Educators

Surgical Assisting – Forms and Facts

Submission Guidelines

Frequent Program Changes


Bookmarking Protocol & Guidelines

All program submissions to the ARC/STSA must be created and sent as one seamless PDF file, with all pages upright/facing the same direction, appropriately labeled and bookmarked as indicated in the bookmarking reference below:

The ARC/STSA will not accept or process submissions that are not appropriately bookmarked. Submissions not following the guidelines will be returned to the program for correction and resubmission.  Please note that the posted document is to be used as a reference and that not all bookmark labels will apply to your submission. Bookmarks should follow the section labels provided with Self-Studies, PRRs, Findings letters or applications.


Program Director (PD) Changes

A change in Program Director (PD) should be reported to the ARC/STSA within 30 days of the change. Effective August 1, 2014, the following documentation should be submitted in support of the appointment:

    1. A SASA-ARC/STSA Program Personnel Data Form – Program Director. This attestation form does not require the submission of additional supporting documentation unless specifically requested by the ARC/STSAPlease note: the program should retain copies of the following documents related to the appointment of the Program Director for review upon request by the ARC/STSA or during On-Site Evaluation:
      • A current résumé indicating experience/training as an educator. The résumé should also indicate employment at the current SA program
      • Documentation indicating proficiency in instructional methodology, curriculum design, and program planning should include one(1) of the following:
        • documentation of previous teaching experience [surgical assisting-related] that includes responsibilities for instructional methodology, curriculum design, and/or program planning
        • documentation of formal coursework in instructional methodology, curriculum design, and/or program planning
        • other documentation from an administrative representative how the school ensures that the candidate possesses proficiency in instructional methodology, curriculum design, and/or program planning
        • a detailed professional development plan of action and timeline for the newly appointed program director to possess proficiency in instructional methodology, curriculum design, and/or program planning
      • Proof of a current CSFA™ or CSA credential. Proof consists of submission of one (1) of the following documents:
        • A copy of the NBSTSA or NCCSA certification card
        • A copy of the NBSTSA or NCCSA certification certificate
        • A copy of the verification page from the NBSTSA website (www.nbstsa.org)
        • A copy of the verification page from the NSAA website (www.nsaa.net)

If an interim program director is appointed while the sponsoring institution conducts a formal search for a permanent program director, please contact the ARC/STSA at info@arcstsa.org or 303-694-9262 to determine the documents required for submission in support of the interim program director appointment. At a minimum, the program should submit a plan of action, using the SASA-ARC/STSA Plan of Action Form-SA and implementation timeline for the appointment of a “permanent” program director, including but not limited to the projected date for the search process to conclude and for the “permanent” program director’s appointment to begin.

In addition, effective January 1, 2009, all newly appointed program directors are required to submit proof of attendance at an ARC/STSA-sponsored 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\Surgical Director (MD) Changes

A change in Medical/Surgical Director should be reported to the ARC/STSA on the program’s next ARC/STSA SA Annual Report. Effective August 1, 2014, the following documentation should be attached to the SA Annual Report in support of the appointment:

  1. A SASA-ARC/STSA Program Personnel Data Form – Medical/Surgical Director. This attestation form does not require the submission of additional supporting documentation unless specifically requested by the ARC/STSA.Please note: the program should retain copies of the following documents related to the appointment of the Medical/Surgical Director for review upon request by the ARC/STSA or during On-Site Evaluation:
    • Current licensure as a physician
    • Proof of certification or board-eligibility for certification in a surgical specialty recognized by the American Board of medical Specialties
    • A current résumé indicating experience in the type of health care for which the SA student is being trained. The résumé should also indicate employment at the current SA program.

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Didactic Faculty Changes

A change in Didactic Faculty (non-PD) who teach core surgical assisting content should be reported to the ARC/STSA on the program’s next ARC/STSA SA Annual Report. Effective August 1, 2014, the following documentation should be attached to the SA Annual Report in support of the appointment:

  1. A SASA-ARC/STSA Program Personnel Data Form – Didactic Faculty. This attestation form does not require the submission of additional supporting documentation unless specifically requested by the ARC/STSA.Please note: the program should retain copies of the following documents related to the appointment of the Didactic Faculty for review upon request by the ARC/STSA or during On-Site Evaluation:
    • A current résumé indicating qualification to teach by education and experience
    • Proof of a current CSFA™ or CSA credential. Proof consists of submission of one (1) of the following documents:
      • A copy of the NBSTSA or NCCSA certification card
      • A copy of the NBSTSA or NCCSA certification certificate
      • A copy of the verification page from the NBSTSA website (www.nbstsa.org)
      • A copy of the verification page from the NSAA website (www.nsaa.net)

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Clinical Preceptor Changes

A change in Clinical Preceptor should be reported to the ARC/STSA on the program’s next ARC/STSA SA Annual Report.

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Clinical Preceptor Delegate Changes

A change in Clinical Delegate Preceptor should be reported to the ARC/STSA on the program’s next ARC/STSA SA Annual Report.

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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 ARC/STSA within 30 days of the change. The following documentation should be submitted in support of the appointment:

For a change in President/CEO [or comparable appointment]:
An ARC/STSA Program Personnel Data Form – President/CEO

For a change in Dean [or comparable appointment]:
A SASA-ARC/STSA Program Personnel Data Form – Dean

 

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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 ARC/STSA on the program’s next ARC/STSA SA Annual Report. The following documentation should be attached to the Annual Report in support of the appointment:

SASA-ARC/STSA SA Program Advisory Committee (PAC) Form

Please note:

  1. 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
  2. Please include the current certification number for the committee member representing the Practicing CSFA® or CSA on the SASA-ARC/STSA SA 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 CSFA certification card
    • A copy of the NCCSA CSA certification card
    • A copy of the NBSTSA CSFA certification certificate
    • A copy of the NCCSA CSA certification certificate
    • A copy of the verification page from the NBSTSA website (www.nbstsa.org)
    • A copy of the verification page from the NSAA website (www.nsaa.net)

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SA Maximum Enrollment Capacity (MEC) Changes

Proposed changes to the program’s maximum enrollment capacity must be reported to the ARC/STSA for review and approval of sufficiency of program resources by the ARC/STSA Board of Directors using the Maximum Enrollment Capacity (MEC) Attestation Form.

This form will replace the documentation previously required for a MEC change. Please note: support documentation must be maintained at your campus to verify sufficiency of the program’s resource to address any needs related to the proposed MEC change, including but not limited to:

  • Classroom equipment
  • Laboratory instrumentation
  • Supplies and equipment
  • Computer resources
  • Instructional aides

(See Standard III.A.- physical resources, Standard III.B. – faculty resources, and Standard III.C. – curriculum resources and clinical case requirement.)

ARC/STSA will contact you if additional documentation is needed.

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SA Facilities Changes

Proposed changes to the program’s facilities – classroom or laboratory facilities – should be reported to the ARC/STSA for review and approval by 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 SASA-ARC/STSA Clinical Affiliation Site Reporting Form – SA, if program maximum enrollment capacity has changed.
  • Any changes in contact information – telephone number, fax number, address, etc.

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SA Curriculum Changes

Proposed changes to the curriculum offered by a CAAHEP-accredited program come under two categories:

  • curriculum changes that include curriculum content found in the Core Curriculum for Surgical Assisting, 3e [CCSA3e] – Core Content
  • curriculum changes that involve curriculum content not found in the CCA3e, such as general education courses not used to teach CCSA3e content – Non-Core Content

Core Content Curriculum Changes

Documentation in support of Core Content curriculum changes typically includes the following:

  • A narrative indicating the nature of the change, including date of effectiveness
  • Proof of institutional accreditor and state approval agency [if applicable] review and approval of the curriculum change
  • Program Advisory Committee minutes indicating review of the proposed curriculum change
  • A completed ARC/STSA Curriculum Sequencing [C-1] Form
  • A master curriculum list of all courses required for program completion
    [Please note that a master curriculum list includes the course designation, course title, clock hours, and time increment (quarter, semester, trimester, etc.) of instruction.]
  • Copies of proposed [new] syllabi [and/or companion documentation, if applicable] that have changed
    [Please note that a comprehensive syllabus and/or companion document includes the course designation, course title, clock hours, time increment (quarter, semester, trimester, etc.) of instruction, course faculty, course schedule, course overview, course objectives, method of teaching, course content outline, outcomes assessment methods, and grading scale. ]
  • A completed SASA-ARC/STSA Curriculum Attestation Form-SA
  • A completed Core Curriculum Outline Comparison Form
  • Copies of publications, draft publications, or a plan of action to update publications to reflect the proposed curriculum change

Please contact the ARC/STSA at info@arcstsa.org or 303-694-9262 to determine which of the above documents are required for submission in support of the curriculum change for your institution.

Non-Core Content Curriculum Changes

Submit the Curriculum Change Attestation Form – Associate Degree for Non-Core content, degree-level curriculum changes, from a certificate or diploma to an associate degree.

Other Non-Core content curriculum changes may be reported on the next SA Annual Report. Please note that curriculum changes submitted and/or approved outside of the SA Annual Report should not be included in the SA Annual Report.

If assistance is required to determine whether a curriculum change is considered Core or Non-Core, please contact the ARC/STSA at info@arcstsa.org or 303-694-9262.

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Findings Letter/Program Change Letter Submissions

When submitting a findings letter or program change to the ARC/STSA, please use the following guidelines when preparing your submission:

  1. A cover letter, on institutional letterhead, should include a reference to the purpose for the documentation submission (for example: “…response to a findings letter from the ARC/STSA dated October 11, 2013…”).
  2. A copy of CAAHEP or ARC/STSA communication(s) related to the submission (e.g., ARC/STSA findings letter, CAAHEP letter, etc.), if applicable
  3. 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). [Please note that any plans of action submitted in the response should be submitted using the SASA-ARC/STSA Plan of Action Form-SA.]
  4. All submissions should be submitted in electronic/digital (CD-ROM, DVD, flash drive) form, using PDF (preferred) format. The electronic/digital copy must be a single, continuous “seamless” document – all files and folders combined into one, continuous document saved as a PDF document. NOTE: Please do not e-mail large documents (more than 20 pages) to the ARC/STSA.
  5. Documentation should be submitted to:
    Ron Kruzel
    Executive Director
    ARC/STSA
    6 West Dry Creek Circle, Suite 110
    Littleton, CO 80120

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On-Site Evaluation Documents

When an On-Site Evaluation is scheduled, two common documents used to support the visit are:

  1. List of On-Site Visit Materials – Surgical Assisting and On-Site Evaluation specific – provided by the ARC/STSA and used by the program to prepare on-site documentation for the visitors to review. Each On-Site Evaluation [Initial, Random/Continuing, Consultative/Comprehensive, Focused] uses a List of Materials specific to that type of evaluation. Please be sure to use the applicable List of Materials to prepare for your program’s evaluation.
  2. On-Site Evaluation Schedule – Surgical Assisting and Evaluation 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*

SA Program Advisory Committee (PAC) Form – SA

Clinical Affiliate Attestation Form – SA 

SASA-ARC/STSA Clinical Affiliation Site Reporting Form – SA

SA Program Personnel Data Form-President

SA Program Personnel Data Form – Dean

SA Program Personnel Data Form-Program Director

SA Program Personnel Data Form-Medical/Surgical Director

SA Program Personnel Data Form-Didactic Faculty

Clinical Preceptor Reporting Form – SA

Clinical Preceptor Delegate Reporting Form – SA

A-1 – ARC/STSA Budget Form

A-2 – Methods of Didactic and Laboratory Evaluation Form – SA

A-3 – Methods of Clinical Evaluation Form – SA

Curriculum Attestation Form-SA

C-1 – Curriculum Sequencing Form – SA

C-2 – Didactic and Laboratory Courses – Summary Form – SA

C-3 – Clinical Courses – Summary Form – SA

Curriculum Change Attestation Form – Associate Degree

Sample Program Effectiveness Plan – SA

SASA-ARC/STSA Plan of Action Form-SA

SASA-ARC/STSA Outcomes Tracking Tool-SA [required for use for tracking ARC/STSA-established outcomes for all cohorts enrolled on or after August 1, 2014 and upon request by the ARC/STSA]

Outcomes Assessment Plan Summary – Report Form – SA

SA Employer Survey Tool
This Employer Survey Tool is used for graduates who completed the program on or before July 31, 2016 and is not administered to employers before 9 months post-employment.

SA Graduate Survey Tool
This Graduate Survey Tool is used for graduates who completed the program on or before July 31, 2016 and is not administered to graduates before 6 months post-graduation.

SA Graduate Survey Tool
This Graduate Survey Tool is used for graduates who completed the program on or after August 1, 2016 and may be administered immediately upon completion of the program.

SA Employer Survey Tool
This Employer Survey Tool is used for graduates who completed the program on or after August 1, 2016 and may be administered immediately upon placement.

Fair Practices Form – SA

* 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.

Standard I.A./I.B/I.C. – Sponsoring Attestation Form

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