acgme • accreditation d ata sys t em (ads) ... program application webads workbook... ·...
TRANSCRIPT
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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
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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)
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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
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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:
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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•
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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 •
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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.
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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
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ACGME - Accreditation Data System (ADS) https://apps.acgme.org/ads/Programs/29104/0veral IEvaluation/Overal IE ...
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•· 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)
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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.
.:
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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:
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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•
•
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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.
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Concloo Summary of Role/Reaponelblllll•• In Pn>gram
Ml11tng lrtfomwtJon
Cum>nt Profoulonal AotMtlee I Commltteta
t•flulnu lnfonn1UOn
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! Add
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Alld
15
ACGME- Accreditation Data System (ADS) https://apps.acgme.orgf ads/Programs/29104/F acuity /3 5 5590/PacultyCV? ... Personal 1nrormali0<
Ora4ua1e MediceJ Educatior
Llcemures
Acedcmie Appointment'
Concise Summll)' of Role/Resf)Of1$1bilities in Progrtm
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Ptt•H list the most rtprtseniaUve , .. , Revfewtd Publlc1Uon1 / .lowmel AniclH trom ttie lesa 6 yff rs, with 1 llmfl of 10. St puAtt ..urtts With a double llne brHk. Do •ot leave blanlc.11 none, please .. ter NONE. ..
Cumnl Proressional Activitie: I Comminees Mtulng lnfonnatton
Bibliographi.,
Anic;les Add :
Patticip:nion in LOC41 Regional M<I N01i°'1al Artlclea A<:livilies I Presen1a1ions I AbsL'aCIS I Grants
PJut.t llt uttctad Nvfitw anfcktt. chapters andlot Nldbc>oks koin the pm I ytltS, wfth a llmtt of 10. Sepenta entttts "'*It a dot1We Uhe bft•k. Do •ol ... Vt bl1nk. If 11:01t, plM .. tnMir NONE.
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Partl<:lp11ton In Loca~ Regional and National ActMUta I Preaentattona I Ab8ttacta I Grante
P-.ue !lat p1rtlclpttton In local, regtonaC and naUonet Ktivtttellpre-Hfltatfons frota the past 5year5, with a Mmlt of 10. hparate .ntrles wt\t. a
douW. llM bruk. Do not tN.ve bll.nk. If none.. pttut enter NOHE.
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ACGME - Accreditation Data System (ADS)
Application Oveivlew Program v
- Fiiter by Type -
Last First
Faculty v
Year In
Program
Sponsored Program.a
Residents v
Status
J\ «:l 2015 Aoeradltatlon Council for Graduate Medlcal EducaUon (ACGMEj
https ://apps.acgrne.org/ads/Progratns/29104/Residents/Residents
Silo l/lslls Reports
Sites
+Add Realdent I
QPmil
Start End
Ol$p/aytng o or o ,.•••>Jf•J
Logout
A Applicatlon Incomplete
Review Steps
Resident Status Legend ....
Missing Information
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
Physician Faculty I
Resident•:
1 0 o.o
Coro Phyalcl1n F1cully I 0.0: 0.0
Resldanta:
Actual Ratio
Physician Faculty I I O O
Real dents:
C«<1 Phyolclan Faculty I 0 0.0
Rosldenta:
Program Director is not
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
<S.Cl<To-..t>
Add Resident
1. Resident lnformatton
Date of Blrtll:
Type of medic.I school ffom Mlkh tt\1• r.·sWent gradu1tod:
Select 1M fypo of med!c:ol sdlool
AV.;tllo:J..lla MtldlcetSc:hooJS!
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2. Resident Status
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-Ratidonl&oois
3. Rtaldent Oetalla
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N•Uon11 Pro\'ldtr ID:
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4. Comments
L<lQout
! None
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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
+AddSlle I c;R=i
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 ...
Ad4 Participating Site
PrlNlf)' TMchlng Sb;
(nttgr1ted:
"'v .. (;No
R""hd Rotation: o Ye$
o No
Do 111 rulckftta n>tllo th<OIAgh thl< <Ito?
o Yes
.. No
Program l.tttt of Agretment (PlA) ex.l:t.tt botwe.en prognim an.d alt•?
"'v .. '.I No
"' NIA (site under govemonee of sponso<tng ""1/lullon)
Rotation Months Y1 Y2
Distance to Primary Teaching FacllKy
MUt1 Minutes
YC YS
Which of the foll0..C119 ai. 1vlilablt within your lnrt«ullon for r .. ld1nts (chocic all lh1tapply):
a Sk>Ol>ingRoomo
e Show«
~ So.curt ll'HI (tock.,. ort0oms Cht\een b& loct<od)
n carotlfla ~ VendiL'!Q machfntt
0 Par1<1ng \\!thin 5 mlnulel offedllly
d v.lfi
" None ol llle AboVe
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MCanul Save Sfte
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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.