American Board of Naturopathic Oncology 2014 Exam Application

Transcription

1 American Board of Naturopathic Oncology 2014 Exam Application SECTION 1. General Information Name Address City, State, Zip Telephone SECTION 2. Education and Licensing CNME Accredited Naturopathic Medical School attended and year graduated: School: Year Graduated States/Provinces in which you are currently licensed to practice naturopathic medicine: State/Province License # Year Licensed State/Province License # Year Licensed Has your naturopathic license ever been revoked or suspended? Yes No Has your naturopathic license ever been under investigation? Yes No *If you answered yes to either of the two above questions, please attach explanation. ***NOTE: Complete either section 3 OR section 4 SECTION year CNME- Approved Residency or Fellowship focusing in Naturopathic Oncology Naturopathic Oncology Residency Location Date Began Date Completed Residency Supervisor Contact Information

2 SECTION 4. Demonstrable Clinical Experience in Naturopathic Oncology (must meet at least one criterion in each of the following 3 categories) A. Category 1: Experience I affirm that my naturopathic oncology experience meets at least one of the following minimum standards (initial one): Minimum of 5 years in practice, and a minimum of 5000 cumulative patient care hours over the past 5 years, and a minimum of 70% of the patient load for the preceding two years in oncology (2250 oncology patient contacts); or Minimum of 5 years of naturopathic oncology research >50 % time, and at least 5 research studies (not review articles) published in peer- reviewed literature which are subject to the approval of the ABNOBoMEx; or Minimum of 5 years of instructing oncology in CNME- accredited institution; or Minimum of 5 years as program director of a CNME- approved naturopathic oncology residency program B. Category 2: Cases (see attached format and guidelines) Please attach one of the following: Detailed case reports on 5 different oncology patients utilizing the Case Documentation Form and demonstrating ongoing naturopathic management. All 5 cases must cover a time period of no less than 12 months; or Publication of 4 cases in peer- reviewed professional journal C. Category 3: Continuing Medical Education: I affirm that I have obtained at least 50 hours of documented oncology continuing medical education within the last 5 years. (initial)* * oncology continuing medical education means any Continuing Medical Education approved or approvable by any state or provincial naturopathic licensing board for the purposes of relicensing or approved by the Accreditation Council for Continuing Medical Education (ACCME), which is directly relevant to the practice of naturopathic oncology. This would include, but is not necessarily limited to topics related to specific cancer types (breast cancer, colon cancer, etc.), conventional cancer therapies (chemotherapy, radiation therapy, etc.), supportive care (pain management, peripheral neuropathy, etc.), management of complications common in an oncology population (intestinal obstruction, superior vena cava syndrome, venous thromboembolism, pulmonary embolism, etc.), nutritional management of compromised patients (enteral and parenteral feeding), as well as naturopathic topics which are applicable to an oncology population. It does not include topics, which are at best only peripherally related to the practice of naturopathic oncology (Homeopathic Remedies for PMS, Restoring Digestive Health in Autoimmune Disease, Practice Pearls in Dermatology, Pediatric Lyme Disease, Environmental Factors and the Treatment of Autism, etc.) ABNO Exam Board Certification Application Packet

3 SECTION 5. Recommendations Three (3) recommendations needed from licensed physicians (ND, MD, DO) I hereby acknowledge by signing this recommendation that I believe the information on this application to be true and accurate, and that this applicant adheres to the ethical and medical standards of naturopathic oncology. Print Name Signature Date Phone Degree Type (circle one) ND MD DO State of License Nature of relationship (check all that apply) I refer patients to the applicant. I consult with the applicant. The applicant refers patients to me. I have knowledge of the applicant s practice Print Name Signature Date Phone Degree Type (circle one) ND MD DO State of License Nature of relationship (check all that apply) I refer patients to the applicant. I consult with the applicant. The applicant refers patients to me. I have knowledge of the applicant s practice Print Name Signature Date Phone Degree Type (circle one) ND MD DO State of License Nature of relationship (check all that apply) I refer patients to the applicant. I consult with the applicant. The applicant refers patients to me. I have knowledge of the applicant s practice SECTION 6. Applicant Signature I hereby affirm that the information provided in this application is true and accurate. Applicant Signature Date FEES AND DEADLINES These fees cover FABNO status for 10 years, at which point you will need to re- certify. Application Deadline for September 2014 Exam is March 23 rd, 2014 Application Fee $275 Payable to: Amer. Board of Nat. Oncology (ABNO) Testing Fee $300 Do Not Enclose Testing Fee at this time. Send completed Application Form and Application Fee to: Corey Murphy, ABNO Exec. Director 5734 North Douglas Juneau, AK ABNO Exam Board Certification Application Packet

4 **All case studies must be submitted electronically. ** American Board of Naturopathic Oncology 2014 Case Study Guidelines In preparing case studies, here is a general guideline to help direct you in some of the areas that should be covered. Please note that this is not a line item requirement, but rather a framework to work from. GENERAL AREAS TO BE COVERED a. Care management guidelines - Initial assessment (include staging information, recent treatment history, brief HPI of cancer, associated and relevant co- morbidities) - Continued evaluation strategies: Patient centered condition evaluation and management - Identification of critical presentations and associated triage for naturopathic management, co- management and urgent referral b. Objective findings - Appropriate physical examination. - Appropriate laboratory and imaging studies c. Assessment - Complete oncological assessment - Naturopathic and other problem list (include brief explanation for underlying factors of each) ABNO Exam Board Certification Application Packet

5 MORE SPECIFICS The treatment plan should include some or all of the following: - Diet and nutrition analysis and counseling. - Lifestyle and risk assessment. - Preventive and Therapeutic interventions. - Appropriate referral when necessary. - Thorough history. The treatment plan should be: 1) Based on naturopathic principles including a. Stimulating the patient's vital force to promote healing or, in special instances, supplementing or replacing the action of the vital force when the patient is unable to respond to curative treatment. b. Removing the cause of conditions, when known c. Choosing treatments which pose the least risk of patient harm. d. Being consistent with the therapeutic order e. Individualizing treatments to the whole patient, including referral to appropriate other health resources for specialized therapies. f. Educating the patient to participate responsibly in his or her own health care and to learn principles for building of health and preventing future disease. g. Involving, when appropriate, others significant to the patient in the treatment plan. h. Prevention of complications of disease/treatment 2) Based on proper assessment including a. Ruling out / identifying life- threatening or hidden conditions with appropriate history, examination and testing, including referral for specialized evaluation, when appropriate. b. Allowing for timely on- going reassessment. 3) Self Critical, i.e. it has: a. A mechanism for timely evaluation of plan effectiveness that is documented following discussion with the patient b. A mechanism for timely modification of failed plans, including referral to other appropriate practitioners that is documented following discussion with the patient ABNO Exam Board Certification Application Packet

6 4) Based on identified needs and rationale articulated. 5) Realistic in its goals. 6) Practical in light of the patient's condition and situation 7) In the best interest of the patient. 8) Logical in sequence and internally consistent. 9) Prioritized to the patient's most pressing conditions. 10) Compatible with other therapies the patient may be undergoing. 11) Cost effective. 12) Flexible to accommodate new developments/ findings 13) Inclusive of patient preferences 14) Based on available research and evidence for efficacy and appropriateness i.e. Evidence Based Naturopathic Medicine (EBNM) 15) Experimental only with informed consent and only in areas of doctor expertise. 16) Inclusive of assessment of patients progress a. Progress is ultimately determined by the physician, in concert with the patient. Family members may be involved in assessment of progress, and may be consulted by the physician to aid in these determinations. Although final assessment must rest with the physician, this is only meaningful when the patient understands and accepts the advice of the physician. If the patient disagrees with the physician over assessment of progress, which cannot be resolved by the application of objective criteria, the patient should be encouraged to seek a second opinion. b. Based on predetermined and documented goals and timeline of therapy, the treatment plan should be continued. Treatment would be discontinued when sufficient progress had been achieved, or revised, based upon the patient's response. c. Lack of appropriate progress could indicate the need for reevaluation of the treatment plan or it may indicate need for reevaluation of the condition or underlying basis of the condition being treated ABNO Exam Board Certification Application Packet

7 American Board of Naturopathic Oncology 2014 Case Documentation Form Must be submitted electronically, preferably in Word format (PDF is also acceptable). Please title files lastname_casestudy# (i.e. murphy_casestudy1) GENERAL INFORMATION Naturopathic Physician s Name Patient s Initials Patient s Date of Birth Cancer Diagnosis Date of Initial Diagnosis SUMMARY CASE INFORMATION Total number of times the patient was seen by you Date of first visit Date of last visit Is the patient deceased? Yes No Case Type (check all that apply) Primary management of active malignancy (paitne is NOT being seen by an oncologist) Active screening for malignancy in high risk cases Collaborative management of malignancy with an oncologist Primary management after definitive treatment for malignancy while patient has no evidence of disease Watchful waiting Supportive care only Other (describe) BRIEF HISTORY OF PRESENT ILLNESS (include diagnosis, staging information, past treatments in chronological order, current extent of disease, symptomatology, co- morbid conditions, patient goals) ABNO Exam Board Certification Application Packet

8 VISIT SUMMARIES Briefly list date of visit; chief complaint; significant symptom changes and responses to treatments from previous visit; new symptoms, relevant findings from physical exam, lab or scans; assessment; problem list; new or ongoing (specify) conventional treatment; and naturopathic plan (include specific substances used, dosage and detailed rationale (not merely to support immune function ) and expected outcome). If there are multiple visits, select only one visit from within each 3- month period of time to highlight your overall and sequential case management ABNO Exam Board Certification Application Packet