Duty Hour Info A Be sure to update the duty hour information for this program.

Step 7: Update Additional Application Questions A 6 of the 6 required question(s) st~I need to be answered.

Step 8 : Overall Evaluation Methods A

l/iew

l/iew

v.ew

View

Logout

Overview L egend

A Missing Data

~ Sectlon Complete

Reference Materials "'

Journal of GME

0 010 Program Application Guide

2

ACGME - Accreditation Data System (ADS) hrtps://apps.acgme.org/ads/Programs/29104/0verview/Overvlew Please complele the questionalre on the overall evaluation methods used by this program. , .... Step 9: Update Faculty Info A Enter the key faculty wiU11n your program. In addition. complete a CV ror any physician or non·physiclan faculty member that requires one (a "View/Edit cv• button will appear next to faculty members req1Jiring a CV). Please review the Physioian and Non-Physician Faculty Definitlon on the 'faculty' tab for further ciaritication on wtlloh faculty members to enter in1o your roster.

You will not .see a green check mark on this step. The total number of faC1Jlty members entered will differ for

eacn new program -. Step 10: View I Update Residents A Your 0 (0 has indicated that there are residents within this program. Data must be provided for the

residents/fellows currently participating in the program.

Add new rasidnnts by selecting 'Add Resident' from the upper righl•hand coiner on lhe Resident tab.

Step 11: Download and Complete the Specialty Specific Application Oownloaa

Download and complele the MS Word specialty specific appllcation document from the

ACGME website for your specialty.

Once wmpleted, convert It to a PDF to be uploaded with the other application attacl1ments in Step 12.

Step 12: Upload Application Attachments A 9 of the 10 required attachment(s) still need lo be uploaded.

Step 13: Review Appllcatlon

Please review and print a copy of your application for your records Enter any miss1ng Information

that has not yet been entered. You will not be able to submit your application if any of the above steps are

incomplete or there is information missing on your application

Step 14: Verify and Submit Appllc;itlon to 010

View

Arter clicking "Verify Application and Submit to 010" button in the header, your appllcallon wlll be submitted to

your 0 10 for review and final submission. After verification, the 010 will electronlcally submit the application to

the ACGME.. Applications can only be submitted to the 010 by the Program Director. Program Coordinators

canno1 submit new applications.

Once the 010 has submitted your application to the ACGME for finol review It cannot be changed,

altered, or amended.

t} \, CJ 2015 Accredlta1lon Coon(llforGradiJale Meolcal Education (ACGME)

..

. -. ...

3

ACGME - Accreditation Data System (ADS)

Sponsored Progirama Site Visits

Application Overview Program v FaOJlly v Residents v Sites

Ortglnal Accreditation O•t•: No Information CurrenUy Present Accreditation Status: No Information Currenffy Present Accreditation Effective Date: No Information CurrenUy Present Accredited Length of Training: 5 Year(s) Program Fonnat: Standard

Total Approved Resident Positions: No Information Currently Present Total Filled Resident Positions•: 0

Reports

'Total n"e<I will reffect the previous academic year until the annual update is completed for the current academic year.

Last Site Visit Date: No Information Currenlly Present Date of Next Site Visit (Approximate): No tnformatiOn Currently Present Self Study Date: No Information Currently Present

Program Roqulros Prior or Addltlonal Accredited GME Training: No Program Requires Dedicated Research Year Beyond Accredlled Program Length: No

Program Profile

~laltyl••··~~ Sponsoring tnstltullon: DIO Namo

Program Director subject lo RC app<oval

Program Leader&hlp

Program Director Amjad Yaish 00

I j \'\ ~ 2015 AcaediUtlioo Council for Graduate M-e<Jical E<Jucation (ACGME)

https://apps.acgme.org/ads/Programs/29 I 04

Edil lnfo

I +Acid Penonnel

A Appllcatlon Incomplete Review Steps

Addltlonal Requirements

Duly HoursA.oamlng

EAWoomen1

Overall Evalu3tion Method$

Notification Letters

View NotiftC'JlliCn Letters

Reference Matertals

Journal of GME

v

4

ACGME - Accreditation Data System (ADS)

< 8.aok To Pfcor1m-&ummarv

Upd1te Proorom lnlom1aUon

1. Prog(llm Information

Addr.ss Une 1:

Chy: 5tolo:

Pu&IJt Conlact EmaUfOl1'9clot's Extom11 Email:

eiq,,,,.1 Commart(s:

2. Accrodlt~tlon lnfot'111allo"

Pro.oram ~qi.dres O.dlc•t.d Ran•.1cb 'VN.t Beyond Ac.cntdtlld Proo.ram Langth?

