ACVR EDI Residency Program Application

ACVR-EDI Residency Program Application
This application is required for institutions desiring ACVR-EDI accreditation of a new residency training program and for institutions requesting re-accreditation of an existing program.

Before beginning the application process, all applicants should review the most recent version of the ACVR-EDI Residency Program Standards document in detail. Use the Residency Essentials document as a reference when completing the application form, as the contents you provide herein will be evaluated by the Residency Standards and Evaluation Committee (RSEC) against the published standards.

During the application review process, the Chair of the RSEC-EDI may contact the Residency Program Director for additional information or clarification.

The Residency Director of the program is expected to be the primary applicant and contact person for this application.
Name of Residency Program Director (Primary Mentor):*

First NameLast Name
Residency Program Director Email:*
example@example.com
Name of Primary Training Institution*
Traditional Residency ProgramAlternative Residency Program (individualized program for 1 individual)

ACVR-EDI Residency Application
Name of Individual*

First NameLast Name
If approved, what is the proposed start date of this residency program?*

MonthDayYear
Date
Succinctly state the objectives of the training program.*
What is the total length of the training program (in months)?*
What is the anticipated length of supervised clinical training a resident will experience during this program?*
Will the resident(s) in this program be eligible to take the ACVR Preliminary Exam in September of their third year (have completed 30 months of supervised clinical training)?*
What are the responsibilities of the resident(s) during non clinical portions of the program?*

ACVR-EDI Residency Application
When calculating time commitment in this section, you may consider a 100% (full time) duty schedule to consist of 48 weeks per year with 8 hours per day or 40 hours per week.

Please review the Residency Director requirements and responsibilities in the ACVR-EDI Residency Essentials document. Note that the Residency Director will be required to provide at least 24 weeks of clinical duty per year in primary support of residents in this program. Additionally, the Residency Director must be an active ACVR-EDI Diplomate in good standing.

Excluding the Residency Director, please list all training diplomates who will act as Non- Primary Residency Mentors/Diplomates of this residency program. Indicate the approximate number of weeks per year each supervisor will be scheduled on clinical duty with primary support of residents and, if applicable, any specific areas of instructional responsibility.
YesNo
What percentage of the Residency Director's time is committed to the clinical service at the primary training institution?*
How many weeks per year will the Residency Director be on clinical service and teaching residents at the primary training institution?*
Please list all non-radiologist mentors who will be providing training in this residency program. Indicate the approximate amount of time each mentor will be providing to the resident's training program. *
Please upload a CV to demonstrate these mentors area of expertise in equine imaging.*

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ACVR-EDI Residency Application
Please identify one supporting member in each of the specialty colleges listed below that has agreed to support this program. Upon completion of this application, the below individuals will receive an email requesting acknowledgement of their support of this residency program.
ACVIM Diplomate Name*

First NameLast Name
Institution*
Email*
example@example.com
ACVP Diplomate Name*

First NameLast Name
Institution*
Email*
example@example.com
ACVS Diplomate Name*

First NameLast Name
Institution*
Email*
example@example.com
ACVSMR Diplomate Name (not required)

First NameLast Name
Institution
Email
example@example.com
Upload a copy of affiliation agreements with any diplomates located at an external institution (see Affiliation Agreement section at the end of this application)

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ACVR-EDI Residency Application
The ACVR-EDI residents are required to acquire post-graduate training under non-radiologist specialists (3 separation rotations of 40 hours each These rotations should allow regular interactions between the specialist and the diagnostic imaging residents. Please state the specialist name, email and whether the specialist is located on-site at the primary institution or at an external institution. Also, please upload a CV of each specialist demonstrating their area of expertise.
Equine Surgery and Lameness
Name of Specialist*

First NameLast Name
Email of Specialist*
example@example.com
Upload CV*

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Institution/Location of Rotation*
Equine Sports Medicine
Name of Specialist*

First NameLast Name
Email of Specialist*
example@example.com
Upload CV*

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Institution/Location of Rotation*
Equine Internal Medicine and/or Cardiology
Name of Specialist*

First NameLast Name
Email of Specialist*
example@example.com
Upload CV*

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Institution/Location of Rotation*

ACVR-EDI Residency Application
Please provide the following information regarding preliminary and certifying board exam pass rates for residents in your program over the past five years.
Upload a schedule for your residents that outlines their clinical and non-clinical work over the course of the residency program. This may be a master schedule or duty roster for your entire radiology section, if desired.*

If available, an example weekly or monthly rounds schedule can also be included.
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ACVR-EDI Residency Application
Please upload digital copies of any affiliation agreements for the following:
External training diplomates (supervising, supporting)

Agreement letters should include a statement on the scope of their resident training duties.
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External rotations or remote institutional affiliations used to supplement resident imaging caseload numbers, species variety, modalities, or study types.

Agreement letters should include the scope of training and the amount of time the resident will be training with the affiliate institution. If affiliations are required to support resident caseload numbers in any core modality/category (radiology/fluoroscopy, CT, MRI, or US), agreement letters should include the expected number of reports that the individual resident(s) can expect to generate (with radiologist feedback) for cases in those categories over the course of the external rotation or agreement.
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ACVR-EDI Residency Program Application