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Surgical Experience Documentation PDF

Beginning July 1, 2014, candidates for the ECFVG Clinical Proficiency Examination must provide validated documentation of surgical experience, including performing at least one ovariohysterectomy as primary surgeon and participating in five additional aseptic surgical procedures as primary or assistant surgeon within the prior five years. Candidates must submit a signed and validated Surgical Experience Form for each procedure documenting their role, date, and details validated by a licensed veterinarian. Falsification of documents would violate the Rules of Conduct.

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373 views

Surgical Experience Documentation PDF

Beginning July 1, 2014, candidates for the ECFVG Clinical Proficiency Examination must provide validated documentation of surgical experience, including performing at least one ovariohysterectomy as primary surgeon and participating in five additional aseptic surgical procedures as primary or assistant surgeon within the prior five years. Candidates must submit a signed and validated Surgical Experience Form for each procedure documenting their role, date, and details validated by a licensed veterinarian. Falsification of documents would violate the Rules of Conduct.

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George
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Surgical Experience Documentation

Beginning on July 1, 2014,, newly-enrolled candidates wishing to take the Clinical Proficiency
Examination (Step 4) of the ECFVG process are required to demonstrate validated proof of
experience performing surgical procedures using aseptic technique prior to application for the
CPE. The validation can be provided by one or more veterinarians licensed to practice
veterinary medicine in any international jurisdiction. At a minimum, candidates are expected
to document their performance of at least one (1) ovariohysterectomy as a primary surgeon and
have participated in at least five (5) additional surgical procedures as either a primary or assistant
surgeon within the 5-year period preceding the candidate’s application. The 5 additional
procedures may be ovariohysterectomies or other surgical procedures, but each should involve
all elements of an aseptic surgical procedure including gowning & gloving, draping of the
patient, and use of sterile instrumentation.

Please submit one (1) signed and validated form for each surgical procedure performed.

Completed forms should be submitted to:


AVMA/ECFVG
1931 N. Meacham Rd., Suite 100
Schaumburg, IL 60173
United States

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Surgical Experience Form

To be completed by ECFVG candidate:

ECFVG Candidate Name (print)_____________________________________________

ECFVG Candidate Signature________________________________________________

ECFVG Candidate I.D._____________________________________________________

Candidates are reminded that falsification of documents would be a violation of the Rules of
Conduct and can resolve in disciplinary actions up to and including dismissal from the program.

To be completed by a licensed veterinarian validating ECFVG candidate’s surgical


experience:

Surgical procedure(s) performed by ECFVG Please indicate role of Date when


candidate named above ECFVG candidate: surgical
Whether primary procedure
surgeon or assistant performed

Reminder: To qualify towards the ECFVG requirement, all surgical procedures must have been performed within a
five-year period preceding application of the CPE.

By signing below, I, the validating veterinarian affirm to the ECFVG that


i) I have read and understood this document in its entirety, as written in English or as
translated into the _____________ language
ii) I have personally witnessed this candidate perform the aseptic surgical procedure(s)
listed above.

Signature_____________________________ Date_________________________

Full Name of Validating Veterinarian (print): _________________________________________

License or Registration Number____________________________________________________

Name of Licensing Authority (state, province, country)_________________________________

_____________________________________________________________________________

Clinic name and contact information (address, phone number, e-mail) where procedure was

performed_____________________________________________________________________

______________________________________________________________________________
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