<: y ..

• ND

Ptogr.m ~q1Jt,.c Ptlo,r Of AdcflHcn•I Accndlted GM£Trall'llng:

,, r .. • No

https:/ /apps.acgme.org/ads/Programs/29104/Edit/Edlt

Lag out

XCll!loel Save P11>oram

AddronLloe3:

5

ACGME ·Accreditation Data System (ADS) https:/ /apps.acgme.org/ads/Programs/29 J 04/Duty Hours/Edit

<Buck To Progtifm SummsfY

Duey !lour, Patlo~t Safety and wmtno Envl!'Onment Vitw?revlous Years

1. 811.rly d8"rtbe yoU< tJ11i:k up .systtm whn t.llrtlcal ure Tlffds exceed the resld~ts' abllity.

S. BrleAy dtlSC:tlb• holN t.._ program d.t,..ctot .tr.ii b,c:ulty •valuate th• r@Sllfal\l's ablUUes la delemthu.~ f)n>grvssNe •uthotlt)i ftftd l'lllflOtttthl'ky, condltlon1.t lnd1p1n411ttc• and a -.upervlsory

rcJo h' 11a.tien1 care.

Spe<ify tno cri!ona, and kow th• proee .. d!So111 bl' y .. , ol ualnl119

4. Exclod!no C-•lf frwn houio. wlt1.t ts the proj1e-ud •\leriged numbtro' tioura on duty p•r wuk per res.tdanr1 lndusfva or 1U houH c.1111and1JJ '"0011ilghUrtq7

6. OUri"tf re.guSar d•ytlmt Murs, lndlc1te whkh of tM fol\o\lftng back-up liys1em5 your program Wiii tlava in place when c11nlc.at cere nHdl nee.ct th• rntd1nl's lblllity.

Chetk up lo 3 o,Non1,

Phytfolan. • tel lnmedtatn~ .Vjllo.blO (on 1lln)

Plly$!dam •"' evalllb!• ty phone

"' S•o!or Affidenhi 01 F•!lows art ltnme<iately avaUab., (011 ;it•)

Soolor Rt.'fl.lctouts or Fellows ere avol!atlle by pttone

Mld-lovol PrOYlders •r• lom.dl>tofy """'loblo (on ell•)

r M+:d-rtWtHPro\?d'ers ere av~labl8 Cy pttt>ne

No t>ack-up- sy51em

Oiiier

( .. i:it, 6MI#)

6 .. Ourino nights 1.nd WHkends, tnd~at• ~kh of the fOllowk1o t>.adc . .up sys1ems your prbgram wOI ht11e In pl~ce when clfnieai care r1Hd1 ••cMd th• Ntldtnl'S •blllty.

Choe.le up ~o 3 optiQ06

Ptiy!iide.ns 11re lmmedietely .w8"1al>le (on .. e)

Ph'f1idi1ns are eval!abte bf silone

Sil:fltor RetfcNub Of FQlfows 1ua lnwn"tl.t&l11ty av~ablo (an aft•)

1 Sen)« R.eaJdents or FoBowa sre avallatM by phona

• Md-#evel ProyjdeJ& ere hnnedt1teity evaltable (or1 tlte)

< Mld.f&•el PrQvtders are avallabl• W p/\o"" I Nu bat::k·up •1flolfl

· O!her

7. lf!dicttt Whlah rruthod• the program wflt UM to en1-ure ~el tierid.ovu procug;~s feeMltatt bo(h tOfllll\ur._y of t4r• ~d patie~ safety?

