Self-Study Format - JRC-CVT
Joint Review Committee
On Education in Cardiovascular Technology ~ JRC-CVT
Self-Study Report Format
For Programs Seeking
Initial Accreditation
For additional information about JRC-CVT and accreditation services visit:
© Copyright 2009-2013 – All rights reserved
INITIAL-ACCREDITATION SELF-STUDY REPORT (ISSR)
FOR A CARDIOVASCULAR TECHNOLOGY PROGRAM
INSTRUCTIONS
Each program conducts a self-study (process), which culminates in the preparation of a report. The JRC-CVT will use the report and any additional information submitted to assess the program’s degree of compliance with the Standards and Guidelines for Cardiovascular Technology Educational Programs of the Commission on Accreditation of Allied Health Education Programs (CAAHEP) []. The JRC-CVT Executive Office will review the ISSR and any additional documentation for completeness and forward them to the Readers for analysis.
In preparing the self-study report, please respond to the questions carefully and completely. One, combined self study report can be submitted for all concentrations: Invasive Cardiovascular Technology (I), Adult Echocardiography (N), Pediatric Echocardiography (P), Non-Invasive Peripheral Vascular Study(V) and Cardiac Electrophysiology (E). Submit three (3) completed copies.
Electronic copies must be submitted on CD or flash/thumb drive in the format set forth in this document and must include all supporting documents. No paper copies will be accepted.
FEES:
The Application fee, Self Study Report Review fee, and Site Visit Administration fee are all due with submission of the ISSR (see fees).
REPORT FORMAT:
• Type the text of the response for each question.
• Consecutively number each page of the report, including appendices.
• Create separate files on the CD/USB drive for supporting materials. Make sure that the filename is readily recognizable for its content and where it fits in the ISSR.
CAAHEP REQUEST FOR ACCREDITATION SERVICES
Programs must electronically file the CAAHEP Request for Accreditation Services at the time the Initial Accreditation Self Study Report (ISSR) is submitted.
Ctrl-Click here to go to the on-line form. (Internet connection required.)
Submit the CDs/USB drives (and fee payment) to:
Joint Review Committee on Education
in Cardiovascular Technology
1449 Hill Street
Whitinsville, MA 01588-1032
TIMING OF INITIAL ON-SITE REVIEW:
An initial on-site review will be scheduled approximately 4-6 months after approval of the ISSR and additional requested materials, if applicable. The JRC-CVT Site Visit Dates Request form must be completed, copied on to each CD/USB drive, and emailed to the JRC-CVT Executive Office.
Ctrl-Click here for the link to the page with the on-line form.
TITLE PAGE
1. Concentration(s) (check all that apply):
Invasive Cardiovascular Technology (I)
Adult Echocardiography (N)
Pediatric Echocardiography (P)
Non-Invasive Vascular Study (V)
Cardiac Electrophysiology (E)
2. Type of Sponsor:
3. Type of award upon program completion:
(Note: post-secondary academic institution sponsor must award a minimum of an associate degree)
4. Name and address of the sponsoring institution:
Name
Address
City/State/Zip
Voice FAX
E-mail
5. Name and contact information of administration and program key personnel (i.e., Program Director, Medical Director, and Clinical Coordinator, if applicable):
a. Chief Executive Officer (to whom all correspondence will be directed)
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
b. Dean or Comparable Administrator
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
c. Program Director: Concentration(s): I N V E
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
Is the Program Director employed full-time by the sponsor? Yes No
Program Director (if applicable) Concentration(s): I N V E
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
Is the Program Director employed full-time by the sponsor? Yes No
d. Clinical Coordinator (if applicable) Concentration(s): I N V E
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
Is the Clinical Coordinator employed full-time by the sponsor? Yes No
Clinical Coordinator (if applicable) Concentration(s): I N V E
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
Is the Clinical Coordinator employed full-time by the sponsor? Yes No
e. Medical Director(s) Concentration(s): I N V E
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
Co-Medical Director (if applicable) Concentration(s): I N V E
Name
Title
Address
City/State/Zip
Voice FAX
E-mail
6. a. Start date of first class ever
b. Graduation date of the first class:
c. Next graduation date of current class:
7. Name and phone number of person(s) responsible for the preparation of the report:
Name:
Title:
Phone #:
FAX #:
Email:
Name:
Title:
Phone #:
FAX #:
Email:
TABLE OF CONTENTS
For each PART, Appendix, and Attachment indicate the page number.
Copy on to the CD/USB drives: CAAHEP Request for Accreditation Services form and JRC-CVT Site Visit Dates Request form.
|Section |Page |Section |Page |
|PART A: Standard I | |PART D: Standard IV | |
|1. | |3. | |
|2. | |4. | |
|3. | |5. | |
|4. | |6. | |
|5. | | | |
|6. | |PART E: Standard V | |
| | |1. | |
|PART B: Standard II | |2. | |
|1. | |3. | |
|2. | |4. | |
|3. | |5. | |
|4. | |6. | |
|5. | |7. | |
|6. | |8. | |
|7. | |9. | |
|8. | | | |
|9. | |PART F: Supplemental | |
|10. | |1. | |
| | |2. | |
|PART C: Standard III | |3. | |
|1. | |4. | |
|2. | |5. | |
|3. | |6. | |
|4. | |7. | |
|5. | |8. | |
|6. | | | |
|7. | |Appendix A | |
|8. | |Appendix B | |
|9. | |Appendix C | |
|10. | |Appendix D | |
|11. | |Appendix E | |
|12. | |Appendix F | |
|13. | |Appendix G | |
|14 | |Appendix H | |
| | |Appendix I | |
|PART D: Standard IV | |Appendix J | |
|1. | |Appendix K | |
|2. | |Appendix L | |
| | |Appendix M | |
PART A: Sponsorship (Standard I)
1. State the legal name, full address, telephone number, FAX number, and web site address of the program sponsor:
2. State the type of sponsor institution, its current institutional accreditation status, dates of the most recent institutional accreditation, dates of the next institutional accreditation review, and the name of the institutional accreditor:
3. If the sponsor is a consortium:
a. Describe generally the role of each institutional member of the consortium.
b. State the accreditation status, dates of accreditation, and accreditor of each participating institution.
c. Place a copy of the consortium agreement in an electronic folder named Appendix J.
d. Describe the enrollment status of cardiovascular technology students in the educational institution.
4. List the other health professions programs offered by or within this institution.
5. Quote the mission of the sponsoring institution.
6. Briefly discuss the historical development of the program. Include the year the program started and major events that occurred since that date. The major events should include changes in the communities of interest that have had an impact on the goal(s) and/or curriculum of the program.
PART B: Program Goals (Standard II)
1. List the communities of interest served by the program as specified in Standard II.A and any additional communities of interest of the program. Describe the needs and expectations of each of the communities of interest.
2. Describe how the program concentration(s) is/are responsive to the demonstrated needs and expectations of the communities of interest. Describe each concentration separately.
3. List of the individuals and the communities of interest that they represent on the program advisory committee (must include at least one representative from each group stated in the list) (for individuals not on the drop down list, use rows 14-18):
|Member Name |Community of Interest |
|1. |Student |
|2. |Graduate |
|3. |Faculty |
|4. |Sponsor Administration |
|5. |Employer |
|6. |Physician |
|7. |Public |
|8. | |
|9. | |
|10. | |
|11. | |
|12. | |
|13. | |
|14. | |
|15. | |
|16. | |
|17. | |
|18. | |
4. Standard II.C. states the minimum expectation goal as: “To prepare competent entry-level cardiovascular technologists in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains for [each concentration].”
Are there any additional goals to be reviewed for accreditation? Yes No
If yes, describe the methods/process by which the stated goal(s) were developed/adopted:
5. Indicate and describe the methods by which the program ensures that the goal(s) and learning domains will continue to meet the needs and expectations of the communities listed.
Advisory Committee
Employer Surveys
Graduate Surveys
Other, please describe:
6. Describe how the goal(s) and learning domains are utilized in program planning and implementation.
7. Has the advisory committee met at least once? Yes No
If No, please explain:
8. List the dates of all advisory committee meetings in the last 3 calendar years:
9. Place in an electronic folder named Appendix M, a copy of the Minutes of all Advisory Committee meetings in the last 3 years.
10. Describe any special considerations that impact your program characteristics.
PART C: Program Resources (Standard III)
1. Complete at least the first four (4) columns of the Resources Assessment matrix named Appendix A in this document.
2. Place in an electronic folder named Appendix B, a programmatic organizational chart of the sponsoring institution (or consortium) that portrays the administrative relationships under which the program operates. Start with the chief administrative officer. Include all program Personnel and faculty, anyone named in the self-study report, and any other persons who have direct student contact except support science faculty. Include the names and titles of all individuals shown.
3. Explain any relationship in the programmatic organizational chart, which is other than direct line.
4. Place in an electronic folder named Appendix C a CV for each of the program Personnel and any other specialty concentration (track) didactic, laboratory, and clinical faculty members (no support course faculty). Limit to two pages, include education, credentials, and years of professional experience. Delete all publications. Also, include in the Appendix the job descriptions of the Program Director, the Medical Director, and Clinical Coordinator (if applicable).
5. Describe the teaching and administrative loads of each cardiovascular technology faculty member. List the actual number of lecture, laboratory, and/or clinical hours each faculty member teaches in each semester or quarter of the curriculum, as well as any assigned administrative time.
6. For each concentration (as applicable), complete the form named Program Course Requirements Table in Appendix D in this document to list all courses required in the curriculum. For a third concentration, complete the supplemental form from the JRC-CVT web site and place in an electronic folder named Appendix D.
7. How many total active clinical affiliates are used by the program?
Complete a Clinical Affiliate Institutional Data form for each active affiliate in Appendix E in this document. (Use one page for each clinical affiliate. For more than two affiliates, use the supplemental forms from the JRC-CVT web site. The supplemental Appendix E file contains 5 forms. Insert or copy to the CD/USB drive in a folder named Appendix E as many files as necessary to report on all affiliates.)
8. Complete the Student Hospital / Clinical Matrix form for each applicable concentration in Appendix F in this document.
9. List the evaluation methods and the results of those methods by which the program has determined that the content of the curriculum meets the minimum expectations goal and learning domains. (i.e. comparison with the appropriate national guidelines).
10. Analyze/discuss the results of those methods and describe the action plan(s) implemented or projected to be implemented to improve unsatisfactory results.
11. Place in an electronic folder named Appendix G a copy of the syllabi (containing at least the components specified in Standard III.C) of all didactic, laboratory, and clinical courses required in the program curriculum.
12. Describe instructional methodologies utilized and how their appropriateness is ascertained for each type of course in the specialty concentration (track) curriculum. (didactic, laboratory, and clinical).
13. Describe how the instruction is an appropriate sequence of classroom, laboratory, and clinical activities and how the clinical and laboratory activities are integrated with the didactic portion of the program.
14. Describe the type and amount of all planned physician instructional involvement in the program. (not required to be answered)
PART D: Student and Graduate Evaluation / Assessment (Standard IV)
1. Describe the type and frequency of evaluations of students that are conducted in the didactic, laboratory, and clinical components of the program.
