ACVR-RO Residency Program One-Time Re-Approval Application

ACVR-RO Residency Program One-Time Re-Approval Application
In April 2020, ACVR Executive Council approved updated radiation oncology residency training requirements outlined in RO Residency Program Essential Training Standards and Requirements. Residency programs approved before April 2020 that are not able to immediately implement these new requirements are eligible to apply for a one-time re-approval of the current program to include one more cycle of residents (i.e. one more year of resident enrollment with the program being on probation while that/those resident(s) complete their program). After that, submission of a new program application is required.

ONE-TIME RE-APPROVAL INSTRUCTIONS:

The application must be received by January 31st of the third year following initial program approval / last re-approval. The RO RSEC will evaluate the application and a vote will be taken. The results of the vote and the majority recommendation of the committee will be forwarded to the President of the Recognized Veterinary Specialty for consideration by Executive Council at one of the two annual meetings.

For the required ACVR and ACVIM (Oncology) Diplomates, please provide a brief, 2-page curriculum vitae up-to-date within one year.

When filling out the application, the first full page of information is entered and you hit next, the form will automatically save the information entered to the emailed link for the submitter to stop and start the application with the emailed link. Once a page is started it must be completed and next hit for that page to save.

ACVR-RO Residency Program One-Time Re-Approval Application
1. Date of Application

MonthDayYear
Date of Initial Program Approval

MonthDayYear
Date
Date of Last Re-Approval

MonthDayYear
Date
Your Name

First NameLast Name
Your Email Address
example@example.com
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2. Program Director:

Must be a Diplomate of ACVR Recognized Veterinary Specialty of Radiation Oncology.
For institutions with only one RO Diplomate, please describe how you will be participating in resident training and overseeing his/her patient care while off clinics?
Additional ACVR-RO Diplomates supporting the program (not Program Directors)
YesNo
Upload CVs of the Program Director and any supporting Radiation Oncologists:

Browse Files

Cancelof
Residents
YesNo

ACVR-RO Residency Program One-Time Re-Approval Application
The following conditions define an Alternative Program:
- If the program is not at least a minimum two-year continuous radiation oncology training program which fulfills all the trainee requirements of the training program guidelines, it will be defined as an Alternative Program.
- If exemption from any other requirement for a Standard program is requested in the application, the program must be submitted as an Alternative Program.
Standard ProgramAlternative Program
5. Primary Site:
Hospital/University:
Department:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cooperating Institution Information
6. Cooperating Institution (if applicable):
Department:
Hospital/University:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
For cooperating institutions, attach current letters of agreement signed on behalf of the institutions by appropriate individual(s):

Upload a File

Cancelof
Cooperating Institution (if applicable):
Department:
Hospital/University:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
For cooperating institutions, attach current letters of agreement signed on behalf of the institutions by appropriate individual(s):

Upload a File

Cancelof
Cooperating Institution (if applicable):
Department:
Hospital/University:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
For cooperating institutions, attach current letters of agreement signed on behalf of the institutions by appropriate individual(s):

Upload a File

Cancelof
Cooperating Institution (if applicable):
Department:
Hospital/University:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
For cooperating institutions, attach current letters of agreement signed on behalf of the institutions by appropriate individual(s):

Upload a File

Cancelof

ACVR-RO Residency Program One-Time Re-Approval Application
Training Period
7. What is the total length of the training program?
Months
YesNo
Number of months dedicated solely to radiation oncology training (excluding time on Medical Oncology service, Radiology/Imaging, etc.)
Months

8. Advanced Degree:

Rows	Yes	No	Optional
Masters
PhD

Upload calendar of resident's activities (24 or 36 month) including required rotations and vacation:

Browse Files

Cancelof

ACVR-RO Residency Program One-Time Re-Approval Application
9. Faculty
Essential Program Faculty:

*If dual-boarded, individual faculty member may serve in only one capacity

*Please list all qualified faculty in support of program
a. Diagnostic Radiologist(s):

Must be Diplomate(s) of the ACVR or ECVDI
How many weeks per year is at least one boarded radiology Diplomate on site and available to a resident on a daily basis?
If off-site, please explain relationship:
Upload CVs (up-to-date within 1 year and maximum of 2 pages each) of diagnostic radiologists listed:

Browse Files

Cancelof
b. Medical Oncologist(s):

Must be Diplomate(s) of the ACVIM, Specialty of Oncology
How many weeks per year is at least one boarded ACVIM-Oncology Diplomate on site and available to a resident on a daily basis?
If off-site, please explain relationship:
Upload CVs (up-to-date within 1 year and maximum of 2 pages each) of medical oncologists listed:

Browse Files

Cancelof
c. Surgeon(s):

Must be Diplomate(s) of the ACVS
How many weeks per year is at least one boarded ACVS Diplomate on site and available to a resident on a daily basis?
If off-site, please explain relationship:
d. Pathologist(s):

Must be Diplomate(s) of the ACVP
How many weeks per year is at least one boarded ACVP Diplomate on site and available to a resident on a daily basis?
If off-site, please explain relationship:
10. All Other Board Certified Specialists:
Please list all additional board certified specialists in direct support of the program. If offsite, please explain relationship:

ACVR-RO Residency Program One-Time Re-approval Application
Course Overview
11. Please describe the role of the radiation oncology resident and the radiation oncology service in the daily clinical management of patients and clients:
12. How will the resident receive training in Medical Oncology? What is the time allotted to this training? Please provide description of formal and informal training experiences as well as description of the resident's role while rotating on a medical oncology service:
13. How will the resident be trained in diagnostic imaging? What time is allotted for this training? Please provide description of formal and informal training experiences:
14. Will the resident be provided with training in anesthesia? If yes, please include a description of the training:
15. How is resident trained in radiation biology? Please provide description of formal and informal training experiences:
16. How is resident be trained in cancer biology? Please provide a description of formal and informal training experiences:
17. How is resident trained in radiation oncology physics? Please provide a description of formal and informal training experiences:
18. Please include a description of the medical physics support available at your institution and any role medical physics support may provide in training of the resident:
19. Please list any formal courses and their instructors included in the residency training curriculum. Please attach syllabi and instructor credentials for each listed course. NOTE: Please ensure syllabi are up-to-date within the last year:
Upload syllabi here:

Browse Files

Cancelof
Upload instructor credentials here:

Browse Files

Cancelof

ACVR-RO Residency Program One-Time Re-Approval Application
Procedures
30. Describe procedures for recording of radiation treatment details of all patients. Is a record and verify system used? If so, please specify.
31. What procedures are in place to facilitate collection of follow up information of patients treated? What is a standard recheck schedule for patients? In the absence of routine patient rechecks at the facility, is there a system in place to obtain follow-up?
32. By what mechanisms and how often will trainees be evaluated? Please comment on radiation therapy specific evaluation as well as general clinical evaluation.
Please upload form used in evaluations.

Browse Files

Cancelof
33. If applicable, please list the residents who have completed the training program within the last five years, including the year that each individual's training program ended. If at all possible, please provide an address, and any information you have on the status of each individual with respect to the board certification process.
34. Please list any additional information of interest in support of this residency application.
Additional Documentation Upload

Browse Files

Cancelof
Should be Empty:

ACVR-RO Residency Program One-Time Re-Approval Application

ACVR-RO Residency Program One-Time Re-Approval Application

2. Program Director:

Additional ACVR-RO Diplomates supporting the program (not Program Directors)

Residents

ACVR-RO Residency Program One-Time Re-Approval Application

Cooperating Institution Information

ACVR-RO Residency Program One-Time Re-Approval Application

Training Period

ACVR-RO Residency Program One-Time Re-Approval Application

9. Faculty

a. Diagnostic Radiologist(s):

b. Medical Oncologist(s):

c. Surgeon(s):

d. Pathologist(s):

10. All Other Board Certified Specialists:

ACVR-RO Residency Program One-Time Re-approval Application

Course Overview

ACVR-RO Residency Program One-Time Re-Approval Application

Ancillary Training Opportunities and Research

ACVR - RO Residency Training Program Re-Approval Application

28. Facilities and Equipment

ACVR-RO Residency Program One-Time Re-Approval Application

Procedures