Cll•ci< ;ill tll•l •lll>I\'

Hand-over form (a stand e&ono 01 part of .on olodronh: rretJlcal recont tyalom) Pt1per 'harid..ovor fonn

Hind ovor tutort•• (¥.~b-bosod oc soll<l<l•cied)

Scheduled loco.to-fnca hwndoff mn.atlrto•

6

ACGME - Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29104/DutyHours/Edit r-: Oireel (In penon) f1culty ·~Mdon cf hancklver

~r 1fts1rect (V(I ~"'or efectronic means) hanct-over supervision

1•, Senior R"tdM.l supervkion of Jl#\lot ruiderrts

c· H1nd-Ovet education Pf<G'rtm (lectur~)

r· Other

I. tnd1c.a1e Ute ways th.at your progrem wlll educate rutdtnts lO recogntz.e the signs of lallgue and Utep depr1W11Uon.

Clled< all that llJll)!y.

"' Dldedlcs.\.edw•

~"' computer be1td teem~ moduJtt

r Grand rounds

c SrraU group eem:nan Of diWUMlon

n Slmulated patfent encounters

« on....,_Job 1111n;ng

f> Ono~ne expori&neos with faculty and att• nding

>"I Olhtr

-'~--

t . Wlllch of the following opllons wlll tf\t pr09rom or lnstilutlon ofltr r .. ldtnts wtio m1y be too l'lllgued to Mftly relum homo?

Choose the moat frequentt;" ~ oPIJon,

c MOfleyfOfteld

~ Mone'/ tor public tren.portallon ,.. Ono·way tra~llcn eeMco (suth es a dodl~od fad lrty bus seMee)

" Tranaportellon ser.fc• which lnclJd .. ""'°"to return 10 the hosplal or facl9!y the nm day

<" Rer&oce on ocher eta If « reisldenta lo provkle tran6port

4? Sleeping rooms evlllable f0< reskt&nts post call

c Not applcabte: resldonts do not tab In houn eel

" Ottlef -·-10. Wltl ,.sldtn1s et the POY0 2.tevel ot above be JltnNtted to moonlight?

,, YH ?,; No

11. If yff, iinderwhlt e-trcumstenws?

12~ On nuaaa, wtll N1Wtnh h•v• 1 tun day out of 1 fNt from t ducatlonat ud dtnlctl r .. pont lbllttlu?

~ Yes e No

13. Wha1 Will be the maximum number of eon-secutlve nl#hU of nlgh1 Boat tsslgnitd to any ntsldent ln th• pto.Qram?

14. On tM most domuiding rotttlon, whet Yf'ltt both• fro..-ncy of In houM c•H?

If resldonl• at dl!lerenl levels ,.;1 be glVen di""""' lrequondet ol ln-hoUff cell, please cho ... the moll ~equent sched4Jle

" Every seoond night

~ Evorythifdnlghl

,. Evory fourth right

No ln·hqo:le call · Nol AC>pti tnblll

t, Other

(.,..wrb•iowt

15. WUI the program UH ~ul1tory tad/or n:ol\~spttal 1ettlhg1 In tM •d uutlon of rt1idents (uptrlel\Cu olhtr tMn Inpatient)?

e Yes n No

\,,. • • •• 4 •

..... ...

7

ACGME - Accreditation Data System (ADS) 1 f , " ,.., lndlt MO tho typo of -gs IMl w!l bo UHd.

Clleci< 11 lhlt1Pl'i'f.

Hoopltol 8ooed Co<lllo•l1y CUrolo

Coovronty or Fedorol Pl.Cle Hooltll ContllS Ambulotory S11111ory Conlo,. (Surg[Oll « tf*lllly centers)

VolOl'lnO Adm-on fil/(j Ambulolory SeMoos

1 Foculty ""*'iotory Pni.-, 1-nolly Doood

Pltvoll l'llyllcion .. otftcoo

-lory I OlllpMlont , .. "9'

Otlllr ,_._

11. Do you - on olodr.nlc-.. N<Onl., ,_ prlowy IMdlJnt ho..,...I?

https://apps.acgme.org/ads/Programs/29104/DutyHours/&lit

11. n 111, wllM porconlAlfO of yoo< ,.,_ wlll use IM llectn>nlc roodlcol tMonl 1y1tom to ~ve tho -h lo• pop<Mtloo "'potlonto7 • g. d~nlno t~ ~ pn>toool for• epedftc chroNo lln"' sleg•, ......,ng •ymf*M'M or tf~ pi!Hefn1 In em>u41tory clrilc, t~ Pf~•MIY•oer•. ttc.

