~ Frequent Program Changes ~
SA Program Director (PD) Change
SA Medical Director Change
SA Program Faculty (non-PD) Changes
SA Clinical Preceptor Change
SA Clinical Preceptor Delegate Change
Institutional Administrator Changes
(President/CEO and Dean)
Program Advisory Committee (PAC) Membership Change
SA Enrollment Capacity Changes
SA Facilities Changes
Findings Letter/Program Change Letter Submissions
On-Site Evaluation Documents
Program Director (PD) Changes
A change in Program Director (PD) should be reported to the SASA-ARC/STSA within 30 days of the change. The following documentation should be submitted in support of the appointment:
- Notification of the name of the new program director and date of the appointment. This notification should be submitted on institutional letterhead and signed by the President/CEO or their designee.
- An ARC/STSA SA Program Personnel Report Form. This form should include information for all program faculty, staff and administration directly related to the Surgical Assisting program.
- An ARC/STSA SA Program Faculty Curriculum Vitae Form
- An ARC/STSA SA Faculty Schedule of Responsibilities Form
- A current résumé indicating experience/training as an educator. Program Directors with instructional responsibilities in core curriculum coursework, laboratory, and clinical instruction must hold a current CFA, CSA or an equivalent credential in the surgical assisting profession. Program Directors must possess proficiency in instructional methodology, curriculum design, and program planning. The résumé should also indicate employment at the current SA program.
- Proof of a current credential in surgical assisting (CFA or CSA). Proof consists of submission of one of the following documents:
- A copy of the NBSTSA certification card (CFA) or NSAA certification card (CSA)
- A copy of the NBSTSA certification certificate or NSAA certification certificate (CSA)
- A copy of the verification page from the NBSTSA website ( www.nbstsa.org ). [NOTE: If the Social Security number is used to access this verification, the Social Security number will appear on the document. Please black out the social security number on the document prior to submission. If the certification number is used to access this verification, the Social Security number will not appear on the document. ]
- In addition, effective January 1, 2009, all newly appointed program directors are required to submit proof of attendance at an Accreditation Fundamentals for Educators (AFE) Workshop during their first year of appointment. Please contact the ARC/STSA for dates and costs for this workshop.
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Medical Director (MD) Changes
A change in Medical Director (MD) should be reported to the SASA-ARC/STSA within 30 days of the change. The following documentation should be submitted in support of the appointment:
- Notification of the name of the new medical director and date of the appointment.
- An ARC/STSA SA Program Personnel Report Form. This form should include information for all program faculty, staff and administration directly related to the Surgical Assisting program.
- An ARC/STSA SA Program Faculty Curriculum Vitae Form
- An ARC/STSA SA Faculty Schedule of Responsibilities Form
- A current résumé indicating experience in the type of health care services for which the student is being trained. The résumé should also indicate employment at or voluntary service to the current SA program.
- Proof of current licensure as a physician.
- Proof of current certification in a surgical specialty recognized by the American Board of Medical Specialties.
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Program Faculty (non-PD/non-MD) Changes
A change in program faculty (non-PD) should be reported to the SASA-ARC/STSA on the program's next ARC/STSA Annual Report. The following documentation should be attached to the Annual Report in support of the appointment:
- An ARC/STSA SA Program Personnel Report Form. This form should include information for all program faculty, staff and administration directly related to the Surgical Technology program.
- An ARC/STSA SA Program Faculty Curriculum Vitae Form
- An ARC/STSA SA Faculty Schedule of Responsibilities Form
- A current résumé indicating qualification by education and experience to be effective in teaching the subjects assigned. Any person with instructional responsibilities in core surgical assisting courses must hold a current CFA, CSA or equivalent credential in the surgical assisting profession, or be a licensed physician certified in a surgical specialty recognized by the American Board of Medical Specialties. The résumé should also indicate employment at the current SA program.