2. Describe how student progress is tracked through the didactic, laboratory, and clinical courses and how students are regularly informed of their academic status throughout the program.
3. Describe the process by which the program will track retention/attrition for each entering cohort of students?
4. Describe how the program will survey its graduates using the JRC-CVT survey items within 6 to 12 months after graduation of each graduating cohort?
5. Describe how the program will survey the employers of its graduates using the JRC-CVT survey items within 6 to 12 months after graduation of each graduating cohort?
6. Describe how the program will utilize the outcomes data (i.e. retention, graduate surveys, employer surveys, credentialing examinations) in program evaluation and revision (if warranted)?
PART E: Fair Practices (Standard V)
1. Place in an electronic folder named Appendix H a copy of the most recent college catalogue and any other documents that make known to applicants and students the information specified in Standard V.A.2. Complete the following table listing the location(s) of the disclosures:
|Disclosures |Source Document(s) |Page |
| | |# |
|Accreditation status of the sponsor with mailing address, web | | |
|address, and phone number | | |
|Accreditation status of the program with mailing address, web | | |
|address, and phone number | | |
|Admission policies and practices | | |
|Technical standards (when used) | | |
|Policies on advanced placement | | |
|Policies on transfer of credits | | |
|Policies on credits for experiential learning | | |
|Number of credits required for program completion | | |
|Tuition, fees, and other program costs | | |
|Policies and procedures for student withdrawal | | |
|Policies and procedures for refunds of tuition/fees | | |
Link to on-line catalogue, if applicable:
2. Place in an electronic folder named Appendix I a copy of additional material to be provided to enrolling students that makes known the information specified in Standard V.A.3 and Standards V.B and V.C. Complete the following table listing the location(s) of the disclosures:
|Disclosures |Source Document(s) |Page |
| | |# |
|Academic calendar | | |
|Student grievance procedure | | |
|Criteria for successful completion of each segment of the program | | |
|Criteria for graduation | | |
|Policies and procedures for performing clinical work while enrolled | | |
|in the program | | |
|Non-discrimination policy for student admissions | | |
|Non-discrimination policy for faculty employment | | |
|Policies and procedures for processing faculty grievances | | |
|Policies and procedures to safeguard student health and safety | | |
Link(s) to on-line additional materials, if applicable:
3. a. Describe the current and consistent information about student/graduate achievement that is maintained by the program, and provided upon request.
b. Which of the following outcomes assessments are included in the information described in question E,3,a? (check all that apply)
national credentialing examinations performance
programmatic retention/attrition
graduate satisfaction
employer satisfaction
job (positive) placement
programmatic summative measures
4. Describe methods to be utilized to select or admit students to the program.
5. Describe the assessment(s) by which the program determines that the admissions process is non-discriminatory; is appropriate to the needs of the program, and selects students who will be successful in the curriculum.
6. a. Does the institution have policies and procedures to
ensure compliance with the ADA? Yes No
b. Does the cardiovascular technology program disclose technical
standards in compliance with ADA? Yes No
c. When are students informed of the program’s technical standards?
7. Is there a faculty grievance policy/procedure? Yes No
8. Are grades and credits for courses recorded on a student
transcript and permanently maintained? Yes No
9. Is there a formal affiliation agreement or memorandum of
understanding with all other entities that participate in the
education of the students? Yes No
Copy to the CD/ flash drive in an electronic folder named Appendix L, a signed copy of the agreement for each active clinical affiliation:
Appendix L – number of affiliation agreements submitted:
PART F: Supplementary Information / Materials
1. Program Information
| |Invasive |Non-Invasive |Vascular |Electro-physiology|
| | |/Echo | | |
|a. Maximum class size (capacity) | | | | |
|b. Enrollment 1st year students | | | | |
|c. Enrollment 2nd year students | | | | |
|d. Number of classes enrolled per year | | | | |
|e. Month(s) classes are enrolled (e.g. Sep) | | | | |
|f. # of paid full-time CVT faculty | | | | |
|g. # of paid part-time CVT faculty | | | | |
|h. # of unpaid CVT faculty | | | | |
|i. # of clinical affiliates | | | | |
2. Are students instructed in ionizing radiation? Yes No
3. Are students monitored for exposure to ionizing radiation? Yes No
4. Any incidences of excessive exposure of students? Yes No
5. Are students instructed in contact precautions? Yes No
Program Strengths & Limitations
6. List the program’s areas of strength:
7. List the program’s limitations (areas that need improvement):
8. Describe the action plans developed to correct deficiencies for all areas in need of improvement (i.e. listed in question 7 above):
9. Insert the completed Faculty Evaluation SSR Questionnaires from each paid faculty member (didactic, laboratory, and clinical) and the Medical Director(s) in an electronic folder named Appendix K.
10. Student Evaluation SSR Questionnaires: JRC-CVT will notify each of your students of the availability of an on-line questionnaire that will provide the JRC-CVT with their perspective on various aspects of your program(s). The steps in the process are:
STEP 1: You send an email to office@ with the names and email addresses of each of the students enrolled in each concentration. Group them by concentration, as applicable.
STEP 2: You explain to the students that they will receive an email from office@ with the link to the online questionnaire, and to please complete the questionnaire promptly.
STEP 3: You explain to the students that all responses are submitted directly to the JRC-CVT, and that program will not see any specific responses.
STEP 4: When JRC-CVT sends the email to the students, you will be notified, so that you can remind the students that the JRC-CVT email has been sent, and for them to please complete the questionnaire
LIST OF APPENDICES FOR SELF-STUDY REPORT
APPENDIX A = RESOURCES ASSESSMENT - complete the first 3 blank columns
(either the matrix format or full-page format).
APPENDIX B = Programmatic organizational chart of the sponsoring institution (or consortium) that portrays the administrative relationships under which the program operates
APPENDIX C = Curriculum Vitae of the key personnel (program director, medical director, and clinical coordinator (if applicable); any other specialty track didactic, laboratory, and clinical faculty members (no support course faculty). Limit CVs to two pages, include education, credentials, and years of professional experience and delete all publications. Job descriptions of key personnel.
APPENDIX D = Completed PROGRAM COURSE REQUIREMENTS table
APPENDIX E = Completed CLINICAL AFFILIATE INSTITUTIONAL DATA forms
Blank copies are available at self_study_reports.htm
APPENDIX F = Completed STUDENT HOSPITAL / CLINICAL MATRIX
APPENDIX G = Syllabi of all didactic, laboratory and clinical courses.
APPENDIX H = Copy of the most recent college catalogue and any other documents related to Standard V.A.2.
APPENDIX I = Additional materials (not provided in Appendix H) related to Standard V.A.3. Reference documents and page numbers in Appendix H materials, as applicable.
APPENDIX J = Copy of the sponsor Consortium agreement, if applicable
APPENDIX K = Copies of Faculty Evaluation Self Study Report Questionnaires.
Blank copies are already included in Appendix K for the program director and medical director. For each additional faculty member, download a blank copy of the evaluation, complete it, give it a unique file name, and save to the CD/flash drive. Print each evaluation and insert appropriately in each notebook.
APPENDIX L = Copies of fully signed agreements with all active clinical affiliates.
APPENDIX M = Copies of Minutes of all Advisory Committee meetings for the past 3 years.
APPENDIX A - Resources Assessment
(Matrix Format)
Programs holding Accreditation are required to complete Resource Assessment at least annually (Standard III.D). Programs seeking Initial Accreditation are required to complete at least columns B, C, and D of this matrix (Purpose, Measurement System, and Dates of Measurement) or complete the same information using the alternative full-page forms. Listed Purpose statements and Measurement Systems are minimally required. Programs may write additional Purpose statements and/or add Measurement Systems for resource(s). (see resource survey instruments at
evaluation_systems.htm)
|# |(A) |(B) |(C) |(D) |(E) |(F) |
| | | | | | | |
| | |PURPOSE (S) |MEASUREMENT SYSTEM * |DATE (S) OF MEASUREMENT |RESULTS and ANALYSIS |ACTION PLAN / FOLLOW UP |
| |RESOURCE |(Role(s) of the resource in the|(types of measurements) | |(Include the # meeting the cut score |(What is to be done, Who is responsible, Due |
| | |program) | | |and the # that fell below the cut |Date, Expected result) |
| | | | | |score) | |
|2 |MEDICAL DIRECTOR (S) |Provide input necessary to |1. Program Personnel Resource | | | |
| | |ensure medical components of |Survey | | | |
| | |curriculum, both didactic and |2. Student Resource Survey | | | |
| | |supervised practice, meet | | | | |
| | |current standards of medical | | | | |
| | |practice. | | | | |
| | | | | | | |
| | |Work directly with students | | | | |
| | |sufficiently to verify the | | | | |
| | |adequacy of the educational | | | | |
| | |process. | | | | |
| | | | | | | |
| | | | | | | |
|3 |SUPPORT PERSONNEL |Provide support |1. Program Personnel Resource | | | |
| |(clerical, academic, |personnel/services to ensure |Survey | | | |
| |ancillary) |achievement of program goals |2. Student Resource Survey | | | |
| | |and outcomes (e.g. admissions, | | | | |
| | |registrar, advising, tutoring, | | | | |
| | |clerical) | | | | |
| | | | | | | |
| | | | | | | |
|4 |CURRICULUM |Provide specialty core and |1. Program Personnel Resource | | | |
| | |support courses to ensure the |Survey | | | |
| | |achievement of program goals |2. Student Resource Survey | | | |
| | |and learning domains. | | | | |
| | | | | | | |
| | | | | | | |
|5 |FINANCIAL RESOURCES |Provide fiscal support for |1. Program Personnel Resource | | | |
| |(fiscal support, |personnel, acquisition and |Survey | | | |
| |acquisition /maintenance |maintenance of |2. Student Resource Survey | | | |
| |of equipment /supplies, |equipment/supplies, and | | | | |
| |continuing education) |faculty/staff continuing | | | | |
| | |education. | | | | |
| | | | | | | |
| | | | | | | |
|6 |FACILITIES (classroom, |Provide adequate classroom, |1. Program Personnel Resource | | | |
| |lab, offices, ancillary); |laboratory, and ancillary |Survey | | | |
| | |facilities for students and |2. Student Resource Survey | | | |
| |EQUIPMENT /SUPPLIES |faculty. | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | |Provide a variety of equipment | | | | |
| | |and supplies to prepare | | | | |
| | |students for clinical | | | | |
| | |experiences. | | | | |
| | | | | | | |
| | | | | | | |
|7 |CLINICAL RESOURCES |Provide a variety of clinical |1. Program Personnel Resource | | | |
| |(affiliations) |experiences to achieve the |Survey | | | |
| | |program goals and outcomes. |2. Student Resource Survey | | | |
| | | | | | | |
| | | | | | | |
|8 |LEARNING RESOURCES (print,|Provide learning resources to |1. Program Personnel Resource | | | |
| |electronic reference |support student learning and |Survey | | | |
| |materials; computer |faculty instruction. |2. Student Resource Survey | | | |
| |resources) | | | | | |
| | | | | | | |
|9 |FACULTY/STAFF CONTINUING |Provide time and resources for |1. Program Personnel Resource | | | |
| |EDUCATION |faculty and staff continuing |Survey | | | |
| | |education to maintain current | | | | |
| | |knowledge and practice. | | | | |
| | | | | | | |
| | | | | | | |
| | | |
| |The following are optional resource evaluations: | |
|10 | |Provide physician-student |1. Program Personnel Resource | | | |
| | |instructional interaction to |Survey (Section X) | | | |
| |PHYSICIAN INSTRUCTIONAL |ensure confident, professional |2. Student Resource Survey | | | |
| |INVOLVEMENT |working relationships between |(Section IX) | | | |
| | |students and physicians. | | | | |
| | | | | | | |
| | | | | | | |
|11 | | | | | | |
| | | | | | | |
| |PROGRAM ENHANCEMENTS | | | | | |
| | | | | | | |
* Programs are required to use the questions/items in the JRC-CVT “Program Resource Survey by Program Personnel” instrument and incorporate the results into the assessment of all of the above resource categories (rows).