8

ACGME ·Accreditation Data System (ADS) https://apps.acgme .org/ads/Programs/29104/0veral I Evaluation/Overal IE ...

Sponsonrd Progfanu 1'UoVistts Rupo1ts Logoul

AWllcallon ovo<Vlaw P<ogmm "' F acuity v Residenls v Siles

<Bad( lo Prngram Summary

Overall Evaluation Methods

Tool Instructions

Using lhe tool t111ow (Add melhod)!

o Provide th<I methods o! evaluation used 101 assessing resld6nt/1ellow oompetenoe In eec/\ or Ille six required ACGME competencies

o Jda(lllfy lhe evaluators 101 ""ch m•tllOd (e.g., If porforrnaf)CO In paUem care is swlua1ed at the end of a rotetiOn using a !)1obal form completed by faculty and senior resldanlS/fellcws and also using a checldlsl lo evaluate observed hislones end physicals by !he ward eltenciflQ and coofinuity Clinic prncep1Qr, lhen under pallenl care selad glooal assessm•nl for a melhod 11ocl faCJ.Jlty member and SO!licr resloenVrelloW !Or evaluators and care Thon add patient care again as a competoncy and select direct observation for a ma!hod and attending and preceptor as lhe evaluators)

QPfinl

Methods + Acid Method

Comp•toncy A"UiSn1onl Morhod

lnlerpersanat 8 Commu!l cahn11 ! Anatomic or anir;ial models

!:vatuator(<)

Allied Health Professlonal

Chlef/Supervfs!ng Re~lden\

r· cisrtcal si.tr t Consullanls

E\laluallOl'I Committee

f~ttJlty Memt>er

Junior RudenVMedlcol StlJ<lonl

Nurw

• Other

r Pntion11fDll'lllV MembO(

Peor RO$fdont

Progrnm Ol111clor

Sall

.. Technicians

1. List olhorkay aasesament 1nethods used but not aval11blo In Iha drop dov.'1'1 lllt ~bovo (loavo blal\I< If not apptlcablo).

Cancel Save

2. W!ll Iha prognim hive a system In plaoa to 0V11lu1te the resldunt/follows· abllltles to de1onnlna whether they may t•k• on progrusslvo aulho11ty ond responsibilities In patien t care?

Yes ,. No

3. tndlcato how evaluators are educated lo u1e the assessment methods !Isled above ao that residents/fellows are evaluated fairl y and conslatently. Select up to 3 or the most commonly usad methods.

r., Workshops/specral lra!nlng on assessment

·- '"!ormGI or formal disoossi<>ns amo<19 Iha faculty

¥' AsS9ssment is a topic or a retreat

; ' F acully re~lew assessments and compete evaluations

PO lnalructs ur educates about asseS$111enl inetnodS

Group or comn'liUee discus!Mons Chat rea1J1t In consensus assessment of msideots

Nono. no Sfl';lCiffc educaUon 011 assessmenl ptolnded

Other (specify below)

Spacl ty only If Othe• Is selected

9

ACGME - Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29104/0veral IEvaluation/Overal IE ...

6

•· Indicate how r.aldenWfellows will be Informed of the performance criteria on Which they wlll be evaluated. Check all that apply

t) During resident orientation

r, General goats and objectives

r; Rotatlon·specific goals and objecilVes

r.' Provided handouts or examples of evaluation forms

~ Other written oommunlca!lons

r.1 Vertial communication or m&eUngs

!:f Reviewed with residents before each rotation

!'.> Reviewed with residents at lhe beginning of each year

fl Residents not informed

r.t Other (Sllecily below)

Specify only If Otllet la eelecled

... .

6. Has a Clinic.I Competency Commlttff been selected to perform reeldent/fellow evahiatlons?

QYes<:>No

. ............ ..... .. . ... .~ Alt ...

e. DeaCf111<1 the eyatem wlllch ens urea 11111 faculty wfW complete written eval11&tlone of reeld.,ta/fellowe In a timely manner following each rotaUon or educ1tlon1l expeitence.

J \ O 2015 Acaecllta!lon Councll IOr Gl1lluale Medical l!dvC<ldOn IACGME)

10

ACGME - Accreditation Data System (A DS) https:/ /apps.acgmc.org/ads/Programs/29104/F acuity /F acu I ty

Sponsored Programs Sito Vl1lts Reporu. I

Apphcahon Overview Program v Faculty " Residents"

Faculty Roster Instructions

Fllterfng faculty: The Faculty tab displays all faculty 1n your program, The tab wrn default to 1111 phy!llcl11n faculty. To view non-physicians or inactive faculty, change lhe dropdown menu al tt>e lop 10 filler what displays

Adding Faculty: To add faculty (physician or non-phy~clan) - click the 'Add Faculty' button. For apeciallies that use case logs, DO NOT enter atlendings on this page unless the attending is also a faculty member To add case log a ttendlngs, click the ' Case Log Attend lngs" button oo ltle rlgtlt hand side cf the screen or go to the 'Case Logs tab".

Removing Faculty: If e faculty member is no longer aotlve In the program. click "Edit' next to the faculty membefs narno and enter a "Date Left Program". The factJlty member will then be moved to 'PasVlnootlve

Faculty''.

SortJReordcr on PIF: To sort physidan faculty on the PIF, click the "Reorder" button Thrs s01een will allow you to sort physician !acuity only.

Ptlygfclan/Non-physlclan data entry error: If a faculty member wa& entered In error as a physioian/non­phys!Qan. you can conven the faculty member by clicking "Edit" next to the faculty name and cflcklng the button to ·convwr to physician or non-phystclan.

Core Faculty; For specialties that have a •core• faculty designalion - the core faculty flag is automatically dotermned by t11e tc>lal number or hours the faculty member de1otes to residency program aelivllies. Hours totaling 15 or more will designate the faculty member as core.

Chair or Department: For programs that have a Department Chair, indicate the !acuity member who Is the Department Cha ir by cllcklng "Edit" next lo the facul1y mernbets name (or add a new facutty member) and Indicate "Yes• for the question "Is also Chair of Department?" T his Will remove the Department Chair designation

for any previously seleclecl faculty member

Physician Faculty Definition

Lisi alphabetically and by site all physician !acuity who have a significant role (teaching or mentoring) In \he education of residents/fellows and who have documented qualifications to instruct and supervise. List the Program Director firs\

All physician faculty must: • devote sufficient time to the educational program to fulfill their supervisory and teaching responslb<ilties and demonstrate a s trong interest In resident education;

• administer and maintain en educational environment conducive lo educating residents In each c l iho ACGME competency aroes:

• participate In !acuity development programs designed to enhance the eflediveness or their leaching and to promote scholarly ectlvity; • establish and maintain an environment of inquiry and scholarship with an active research component;

• regularly penlcipate In organized ctlnlcat discussions. rounds. journal clubs, and conferences; • encourage and support residents In pursuing scholarly activities

A por11on or the faculty mus1 be lndleated as core physician faculty All physicians Who devote et least 1 S hours per week to rosidcnt oducallon and administration are designated as core faculty Alt core physician faculty should

teach and advise residents as well as participate in at least 1 of the tollowlng:

• evaluate the competency ciomalns,

• work closaty with and suppon the program director· and

• assist In developing and lmplemen\lng evaluation systems.

Program directors will not oe designated as core faculty.

Continued Accredllalion programs; A CV ls only required for the prol)ram director

Logout

A Application Incomplete

Review Steps

Facu lty Legend

Core F acuity

A Missing Profile Data

!i Missing CV Data

Program Director

~ast I tnactlve Faculty

Faculty Ratio

Reduced Ratio

Phyolcl1n F1cuJty I

Residents:

10 00

C0<e Physician Focully r O o O O

Rocldents:

Actual Ratio

Pbysltlon F•culty I I 0 0

Residents:

Core Physician Fa<:Ulty I 0 DD

Residents:

Program Dlrector is not included in core faculty

Reference Materials

Journal of GME

11

ACGME - Accreditation Data System (ADS) https://apps.acgme.orglads/Programs/29104/Paculty/Faculty

New Applications aild Initial Accreditation programs: A CV is required for the program director and each active physician faculty member that has been designated as a ' Core" faculty member on your roster.

Non.Physician Faculty Deflnltlon

list alphabetically the non-physician faculty who provide required instruction or supervision of residents/fellows in the program. A CV is required for eactl non-physician faculty member on your roster.

Faculty Members

Physician Faculty Search Faculty

Last First Degrees Title

00 Program Direclor

j·~ 02015 Accreditation Council for Graduate Medical Education (ACGME)

~ . .. f'. 'l• .

~

+Add Faculty , ,.., -E-R-e-or-de_r_,I

Disp/1ying 1 of f rocorrf(•J.

.:

12

ACGME. Accreditation Data System (ADS)

11pp1a11on OveMew Program v Faculty v Residents v Sites

<Back To f acuJly

Mlsslng lnioimallOn lor: Spedally r Fleld

Mlutng lnformotlon lor: Medical School

Program Director Chango Roquost •

General tnform1tlon

Salutallon; First Name: 0 Middle 1n11111:

Or.

Oogrooa: O

f DO I Ed• )( 0 01 ...

Tiiie:

Prc>gllm 01111c101

Emall address lo• coinm1.11lc1tlng wtth ACGME:

Natlonal ProvldOf ID:

Emall addreH to be u11d as a aocondll'y point ol contact

Ptiono Number. Extension: -F•a. Number: -Primary lnatffullon:

Date Ftral Appointed F1culty Memt>•r In this program:

July hi 2002 D x

Date Arat Appol..ted Program Director.

l\prtl 161

Tenn of Appointment

lndel'lnlle

Year Started Tuclllng In this Spocl.ity (Orthopaedic s..-gery):

Is also Chair ol Dtpal1ment?

Yo•

• No

Medlcal Sc'1ool

Mltelng lnlormollon

Last Name:

https://apps. acgmc.org/ads/Programs/29 l 04/F aculty /35 5 590/Ed ltF acu lty ...

IC Cancel Complete Request

sumx:

13

ACGME - Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29104/Faculty/355590/EditFaculty ... General lnfonnallUI• of medical schfl:

Medical sc'li:,'0 )0

Se4ect Ille lype cl medical school

Specially I Ficl..-.vallabl• Modlcal Schools:

Foculiy Ho~ Select lho mediall acl1ool

Medk:tl SChool Graduation Year:

Other School Name:

Speclelty I Fleld

MllOlng lnlonnotlon

Faculty Houra

Number of hours per weok l•cully member devotes to this program'• actlvlUea In the followtng:

c•nlcat auporvtalon of rHldent1 O Admlnlatrallon of tho program O , ~ .. Research/Hholuty ocltvtty with resident• 0 DldactlQ/leac:hlng wtlh realdenta 0

Total houra devottd to !hi• program:

0

J \, 0 2015Aoolod111too Councl l'or Groouatt Modlc:OI Educa!lo<l (ACGMEJ

~., ... _.,,. •

+Add

.. ... 1•

•

14

ACGME - Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29104/F aculty/3 5 5590/PaoultyCV? ...

RllflOlt• 1

Faculty CV

M.l•stno larormatlon fo.r. Graduate Mtdh:at EdUeeaon

Mtnh1g lntom:urtion tor: llcomntrun

Mining lnfomieUon for. Ctment Prof-11 Ac!Mllos / Comf!'ltt ...

Mllalng lnloml1Uon far. Pw11dpe11an In Local, Reolanol and Na~onal Adl'lll .. / P1oo&ntaiono / Abeln>e\11 G111ol8

Paraonel Information

N.,,,. •••• TitJ•: Prcoram OktctM o._:oo, Medlc:aJ Sehoot No lnfomt.iton Ctntwnlly PrNer.t OagruOale:

Gr•dunto Modli;al Education

Mtollno tnrannatton

Ucan•un•

MIHing tn.fornutlon

AcadO<lllo Appol-

PfiNw llal the past tel'! )"Hl'5 o.f •cld4tmk: 1ppotnt.m1nt1 (1mploymenl}, b1glnnlrio with your 'urrent pvsttlon.