- Proof of an current credential in surgical assisting (CFA or CSA). Proof consists of submission of one of the following documents:
- A copy of the NBSTSA certification card (CFA) or NSAA certification card (CSA)
- A copy of the NBSTSA certification certificate or NSAA certification certificate (CSA)
- A copy of the verification page from the NBSTSA website ( www.nbstsa.org ). [NOTE: If the Social Security number is used to access this verification, the Social Security number will appear on the document. Please black out the social security number on the document prior to submission. If the certification number is used to access this verification, the Social Security number will not appear on the document. ]
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Clinical Preceptor Changes
A change in Clinical Preceptor should be reported to the SASA-ARC/STSA within 90 days or on the next Annual Report, whichever is earlier. Clinical Preceptor change documentation should include:
- An ARC/STSA SA Clinical Preceptor Report Form, including information for all Clinical Preceptors actively participating in the SA program
- Proof of MD or DO credential
- Proof of privileges at an accredited institution/healthcare facility
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Clinical Preceptor Delegate Changes
A change in Clinical Preceptor Delegate should be reported to the SASA-ARC/STSA on the next Annual Report, whichever is earlier. Clinical Preceptor Delegate change documentation should include:
- An ARC/STSA SA Clinical Preceptor Delegate Report Form, including information for all Clinical Preceptor Delegates actively participating in the SA program
- A current résumé
- Proof of a current credential in surgical assisting (CFA or CSA). Proof consists of submission of one of the following documents:
- A copy of the NBSTSA certification card or NSAA certification card (CSA)
- A copy of the NBSTSA certification certificate (CFA) or NSAA certification certificate (CSA)
- A copy of the verification page from the NBSTSA website ( www.nbstsa.org ). [NOTE: If the Social Security number is used to access verification, the Social Security number will appear on the document. Please black out the Social Security number on the document prior to submission. If the certification number is used to access this verification, the Social Security number will not appear on the document.]
- A copy of the verification page from the NSAA website ( www.nsaa.net ).
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Institutional Administrator Changes
(President/CEO and Dean)
A change in an institutional administrator directly related to the Surgical Assisting program (President/CEO or Dean - or comparable appointments) should be reported to the SASA-ARC/STSA within 30 days of the change. The following documentation should be submitted in support of the appointment:
- Name, credentials and official position/job title of the new administrator
- Date of appointment
- Institutional contact information, including:
- Mailing Address
- Telephone Number
- Fax Number
- E-mail Address
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Program Advisory Committee (PAC) Membership Change
Changes to the membership of the Program Advisory Committee (PAC) should be reported to the SASA-ARC/STSA on the program's next ARC/STSA Annual Report. The following documentation should be attached to the Annual Report in support of the appointment:
Program Advisory Committee (PAC) Form - SA
Please note:
- The public member appointed to the Program Advisory Committee (PAC) holds a duty to represent the interests of the patient that may come under the care of the surgical assistant, and therefore has a vested interest in the proper education of the surgical assistant for quality patient care. The public member must not be:
- A current or former employee of the sponsoring institution
- A current or former employee of any clinical affiliate associated with the program
- A current of former student of the surgical assistant program
- A current or former healthcare provider
- Please include the NBSTSA or NSAA certification number for the committee member representing the Practicing CFA/CSA (surgical assisting) on the ARC/STSA Program Advisory Committee (PAC) Form and submit proof of certification and currency. This proof can consist of one (1) of the following:
- A copy of the NBSTSA certification card (CFA) or NSAA certification card (CSA)
- A copy of the NBSTSA certification certificate or NSAA certification certificate (CSA)
- A copy of the verification page from the NBSTSA website ( www.nbstsa.org ). [NOTE: If the Social Security number is used to access this verification, the Social Security number will appear on the document. Please black out the social security number on the document prior to submission. If the certification number is used to access this verification, the Social Security number will not appear on the document. ]
- A copy of the verification page from the NSAA website ( www.nsaa.net ).
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SA Enrollment Capacity Changes
Proposed changes to the program's maximum enrollment capacity should be reported to the SASA-ARC/STSA for review and approval by the SASA and the ARC/STSA Board of Directors. The following documentation should be submitted in support of approval of the maximum enrollment capacity change:
• Clarification regarding the exact maximum enrollment capacity of each enrollment cohort and number of cohorts per year. Also, please indicate the number of cohorts that overlap at any point in the program, if any.
• Documentation of a Needs Assessment supporting the change in maximum enrollment capacity, including Program Advisory Committee minutes reflecting discussion and support of this change
• Clarification regarding sufficiency of the program's resources, such as classroom equipment, laboratory instrumentation, supplies and equipment, computer resources, instructional aides, etc. to address any needs related to this change in enrollment capacity (Standard III.A.)
