ComACC Self-Study Submission, 2023

ComACC Self-Study Submission, 2023
Date

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1. Create your self-study by completing the fields on each page. You can expand the sections by clicking on the session title.

2. By clicking the “next” button at the bottom of each page, the form will be automatically saved for you to continue working on later (simply exit the browser - you won't see a "Save" button).

3. You can continue on your self-study submission at another time using the second Form session link in the email from JotForm.

4. When you complete the self-study, click "Submit" at the end of the form. You will receive an email confirmation (to the email you enter in the contact form) with a PDF of your self-study.

5. When you upload documents, you will not be able to test the link until you click "Submit" at the end of the submission.

6. If you experience issues with uploading forms please contact Kamisha Johnson-Davis, PhD (kamisha.johnson-davis@aruplab.com)
Cover Letter
A cover letter, on institutional letterhead, must accompany the self -study materials and address the following items: Permission to release the results of the accreditation ion process to the National Registry for Clinical Chemistry (NRCC) and the American Board of Clinical Chemistry (ABCC) for the purpose of exam eligibility for the trainee; Permission to review evaluation forms of the trainees and the program for the purpose of evaluating the completeness of such evaluations as a component of the program; Permission to conduct a one-day on-site visit, if applicable; Acknowledgement of fees: $1,000 for the application and, if applicable, $3,500 for the on-site visit to be invoiced after the on-site visit The cover letter must include the following signatures: Director (and any Co-Director) of the Clinical Chemistry Fellowship ; Representative of the Division if different from above; Representative of the Department (Chair) ; Representatives of the Institution (GME Director, Dean, etc.) if applicable

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Fellowship Details
Fellowship Director

and Program Coordinator
Director Contact*

First NameLast Name
Email*
Other Contact Person*

First NameLast Name
Email*
example@example.com
Fellowship Demographics
Fellowship Program Institution Name
Contact Phone Number*

Area CodePhone Number
Contact Fax Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Program Perspective
Briefly describe your program's mission and goals.
Summarize your program's accomplishments and future plans (established programs only)

Program Organization
Outline institutional administrative framework and where the program fits in the structure
Upload Organizational Chart Here

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If there is external fellowship training outside of the parent institution, describe the scope of the training and any associated agreements.
If you have a file that describes external training sties, upload it here:

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Faculty
Program Director

First NameLast Name
Co-Director (If Applicable)

First NameLast Name
Description of program director(s), including years of experience and certification status.

Key Faculty Roles in the Program - if there are more than 10, please include a complete list in the separate upload field below.

	Faculty Name	Degree, Certification	Role in Program	Approx. % Time Devoted
Faculty 1
Faculty 2
Faculty 3
Faculty 4
Faculty 5
Faculty 6
Faculty 7
Faculty 8
Faculty 9
Faculty 10

Faculty List if greater than ten faculty

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Upload faculty CVs. MUST use NIH style format, no longer than 4 pages.

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Institutional Support
Source of salary support, amount of said support, and any additional financial benefits provided to Fellow(s), e.g., book funds or travel funds.
Description of physical office space provided and location of the space in relation to Pathology Residents or other Fellows within the department.
Learning/teaching resources available, e.g., computers, IPads, library and journal access and access to LIS and/or EMR systems.
Any additional teaching/learning resources utilized, e.g., online or specific didactic courses at the parent or other institutions?
Upload any relevant documents here:

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Laboratory Facilities
Describe laboratory facilities. If training is provided in other disciplines such as hematology, microbiology, or molecular diagnostics, a brief description of instrumentation in those areas should be included.
Upload a list of clinical laboratory equipment at the parent institution and any other laboratories where the Fellow trains (should include all clinical chemistry instrumentation).

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Provide a URL/link to the online test catalog (if available)
Upload a copy of the test catalog if an online version is not available.

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Curriculum
Full description of the program curriculum and how the structure leads to achievement of the programs goals, how the Fellow(s) spend their time, and how learning progresses throughout the training period.
Upload examples of any formal courses, didactic sessions, seminar series, or conferences that are required or recommended.

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Description of clinical on-call process and documentation, e.g., written or electronic logs and/or reviews of the trainee's performance.
Upload an example of a call-log.

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Describe the goals and objectives for an acting directorship.

Trainee Selection
Describe the recruitment process for fellowship positions and selection of trainees and specific application requirements.
Upload examples of forms used in the application process

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Evaluations
Trainee evaluation - Detailed outline of the process
Upload examples of any forms used in trainee evaluation

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Program evaluation - Detailed outline of process by which trainees can provide feedback on the program structure and content. If a formal faculty review/self-assessment of the program occurs, this process and any associated outcomes should also be provided.
Upload any examples of forms used in program/faculty evaluation.

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Trainees
Current Trainees - List current trainees and their status in the program
Full CVs for all current trainees.

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Upload a list of past trainees, their certification status, and their current positions.

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ComACC Self-Study Submission, 2023

Fellowship Details

Program Perspective

Program Organization

Faculty

Institutional Support

Laboratory Facilities

Curriculum

Trainee Selection

Evaluations

Trainees