Ml•ling ~IOIT!11\loo

Concloo Summary of Role/Reaponelblllll•• In Pn>gram

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15

ACGME- Accreditation Data System (ADS) https://apps.acgme.orgf ads/Programs/29104/F acuity /3 5 5590/PacultyCV? ... Personal 1nrormali0<

Ora4ua1e MediceJ Educatior

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16

ACGME - Accreditation Data System (ADS)

Application Oveivlew Program v

- Fiiter by Type -

Last First

Faculty v

Year In

Program

Sponsored Program.a

Residents v

Status

J\ «:l 2015 Aoeradltatlon Council for Graduate Medlcal EducaUon (ACGMEj

https ://apps.acgrne.org/ads/Progratns/29104/Residents/Residents

Silo l/lslls Reports

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Review Steps

Resident Status Legend ....

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Unconfirmed

Resident Aggregate 2016 v

Actlve Residents 0

Year 1: 0 Year2: 0 Year3: 0

Voar 4: 0 ........ 6: 0

Total: I)

Lall. Program: 0 0 Complet.od Training; 0 Inactive: 0

Faculty Ratio v

Reduced Ratio

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1 0 o.o

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Real dents:

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included In core faculty

Reference Materlals I\

Journal of GME

17

ACGME - Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29 I 0 I /Residents/ Add Resident

AppDcaf on Overview Progt111m v F1evtty v Re&idtnls v Sites

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18

A CG ME - Accreditation Data System (A OS) https://apps.acgme.org/ads/P rograms/29104/S ites/Sites?Rell1 rnUrl=https: ...

SPonsored Progr•ms Site Vi&fls Re.ports

Application Overview Program v Faculty v Residents v Sites

< Back To Application Steps

Participating Site Definition

An organizalion (or entity) providing educational experiences or educational assignments/rotations for

residents/fellows. Examples of sites include· a teaching hospital whicl1 indudes its ambulatory dinics and related

facilities. a private medical practi<:e or group practice, a nursing home, a school or public health. a health

department, a federany qualified health center, a public health agency, a health maintenance organization (HMO),

a medical examiner's office, a consortium o r an educational foundation. There may be a need to indicate a silo as

"clinical" In rara oCCllsions. A clinical site exists when the sponsor of a program Is in a different site (location) than

the PRIMARY clinical site out or which the program operates.

Sponsoring Institution Definition

The organization (or entity) that assumes the ultimate financial and academic responsibility for a program of GME.

The sponsoring institution has the primary purpose of providing educational programs and/or health care services

(e.g .. a university, a medical school, a hosp~al, a school of public health, a heatth department, a public hea'lh

agency, an organized health care delivery system, a medical examiner's ollice, a consortium, an educational

foundation).

Clarification: When the sponsoring institution is non-rotation site the major associated hospital is the participating

rotation site. Additk>nally, for multiple ambulatory medical sites under separate ownership from the sponsoring

institution one central or corporate site (and address) must represent the satellite clinics (that are located within 10

miles of the main site).

Block Diagram Upload Complote

f'l Block Diagram Instructions/Sample

The last diagram that the ACGME has on file for your program is from September 10, 2015. You can v iew the file

by clickJng the link below. or you can upload a new PDF diagram using the "Upload" button.

8 View Bloek Diagram

Browse... No file selected. ©Upload

Uploaded files must be in PDF format and be no larger than 10 MB. Other f~o formats, or files larger than 10 MB,

wift not be accepted.

Participating Site Information

# ID Site Nam e

Comments:

Required

Rotation

Yes

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Rotation Months

Y1 Y2 Y3 Y4 Y5

12 12 12 12 12

If the total number of rotaton months per year does not equate to 12 months (for all sites combined) provide an

explanation:

Logout

A Application Incomp lete

Review Steps

Legend

Site Sponsor

Primary Teaching Site

Missing Data

; Referen ce Materials

Journal of GME

19

ACGME- Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29 I 0 I /Sites/ AddNewSite?Return U ...

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20

Guide to Construction of a Block Diagram

A block diagram is a representation of the rotation schedule for a resident in a given post­graduate year. It offers information on the type, location, length, and variety of rotations for that year. The block diagram shows the rotations a resident would have in a given year; it does not represent the order in which they occur. There should be only one block diagram for each year of education. The block diagram should not include resident names.

