American Board of Allergy and Immunology

ASSESSMENT OF PROCEDURAL SKILLS SUMMARY

A summary of the procedures reflected in the resident's log should be submitted by the program director only once to the ABAI at the end of training or upon completion of the required procedures and additional procedures.



First Name
Middle Name
Last Name
Months of Training
Name of ACGME-Training Program
ACGME/RRC #
Program Director (Full Name)
Program Director Email


Directions to the Program Director:
Please insert the achievement date of competency for each skill assessed. Submit an electronic copy to the ABAI and retain a hard copy for your records. Both you and the resident must sign the hard copy for the ACGME

REQUIRED PROCEDURES AND ACHIEVEMENT OF COMPETENCY

(please check one or more of the following)

  Procedure Name Date
ALLERGEN IMMUNOTHERAPY
DELAYED HYPERSENSITIVITY SKIN TESTING
DRUG DESENSITIZATION AND CHALLENGE
IMMEDIATE HYPERSENSITIVITY SKIN TESTING
IMMUNOGLOBULIN THERAPY TREATMENT
PULMONARY FUNCTION TESTING
PHYSICAL URTICARIA TESTING

PROCEDURES & ACHIEVEMENT OF COMPETENCY (DESIRABLE, NOT REQUIRED)

(please check one or more of the following)

  Procedure Name Date
Exercise Challenge
Methacholine and Other Bronchial Challenge Testing
Nasal Cytology
Oral Challenge Testing
Patch Testing
Rhinolarynoscopy

REVIEW AND SIGN:

Resident's Full Name:


Resident's Signature:
 Program Director/Supervisor (Full Name):


Program Director/Supervisor (Signature):
I have assessed the competency of the above-named resident in each of the procedures listed and verify that the resident is skilled to perform these procedures. (Supporting information is on file).
Signed 5/11/2008