Programs are required to use the questions/items in the JRC-CVT “Program Resource Survey by Students” instrument and incorporate the results into the assessment of all of the above resource categories (rows), except “Faculty/Staff Continuing Education”.
Programs are encouraged to use other instruments and mechanisms to provide additional information about the status of program resources.
Rev 05/12/2008
Appendix B – Programmatic Organizational Chart
Insert programmatic organizational chart ...
here
or copy to an electronic folder named Appendix B on the CD/USB drive with a readily recognizable filename.
A separate file for this Appendix has been placed on the CD/drive named:
Appendix C – Curriculum Vitae and Job Descriptions
Insert CVs of key personnel (Program Director, Medical Director, and Clinical Coordinator, if applicable).
Insert CVs of any other specialty track didactic, laboratory, and clinical faculty members (no support course faculty). Limit to two pages, include education, credentials, and years of professional experience, delete all publications.
Insert job descriptions of key personnel…
here
or copy to an electronic folder named Appendix C on the CD/USB drive with a readily recognizable filename.
A separate file for this Appendix has been placed on the CD/drive named:
Total number of CV files:
APPENDIX D1 – Program Course Requirements Table
For each concentration, list all the courses that are required for completion of the concentration in the sequence in which the students would typically enroll in them. (For a third concentration, download the Appendix D file from the JRC-CVT web site (see ), complete the table, and insert the file at the end of this Appendix.
|Overall length of program in months = | |Or in years = | |Type of credits is: | |Semester |
|Length of semester/quarter in weeks = | | | | | |Quarter |
| | | | | | |Other |
|Concentration (check only one): | Invasive (I) | Non-Invasive/echo cardiology (N) | Vascular (V) | Electrophysiology (E) |
|Sequence by Sem/ |Course Number |Course Title |# Lecture Hours |# Lab Hours |# Clinical Hours |# Credits |
|Quarter # | | | | | | |
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|Sequence by Sem/ |Course Number |Course Title |# Lecture Hours |# Lab Hours |# Clinical Hours |# Credits |
|Quarter # | | | | | | |
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|Totals ==> | | | | |
APPENDIX D2 – Program Course Requirements Table
For each concentration, list all the courses that are required for completion of the concentration in the sequence in which the students would typically enroll in them. (For a third concentration, download the Appendix D file from the JRC-CVT web site (see ), complete the table, and insert the file at the end of this Appendix.
|Overall length of program in months = | |Or in years = | |Type of credits is: | |Semester |
|Length of semester/quarter in weeks = | | | | | |Quarter |
| | | | | | |Other |
|Concentration (check only one): | Invasive (I) | Non-Invasive/echo cardiology (N) | Vascular (V) | Electrophysiology (E) |
|Sequence by Sem/ |Course Number |Course Title |# Lecture Hours |# Lab Hours |# Clinical Hours |# Credits |
|Quarter # | | | | | | |
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|Sequence by Sem/ |Course Number |Course Title |# Lecture Hours |# Lab Hours |# Clinical Hours |# Credits |
|Quarter # | | | | | | |
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|Totals ==> | | | | |
Insert additional Program Course Requirements Table for third concentration from
self_study_reports.htm here.
APPENDIX E1 – Clinical Affiliate Institutional Data Form
Complete as many of these forms as necessary to report data on all clinical affiliates. A file with an additional form is available on the JRC-CVT web site.
( )
NOTE: this form is not fill-in-the-blanks formatted.
Insert the file of completed supplemental forms at the end of this Appendix or copy to an electronic folder named Appendix E on the CD/USB drive with a readily recognizable filename.
| |
|Self Study Report (SSR) AFFILIATE #: [ ] |
|CLINICAL AFFILIATE INSTITUTIONAL DATA |
| |
|Name: |
| |
|Address: |
| |
|Clinical Department: |
| |
|Telephone # |
|Is there a signed, current agreement with this affiliate? [ ] Yes [ ] No |
|Who supervises the students? [ ] affiliate employees [ ] program personnel |
|Are there written policies as to what students may do in each area? [ ] Yes [ ] No |
|Name of institutional accreditor: |
| |
|Current accreditation good through (date): |
|Are the preceptors formally trained? [ ] Yes [ ] No |
| |
|For how many hours? [ ] |
|List the names and credentials of all clinical preceptors / instructors. |
| |
|1. |
|2. |
|3. |
|4. |
|5. |
|6. |
|7. |
|8. |
|9. |
| |
|Additional: |
|Department Manager: | |
|Date of Form Completion: | |
APPENDIX E2 – Clinical Affiliate Institutional Data Form
Complete as many of these forms as necessary to report data on all clinical affiliates. A file an additional forms is available on the JRC-CVT web site.