• Create and upload a PDF of your program's block diagram using the information below as a guide. If needed, additional information to aid in understanding your program's block diagram may be entered in a "Notes" section at the end of the Block Diagram Data Collection Form. If your program has already prepared a block diagram or follows an established institutional format, there is no need to change your document to follow this format. The general information reported should be the same, however. Once you have uploaded your program's block diagram, a new one should be uploaded only if there is a substantive change.

• Two common models of the block diagram exist: the first is organized by month; and the second divides the year into 13 four-week blocks. Rotations may span several of these time segments, particularly for subspecialty programs. Both models must indicate how vacation time is taken. This can be done by allocating a time block to vacation, or by indicating this in a "Notes" section accompanying the block diagram. Examples of other less common models are also provided below.

• In constructing the block diagram, include the part.icipating site in which a rotation takes place, as well as the name of the rotation. If the name of the rotation does not clearly indicate the nature of the rotation, then clarifying information should be provided as a footnote to the block diagram or elsewhere in the document.

• Group the rotations by site. For example, list all of the rotations in Site 1 first, followed by alt of the rotations in Site 2, etc. The site numbers listed in the Accreditation Data System (ADS) should be used to create the block diagram.

• When "elective" time is shown in the block diagram, the choice of elective rotations available for residents should be listed below the diagram. Elective rotations do not require a participating site.

• Clinical rotations for some specialties may also include structured outpatient time. For each rotation, the percentage of time the resident spends in outpatient activities should be noted.

• Clinical rotations for some specialties may also include structured research time. The fourth line of the schedule should be used to represent the percentage of time devoted to structured research on a clinical rotation . If a block is purely research, it should be labeled as such, and should not be associated with a participating site.

21

Sample Block Diagrams

Pl Block Diagram 1 In this example. the year's rotations are divided into 12 (presumably one-month) clinical rotations. Rotations may include

structured ou111atient or research time and electives. Block 1 2 3 4 5 6 7 a 9 10 11 12 Site Site 1 Site 1 Site 1 Site 1 Site 1 Site2 Site2 Site 2 Site2 Site3 Site 3

Rotation Name Wards Wards ER CCU ICU Wards ER ICU Clinic Wards Clinic Elec/Vac

% Outpatient 20 20 100 0 0 40 100 0 100 20 100

% Research 0 0 0 0 0 0 0 0 0 0 0

C1J Block Diagram 2 In this example, the year's rotations are divided into 13 equal (presumably four-week) dinical rotations. Rotations may

include structured outno:itient or res.earch bme, and electives.. Block 1 2 3 4 5 6 7 a 9 10 11 12 13

Site Site 1 Site 1 Site 1 Site 1 Sile 1 Site2 Site 2 Site2 Site2 Site3 Site3 Site 3

Rotation Name Wards Wards ER CCU ICU Wards Wards ICU Clinic Wards Wards Clinic ElecNac

% Outpatient 30 30 100 0 0 20 20 0 100 0 0 100 o/, Research 0 0 0 0 0 0 0 0 0 0 0 0

(1)

Block Diagram 3 In this example, the year's rotations are divided into six blocks of equal duration. One of the blocks is used for an elective, which can be chosen from a list of elective rotations and a vacation month

Block 1

Site Site 1 Rotation Name CCU % Outpatient 0 % Research 0

Possible electives: Cardiology Inpatient Site 1 Cardiology Outpatient Site 2 Pulmonary Disease Inpatient Sile 2

2 Site 1

Med. Outpt 100

0

3 4

Slte2 Site2 Wards ER

0 100

0 0

Pulmonary Disease Outpatient Site 3 Gastroenterology Inpatient Site 3 Gastroenterology outpatient Site 1

5 6 Site3 Wards ElectiveNacation

0 0

c•> Block Diagram 4 In this example for a subspecialty program, the year's rotations are divided into four equal blocks. Structured research time

comprises 40% of the resident's time on the specialty outpatient month. There is one three-month block devoted entirely to research

Block 1 2 3 4

Site Site 1 Site2 Site2

Rotation Name Specialty Outpatient Soecialty Outpatient Wards Research

% Outpatient 100 100 0 % Research 0 40 0 100

(11 In any block diagram, there must be a fonnal auocatlon tor vacation time. If not shown Jn the block diagram, a "Notes• se<:tlon must Indicate how vacallon time Is taken.