• Clarification and documentation of sufficient clinical affiliation sites and slots for this new enrollment capacity (ARC/STSA Clinical Affiliation Site Report form)
• Revised program publications reflecting this change in maximum enrollment capacity and enrollment opportunities
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SA Facilities Changes
Proposed changes to the program's facilities - classroom or laboratory facilities - should be reported to the SASA-ARC/STSA for review and approval by the SASA and the ARC/STSA Board of Directors. The following documentation should be submitted in support of approval of the facilities change:
- A blueprint or floor plan showing the surgical assisting classrooms, laboratory space, and faculty offices, including measurements, and photographs of these areas
- An updated list of laboratory furnishings, equipment, and supplies
- Verification of the program annual maximum enrollment capacity and actual (current) enrollment and start date(s) for the actual (current) cohort(s)
- Verification of faculty didactic and laboratory assignments, if program maximum enrollment capacity has changed
- Submission of an ARC/STSA Clinical Affiliation Site form, if program maximum enrollment capacity has changed. Any changes in contact information - telephone number, fax number, address, etc.
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Findings Letter/Program Change Letter Submissions
When submitting a findings letter or program change to the SASA and the ARC/STSA, please use the following guidelines when preparing your submission:
- A cover letter, on institutional letterhead, should include a reference to the purpose for the documentation submission (e.g.: response to a findings letter from the ARC/STSA dated October 11, 2008).
- A copy of ARC/STSA communications related to the submission (findings letter, CAAHEP letter, etc.), if applicable.
- If the submission is related to a findings letter, for each Standard citation:
- Section I - Narrative Response
- List the Standard, finding and request from the findings letter.
- Insert the program's narrative response
Note: If supporting documentation is included to demonstrate compliance to clarify a change, please insert the supporting documentation in an appendix, labeled numerically, following the complete narrative response. Please reference the appendix number and page number in the narrative.)
- Section II - Supporting Documentation - on the pages following the complete narrative response, insert any supporting documentation that provides evidence of compliance with the Standards.
Note: For a findings letter with more than two (2) citations, each citation/response should be listed on a table of contents that includes the Standard and the page of the narrative where the response is located. Citations with the same Standard number should be listed separately (e.g.: III.A. - Resources - Budget and III.A. - Resources - Computers).
- All pages of the submitted response, both hardcopy (paper) and electronic/digital form - including supporting documentation, should be numbered sequentially as one document, beginning with the first page of the narrative through the final page of the supporting documentation.
- All submissions should be submitted in BOTH a bound [3-ring binder, spiral, or other], hardcopy (paper) form and electronic/digital (CD-ROM, DVD, flash drive) form, using PDF (preferred) or Microsoft Word format. The electronic/digital copy should be a single, continuous "seamless" document - all files and folders combined into one, continuous document - and an exact duplicate of the hardcopy (paper) submission, preferably saved as a PDF document. NOTE: Please do not e-mail large documents (more than 20 pages) to the ARC/STSA.
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On-Site Evaluation Documents
When an On-Site Evaluation is scheduled, two common documents used to support the visit are:
- List of On-Site Visit Materials - SA specific - provided by the ARC/STSA and used by the program to prepare on-site documentation for the visitors to review
- On-Site Evaluation Schedule - Surgical Assisting and visit specific - completed and submitted to the ARC/STSA separate from any additional documentation (not bound into the Self-Study, etc).
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SA FORMS
Needs Assessment Form - SA
List of On-Site Visit Materials - SA*
On-Site Evaluation Schedule - SA*
Fair Practices Form - SA
Program Advisory Committee (PAC) Form - SA
Clinical Affiliation Site Report Form - SA
Program Faculty Curriculum Vitae Form - SA
Program Personnel Report Form - SA
Faculty Schedule of Responsibilities Form - SA
Clinical Preceptor Reporting Form - SA
Clinical Preceptor Delegate Reporting Form - SA
SA Employer Survey Form
SA Graduate Survey Form
* Please contact the ARC/STSA office at info@arcstsa.org or 303-694-9262 for forms marked with an asterisk above.
The following form is being piloted for use. It should only be used when directed to do so by the ARC/STSA office. Instructions for its use are embedded in the form. If needed, please contact the ARC/STSA office (303-694-9262) for further assistance in completing this form.
ARC/STSA Curriculum Comparison Form - SA
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