CREDENTIALS REVIEW

EVALUATION FORM

Applicant
Reviewer
Credentials Application Form
Type of Training Program / rResidency rAlternate Pathway rDVM/DDS
Form dated and is signed? / r Yes r No
Check list section completed? / r Yes r No Comments:
Any Case reports, Publications or Radiograph Sets listed as ‘Submitted’? / r Yes r No
If Yes, which items?
Has applicant stated whether the CREP system or the 2014 Publication Requirement is selected? / r Yes r No
Which? r Yes CREP System
r Yes 2014 Publications
Comments on Application Form:
Vet School Diploma and License
Veterinary school diploma included? / r Yes r No Comments:
Current veterinary license included? / r Yes r No Comments:
Curriculum Vitae
Curriculum vitae included in AVDC or another coherent format? / r Yes r No
Comments:
Professional activities clear from CV? / r Yes r No
Comments:
Any unexplained time gaps in CV? / r Yes r No
Comments:
One-year internship or equivalent prior to starting veterinary dental training program? (Required for all training tracks) / r Yes r No
Comments:
Nature and content of formal courses satisfactory?
Nature/duration of informal training sufficiently documented? / r Yes r No
Comments:
If an Alternate Pathway candidate, is documentation of dental/veterinary dental training in addition to formal diplomate visitation included? / r Yes r No
Comments:
Overall comments on CV:
Specialist Training
Documentation of completion of specialist training (40 hours each in anesthesia, radiology and surgery) in acceptable format (Pre-Approval certificates or completed ARS forms)? / Anesthesia r Yes r No
Radiology r Yes r No
Surgery r Yes r No
If No, what is missing or incorrect?
Visitation (AP candidates only)
Visitation requirement documented (12 weeks / 480 hours)? / r Yes r No
If no, what is missing or incorrect?
Charts, Equipment, Supplies / (Not required for Residents)
Oral-dental record charts currently used by candidate. The Pre-Approval certificate will be in the Program Summary. If listed as ‘Submitted’, it will be undergoing review. (Not required for Residents) / r Yes Pre-approved
r Yes Listed as Submitted
r No
If no, what is missing, unclear or incorrect?
Comments:
Veterinary dental equipment and supplies. The Pre-Approval certificate will be in the Program Summary. If listed as ‘Submitted’, it will be undergoing review. (Not required for Residents) / r Yes Pre-approved
r Yes Listed as Submitted
r No
If no, what is missing, unclear or incorrect?
Comments:
Case Reports or Publications
Read the CREP document and the 2014 Publications document so that you understand the requirements.
The items will either be present as Pre-Approval certificates in the Program Summary, or will have been Submitted and are undergoing blinded review.
blinded review if submitted with application). / If the CREP system is used:
r  All four reports or ‘equivalent articles’ are Pre-Approved – the Pre-Approval certificates will indicate the number of CREP points for articles.
r  One or more reports or CREP articles are listed as Submitted and are undergoing blinded review, result pending.
r  Is the required spread of dental disciplines met by the CREP items approved
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If the 2014 Publication Requirement is used:
r  A First Article is either Pre-Approved (the Pre-Approval certificate will indicate First or Second article status) or listed as Submitted, or a Delayed Submission request has been approved by the Cred Comm chair (this will be mentioned in a Document note in the Credentials Application DMS document).
r  A Second Article is either Pre-Approved (the Pre-Approval certificate will indicate First or Second article status) or is listed as Submitted. Note: Some Pre-Approved items will state 0.5 Second Article, in which case two 0.5 Second Article approvals are required.
Comments:
Radiograph Sets
Submitted as Pre-Approval certificates or listed as ‘Submitted undergoing blinded review if submitted with application. / Dog: r Pre-Approved r Submitted (result of blind review pending)
Cat: r Pre-Approved r Submitted (result of blind review pending)
Comments:
Case Log
Examine MRCL Log only. / r Yes r No
If no, what is missing, unclear or incorrect?
Comments:
MRCL cases all logged within the last six years? / r Yes r No
Comments:
MRCL cases – resident status. 50% as ‘primary dentist’ (P, P/D or RA) in overall MRCL list? / r Yes r No
Comments:
MRCL Diplomate Review Forms for MRCL cases logged since last TSC Annual Report are included and appropriate? (MRCL forms are in separate MRCL Case Review Forms DMS document) / r Yes r No
If no, what is missing, unclear or incorrect?
Comments:
Overall, caseload is acceptable? / r Yes r No
Comments:
Cadaver Procedure Log (optional) / Comments:
Additional Materials (optional) / Comments:
Supervisor Report Form
Certification of completion of training program by Residency Program Director or Mentor is satisfactory? / r Yes r No
If no, what is missing, unclear or incorrect?
Comments:
Any negative or questionable comments made by Supervisor? / r Yes r No
Comments:
Letters of Reference
Are at least two confidential letters of reference included?
Do the writers state their relationship/ duration of contact with the candidate, and are the writers qualified to give an informed opinion of the candidate?
Do the writers support this candidate’s application, and overall, are the letters satisfactory as a recommendation for AVDC membership? / r Yes r No
If no, what is missing, unclear or incorrect?
Comments:
TSC Annual Report Reviews
Comments or questions after reading the most recent TSC Annual Report reviews (included in the Program Summary) and any follow-up comments by the resident (included in the Comments for Cred Comm item in the Check List….. / Comments:
Summary of Application
Is the sum of the formal and informal training satisfactory? / r Yes r No
Format of application package is satisfactory? / r Yes r No
Dental caseload satisfactory? / r Yes r No
Charts, equipment and supplies satisfactory? / r Yes r No
Four case reports or publications satisfactory? / r Yes r No r Review results pending
Radiograph sets satisfactory? / r Yes r No r Review results pending
Supervisor report satisfactory? / r Yes r No
Letters of reference satisfactory? / r Yes r No
OVERALL RECOMMENDATION
Candidate is APPROVED for admission to AVDC examination / r Yes r No r Recommendation pending result of case report or radiograph set review.
Comments:
Reviewer’s name
Date review completed and uploaded to DMS: