ACVR Diagnostic Imaging Residency Training Program Annual Update

Annual Update Form

Purpose: To provide current information to ACVR and the Diagnostic Imaging Residency Standards and Evaluation Committee (DI-RSEC) on the status of each radiology residency training program.

This form is to be completed by January 31st of each year. The form should be completed by the radiology residency program director. The form will be reviewed by DI-RSEC and any questions and/or concerns from the committee will be forwarded to the program director.

Date

Institution Name*

Residency Program Director Name*

First NameLast Name

Residency Program Director Email*

example@example.com

What is the actual imaging caseload at the primary institution over the past the past 12 months?

How does this caseload compare to previous years? *

(e.g. increased by x%, decreased by x%, or similar within x%)

Please list current diagnostic imaging residents in your program:

List all residents who have successfully completed the training program in the past year.

Please list all post-trainee(s) from your program who have completed their residency but have not yet passed the certifying board exam.

Please list all Radiology diplomates involved in the training program, including the program director. Note any changes involving training diplomates since the last update, including those that have already been communicated to DI-RSEC over the course of the previous year.

Please list any changes in the facility and/or equipment available to the residents:

Please list any changes to affiliate agreements that are in place for this residency program. Upload a copy of new affiliate agreements as needed.

Upload new affiliate agreements:

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List any changes to the resident clinical duty schedule (e.g. time with each modality, special training like cardiology, or off clinics/research/study time, etc.).

Please list any changes in the resident's schedule for rounds, seminars, conferences, journal clubs, etc:

YesNo

If the answer is no, please explain:

List any residents who have withdrawn from the program in the last year. Indicate whether the withdrawal was due to transfer or resignation and provide a brief explanation of the circumstances for the withdrawal.

YesNo

If no, please explain:

List the current members of the resident's review committee:

List the mechanisms in place to protect your resident if conflict arise: