Provide answers and/or descriptions to the following questions on the proposed residency
1. How many residents have completed your program in the past five years? ~
a. First application for residency accreditation 0
Residents Completed: b. Orthotic:
_1_ __
c. Prosthetic: 1 --
2. Do you have a university affiliation? 0 Ves 0 No
If yes, identify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
0
3. Identify planned seminars/education experiences for the resident:
*'
IZl
Clinical lectures
0
Grand Rounds
[Zj Regional/State Academy Meetings
0
0
Local Seminars
0
Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
[Zj Manufacturing Workshops Ii] National O&P Meetings
4. Which of the following and how many will assist as staff for the residency program?
d. Administration: 8 e. Clinicians:
g. Certified Fitters: h. Certified CPed.: _ _ _ __
5
f. Technicians: 5 ----
/
5. What is/will be the resident application process?
i. Does the program have written selection procedures, including admission eligibility criteria to provide residents? 0 Ves [Z] No
/ If no, provide explanation: Residents will be evaluated on their education and references
Submit with application acopy of the selection procedure/admission to residency program and the Resident Agreement.
(Reference Standards 3,2 and
j.
Do you require submission of a resume with cover letter?
k. Do you perform an on-site interview?
I.
Do you perform a phone interview?
m. Do you have aset calendar day by which all residents must apply?
. / n. Will the residency site pay the resident fee?
/0.
IZl Ves
DNo
[Z] Ves DNa
[ZjVes DNa
DVes IZ1 No
[Z]Ves DNo
If yes, what is the date?
What are the transportation requirement(s) of the residents to partiCipate at the proposed residency program?
They are responsible for travel and relocation expenses associated with the residency program,
/
p. Do you require the residents to sign a non-compete contract?
DVes [Z] No
q, Will there be times when a resident is supervised directly via live video, web cam, or by other means of live visual technology?
In space below provide detail.
No
r. In space below provide The Program's Mission Statement. Please attach additional pages if needed.
THE PROGRAM MUST HAVE AMISSION STATEMENT THAT DESCRIBES THE OVERALL PURPOSE(S) OF THE RESIDENCY PROGRAM
J
>t::"
The mission of the Clark & Associates Prosthetics and Orthotics residency program is to provide a well-rounded cHnical
experience to educate residents so they are ready for the rigors of daily orthotics and prosthetics practice.
s, In space below provide any additional information on the application process of residents for the proposed program:
NCOPE APPLICATION FOR ACCREDITATION OF RESIDENCY PROGRAM
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Provide answers and/or descriptions to the following questions on the proposed residency program.
6. What is the expected percentage of time spent by the resident in the following areas of the practice:
q. Clinical:
r. Fabrication:
/
s. Practice management (administrative):
TIme spent in the three areas
should be a combined total of 100%
%
10
%
_2_0_ _ _%
100%
70
7. Identify the percentage of time in the specific setting that direct patient care is provided by tile practice:
Setting
Orthotics
Primary facility:
50
Affiliate facility:
30
/
Settings for
each discipline
should be a
combined total
of 100%
%
%
%
Specialty clinic:
(e.g" neuromuscular, cerebral palsy, spina bifida)
Acute care hospital setting:
10
Long-term rehabilitation Facility:
(e.g., nursing home, Assisted living facility)
10
Prosthetics
50
%
30
%
%
%
10
%
%
10
%
%
100%
8. Identify the percentage of devices fabricated on-site at the residency site and outsourced to central:
Other facility:
Fabricated
>k
Onsite:
Outsourced:
Orthotic
Prosthetic
90
- - -%
----
10
90
%
/
%
100%
%*
_1_0_ __
9. Identify the percentage of devices which incorporates the use of CAD/CAM in the practice.
Orthotic
Upper limb
Lower limb
%
_0_ _ _ _%
Spinal
100_ _ _01/0
_
Prosthetic
Upper limb 10
0
Cranial Facial 0
%
Lower limb _9_5_ _ _ %
%
10. Does this practice participate in any specialty clinic affiliations? C/7eck al/ tl7at apply:
FREQUENCY
o Management of spine
o Spine (post-operative)
D
o
D
o
D
o
o Brain Injury
D Burns
D
D
Scoliosis
Diabetic/Neuropathic foot
OSpina Bifida
({] Veterans
D
o CPClinic
2 days/month
Indigent care outreach
o MSClinics
o Shriners Hospital
D
o
D
o
FREQUENCY
Wound Care
Muscular Dystrophy
Pediatric Orthopedic
Hand Clinic
Amputee Clinic
Sports Medicine
Pedorthotic
Gait
Cranial Facial
Upper
Identify specialty clinics not listed:
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NCOPE APPLICATION FOR ACCREDITATION OF RESIDENCY PROGRAM
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Provide answers and/or descriptions to the following questions on the proposed residency program.
'j(. 11. Will the resident have the opportunity to observe surgical procedures? 0
j
/
Yes
0
No
12. Are you able to accommodate aresident seeking a clinical track residency experience?
(Reference Standard 2.6.2)
0
Yes
D No
13. Are you able to accommodate aresident considering aResearch and Development residency track experience? [{] Yes
(Reference Standard 2.6.2)
~
14. Please identify types of activities you anticipate a"Clinical Track" resident can complete from the checklist below. (must choose at least three
activities to qualify)
o Critically Assessed Topic (CAn
o Professional in-service
0
o
Ii] Case Presentation
Presentation at grand rounds, state, regional, national or international meeting
Journal Club presentation
CRITICALLY ASSESSED (APPRAISED) TOPIC (CAn - A CAT is a brief summary of the most currently published research that is used to answer a specific clinical
Question. The author defines the scope of the CAT based on his/her knowledge of the topic and research at hand, The CAT is abrief critical appraisal of the literature.
It may be used to inform clinical practice as a secondary knowledge source.
CASE PRESENTATION - Acase study presentation given to colleagues within the residency program. A case study involves a particular method of research. Rather
than using large samples and following a rigid protocol to examine a limited number of variables, case study methods involve an in,depth, longitudinal examination of
a single instance or event. Case studies lend themselves especially to generating (rather than testing) hypotheses.
IN-SERVICE - Apresentation on atopic related to O&P given to agroup of professionals at alocal hospital, nursing facility, physical therapy office, or similar, with the
intention of increasing the knowledge level of the attendees on the specific O&P topic.
15.
Please identify types of directed studies you anticipate a"Research and Development Trackff resident to complete from the checklist below.
D Case Study Involving Human Subjects D Scientific Study
D Scientific Study Supervised by a Qualified Research Organization
D Other Study
11] literature Review
FOR MORE INFORMATION ON DIRECTED STUDY GO TO WWW.NCOPE.ORG.
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Provide answers and/or descriptions to the following questions on the proposed residency program.
/
16. Identify all resources available for the resident to perform their directed study:
a. Internet accessibility
III
b. University library
0
c. In-house library
0
d. Release time to complete study
0
e. Instrumentation/specialty equipment on-site
D
t. Access to off site specialty equipment, i.e., gait lab 0
Please list any additional resources not listed:
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