( )
NOTE: this form is not fill-in-the-blanks formatted.
Insert the file of completed supplemental forms at the end of this Appendix or copy to an electronic folder named Appendix B on the CD/USB drive with a readily recognizable filename.
| |
|Self Study Report (SSR) AFFILIATE #: [ ] |
|CLINICAL AFFILIATE INSTITUTIONAL DATA |
| |
|Name: |
| |
|Address: |
| |
|Clinical Department: |
| |
|Telephone # |
|Is there a signed, current agreement with this affiliate? [ ] Yes [ ] No |
|Who supervises the students? [ ] affiliate employees [ ] program personnel |
|Are there written policies as to what students may do in each area? [ ] Yes [ ] No |
|Name of institutional accreditor: |
| |
|Current accreditation good through (date): |
|Are the preceptors formally trained? [ ] Yes [ ] No |
| |
|For how many hours? [ ] |
|List the names and credentials of all clinical preceptors / instructors. |
| |
|1. |
|2. |
|3. |
|4. |
|5. |
|6. |
|7. |
|8. |
|9. |
| |
|Additional: |
|Department Manager: | |
|Date of Form Completion: | |
INSERT the supplemental Appendix E file...
here
APPENDIX F – Student Hospital / Clinical Matrix
For each concentration offered by the program, complete the corresponding section of this matrix. Report the typical numbers for students who have graduated from the program.
Concentration(s) (check all that apply):
Invasive Cardiology (I)
Non-Invasive/Echo Cardiology (N)
Non-Invasive Peripheral Vascular (V)
Cardiac Electrophysiology (E)
|Procedure – Invasive Cardiology |# Required by |Average # Per |Range Per |
| |Program |Student |Student |
|Sterile scrub and dons sterile attire | | | |
|Safely transports patients | | | |
|Pre cath assessment, teaching and preparation | | | |
|Sterile tray set-up for diagnostic left heart case | | | |
|Sterile tray set-up for diagnostic right heart case | | | |
|Sterile tray set-up for diagnostic complete heart case | | | |
|Scrub diagnostic left heart case | | | |
|Scrub diagnostic right heart case | | | |
|Scrub diagnostic complete heart case | | | |
|Monitor/Record diagnostic left heart case | | | |
|Monitor/Record diagnostic right heart case | | | |
|Monitor/Record diagnostic complete heart case | | | |
|Circulate diagnostic left heart case | | | |
|Circulate diagnostic right heart case | | | |
|Circulate diagnostic complete heart case | | | |
|Safely administer medications | | | |
|Manipulate imaging equipment in diagnostic left heart case | | | |
|Manipulate imaging equipment in diagnostic right heart case | | | |
|Manipulate imaging equipment in diagnostic complete heart case | | | |
|Quality control for imaging equipment | | | |
|Practice proper radiation safety technique | | | |
|Sterile tray set-up for interventional PCI case | | | |
|Scrub interventional PCI case | | | |
|Record interventional PCI case | | | |
|Circulate interventional PCI case | | | |
|Manipulate imaging equipment in interventional PCI case | | | |
|Post cath assessment, teaching and hemostasis | | | |
|Temporary pacemaker implantation | | | |
|Permanent pacemaker implantation | | | |
|Intra-aortic balloon pump operation | | | |
APPENDIX F – Student Hospital / Clinical Matrix (continued)
|Procedure – Non-Invasive/echo cardiology |# Required by |Average # Per |Range Per |
| |Program |Student |Student |
|Proper patient identification technique | | | |
|Introduce and explain the ultrasound procedure to the patient | | | |
| a. properly positions the patient for the exam. | | | |
| b. properly drapes the patient | | | |
| c. provides privacy for the patient | | | |
|Parasternal Position | | | |
|Apical Position | | | |
|Subcostal Position | | | |
|Suprasternal Notch Position | | | |
|Color Flow Imaging | | | |
|Pulsed-Wave Doppler | | | |
|Assessment of Diastolic Function | | | |
|CW Doppler - Guided | | | |
|CW Doppler – Pedoff, Unguided | | | |
|Coronary Artery Disease – RWMA | | | |
|Aortic Valve Stenosis | | | |
|Aortic Valve Regurgitation | | | |
|Mitral Valve Stenosis | | | |
|Mitral Valve Regurgitation | | | |
|Assessment of Right Heart Valves | | | |
|Assessment of Prosthetic Valves | | | |
|Cardiomyopathy | | | |
|Systemic Diseases | | | |
|Cardiac Mass, Thrombus, Vegetation | | | |
|Pericardial Disease | | | |
|Congenial Heart Disease | | | |
|Exercise Stress Echocardiography | | | |
|Pharmacologic Stress Echo | | | |
|Observation of TEE | | | |
APPENDIX F – Student Hospital / Clinical Matrix (continued)
|Procedure – Non-Invasive Peripheral Vascular (V) |# Required by |Average # Per |Range Per |
| |Program |Student |Student |
|Perform extracranial cerebrovascular duplex examination | | | |
|a. common carotid artery | | | |
|b. internal carotid | | | |
|c. external carotid | | | |
|d. vetebral | | | |
|Determine percentage stenosis from velocity criteria | | | |
|Perform LE venous duplex evaluation for acute thrombosis | | | |
|a. common femoral vein | | | |
|b. femoral | | | |
|c. popliteal | | | |
|d. Calf veins: PTV, Peroneal, gastrocnemius, Soleal vessels | | | |
|e. Long and short saphenous veins | | | |
|Perform LE arterial segmental pressure and waveform evaluation | | | |
|Perform UE venous duplex evaluation for acute thrombosis | | | |
|Perform UE arterial duplex examination | | | |
|a. subclavian | | | |
|b. axillary | | | |
|c. brachial artery | | | |
|d. radial artery | | | |
|e. ulnar artery | | | |
|Perform abdominal aorta duplex evaluation for aneurysm | | | |
| | | | |
|The following procedures may either be observed and/or performed depending on the availability:| | | |
|Observe/Perform Transcranial Doppler/Imaging | | | |
|Observe/Perform LE venous duplex evaluation for vein mapping | | | |
|Observe/Perform LE venous duplex evaluation for insufficiency | | | |
|Observe/Perform LE arterial duplex evaluations for PAD | | | |
|Observe/Perform LE arterial bypass graft duplex evaluation | | | |
|Observe/Perform UE arterial pressure/waveform evaluations | | | |
|a. Segmental pressures and waveforms | | | |
|b. Allen Test | | | |
|c. TSO | | | |
|Observe/Perform mesenteric artery duplex evaluation | | | |
|Observe/Perform Renal artery duplex examination | | | |
|a. renal aortic ratio | | | |
|Observe/Perform Portal vein duplex evaluation | | | |
|Observe/Perform Dialysis Imaging | | | |
|Observe/Perform Endograft Imaging | | | |
APPENDIX F – Student Hospital / Clinical Matrix (continued)
|Procedure – Electrophysiology/Pacing (E) |# Required by |Average # Per |Range Per Student |
| |Program |Student | |
|Atrial single pacemaker | | | |
|AV/Double pacemaker | | | |
|Body surface mapping | | | |
|C-Diagnostic elect. physical evaluation | | | |
|Cardioversion | | | |
|Comp. EP w/la | | | |
|Comp. EP w/lv | | | |
|EP map study | | | |
|EPS follow up | | | |
|EPS ICD evaluation | | | |
|EPS with drug study | | | |
|ICS analysis | | | |
|His bundle study | | | |
|Peds complete EPS | | | |
|Peds temp pacemaker | | | |
|Peds his bundle recording | | | |
|Peds limited EPS | | | |
|Peds post-op EPS | | | |
|Permanent Pacemaker | | | |
|RF ablation | | | |
|Temporary pacemaker | | | |
|Temporary trans. Pacing wire insertion | | | |
|Tilt table test | | | |
|Vent/Single pacemaker | | | |
|Single chamber ICD implant | | | |
|Dual chamber ICD implant | | | |
APPENDIX G – Course Syllabi
Insert syllabi for ALL didactic, laboratory and clinical courses for each specialty concentration (track).
here
or copy to an electronic folder named Appendix G on the CD/USB drive with a readily recognizable filename.
A separate file for this Appendix has been placed on the CD/drive named:
Total number of course syllabi submitted:
APPENDIX H – College Catalogue and Documents
Insert copy of the most recent college catalogue and any other documents related to Standard V.A.2.
here
or copy to an electronic folder named Appendix H on the CD/USB drive with a readily recognizable filename.
A separate file for this Appendix has been placed on the CD/drive named:
APPENDIX I – Additional College Materials
Insert additional materials related to Standard V.A.3.
here
A separate file for this Appendix has been placed on the CD/drive named:
APPENDIX J – Consortium Agreement, if applicable
Insert a copy of the Consortium agreement.
here
A separate file for this Appendix has been placed on the CD/drive named:
APPENDIX K – Faculty Evaluation SSR Questionnaires
Joint Review Committee on Education in Cardiovascular Technology
Faculty Evaluation SSR Questionnaire
For Self Study Report
Instructions: Have each specialty concentration (track) faculty member (didactic, laboratory, and clinical), the Program Director, the Medical Director(s) and the Clinical Coordinator, if applicable, complete this questionnaire as a part of the self-study process.
Name of Sponsoring Institution:
Concentration: Invasive Cardiology (I) Non-Invasive/Echo Cardiology (N)
Non-Invasive peripheral vascular (V) Cardiac Electrophysiology (E)
Your responsibility with the program is (check one), then indicate paid/unpaid
|( |Program Director |
| |Clinical Coordinator, if applicable |
| |Medical Director ( Paid ( Unpaid |
| |Full-time Faculty member |
| |Part-time Laboratory instructor: ( Paid ( Unpaid |
| |Part-time Didactic instructor: ( Paid ( Unpaid |
| |Part-time Clinical instructor: ( Paid ( Unpaid |
Please rate each of the following items by circling the appropriate rating according to the following scale:
|Strongly Agree |Generally Agree |Neutral |Generally Disagree |Strongly Disagree |Not Applicable |
|5 |4 |3 |2 |1 |N/A |
|Administrative support is sufficient to meet program goals. |5 |4 |3 |2 |1 |N/A |
|A. College Administration (Dean, Division Chair) | | | | | | |
|B. Financial Resources | | | | | | |
|C. Teaching Loads | | | | | | |
|Program resources meet the stated purpose for the program. |5 |4 |3 |2 |1 |N/A |
|A. Clerical Support | | | | | | |
|B. Support Staff | | | | | | |
|C. Classroom Facilities | | | | | | |
|D. Laboratory Facilities | | | | | | |
|E. Laboratory Equipment and Supplies | | | | | | |
|F. Instructional Reference Materials | | | | | | |
|G. Overall Clinical Resources | | | | | | |
|H. Computer Resources | | | | | | |
|Faculty teach effectively. *Faculty (do not rate your own position) |5 |4 |3 |2 |1 |N/A |
|A. Program Director | | | | | | |
|B. Clinical Coordinator, if applicable | | | | | | |
|C. Medical Director | | | | | | |
|D. Clinical Faculty | | | | | | |
|E. Other Cardiovascular Technology Faculty | | | | | | |
|F. Science Faculty | | | | | | |
|Curriculum is sufficient to meet program goals. |5 |4 |3 |2 |1 |N/A |
|A. Depth and scope of program | | | | | | |
|B. Course Sequencing | | | | | | |
|C. General Education and Science Courses | | | | | | |
|D. Basic Theory | | | | | | |
|E. Basic Skill Development | | | | | | |
|F. Advanced Theory | | | | | | |
|G. Advanced Skill Development | | | | | | |
|H. Compliance of Professional Society Guidelines | | | | | | |
|Clinical Coordination is sufficient to meet program goals. |5 |4 |3 |2 |1 |N/A |
|A. Communication between program and Clinicals | | | | | | |
|B. Clinical Evaluation Instruments | | | | | | |
|C. Parallel experiences among students | | | | | | |
|D. Supervision of students | | | | | | |
|E. Consistency of evaluation of students | | | | | | |
What do you consider to be the major strengths of the program?
What areas do you believe need improvement?
Thank you for completing this questionnaire.
Joint Review Committee on Education in Cardiovascular Technology
Faculty Evaluation SSR Questionnaire
For Self Study Report
Instructions: Have each specialty concentration (track) faculty member (didactic, laboratory, and clinical), the Program Director, the Medical Director(s) and the Clinical Coordinator, if applicable, complete this questionnaire as a part of the self-study process.
Name of Sponsoring Institution:
Concentration: Invasive Cardiology (I) Non-Invasive/Echo Cardiology (N)
Non-Invasive peripheral vascular (V) Cardiac Electrophysiology (E)
Your responsibility with the program is (check one), then indicate paid/unpaid
| |Program Director |
| |Clinical Coordinator, if applicable |
|( |Medical Director Paid Unpaid |
| |Full-time Faculty member |
| |Part-time Laboratory instructor: ( Paid ( Unpaid |
| |Part-time Didactic instructor: ( Paid ( Unpaid |
| |Part-time Clinical instructor: ( Paid ( Unpaid |
Please rate each of the following items by circling the appropriate rating according to the following scale:
|Strongly Agree |Generally Agree |Neutral |Generally Disagree |Strongly Disagree |Not Applicable |
|5 |4 |3 |2 |1 |N/A |
|Administrative support is sufficient to meet program goals. |5 |4 |3 |2 |1 |N/A |
|A. College Administration (Dean, Division Chair) | | | | | | |
|B. Financial Resources | | | | | | |
|C. Teaching Loads | | | | | | |
|Program resources meet the stated purpose for the program. |5 |4 |3 |2 |1 |N/A |
|A. Clerical Support | | | | | | |
|B. Support Staff | | | | | | |
|C. Classroom Facilities | | | | | | |
|D. Laboratory Facilities | | | | | | |
|E. Laboratory Equipment and Supplies | | | | | | |
|F. Instructional Reference Materials | | | | | | |
|G. Overall Clinical Resources | | | | | | |
|H. Computer Resources | | | | | | |
|Faculty teach effectively. *Faculty (do not rate your own position) |5 |4 |3 |2 |1 |N/A |
|A. Program Director | | | | | | |
|B. Clinical Coordinator, if applicable | | | | | | |
|C. Medical Director | | | | | | |
|D. Clinical Faculty | | | | | | |
|E. Other Cardiovascular Technology Faculty | | | | | | |
|F. Science Faculty | | | | | | |
|Curriculum is sufficient to meet program goals. |5 |4 |3 |2 |1 |N/A |
|A. Depth and scope of program | | | | | | |
|B. Course Sequencing | | | | | | |
|C. General Education and Science Courses | | | | | | |
|D. Basic Theory | | | | | | |
|E. Basic Skill Development | | | | | | |
|F. Advanced Theory | | | | | | |
|G. Advanced Skill Development | | | | | | |
|H. Compliance of Professional Society Guidelines | | | | | | |
|Clinical Coordination is sufficient to meet program goals. |5 |4 |3 |2 |1 |N/A |
|A. Communication between program and Clinicals | | | | | | |
|B. Clinical Evaluation Instruments | | | | | | |
|C. Parallel experiences among students | | | | | | |
|D. Supervision of students | | | | | | |
|E. Consistency of evaluation of students | | | | | | |
What do you consider to be the major strengths of the program?
What areas do you believe need improvement?
Thank you for completing this questionnaire.
APPENDIX K – Faculty Evaluation SSR Questionnaires (continued)
For each additional faculty member, download a blank copy of the evaluation from self_study_reports.htm, complete it, give it a unique file name, and save to the CD/flash drive. Print each evaluation and insert it appropriately in each notebook.
JRC-CVT will insert the additional completed Faculty Evaluation SSR Questionnaires.
here
A separate file for this Appendix has been placed on the CD/drive named:
Number of Faculty SSR Questionnaires copied to the CD/drive:
APPENDIX L – Affiliation Agreements
Insert copies of agreements with all active clinical affiliates...
here
A separate file for this Appendix has been placed on the CD/drive named:
APPENDIX M – Advisory Committee Minutes
Insert copies the Minutes from all Advisory Committee meetings for the past 3 years...
here
A separate file for this Appendix has been placed on the CD/drive named:
-----------------------
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