Uch Advanced Surgical Anesthesiology Ca-3

SURGICAL ANESTHESIOLOGY-UCH GOALS AND OBJECTIVES CA 3 Level

DEFINITION

During the CA-3 year, residents may elect to take between 1-4 months of the Advanced Surgical Anesthesiology rotation. The CA-3 resident is identified as the senior resident and will be assigned to the most advanced cases in the OR for a given day. This may include several surgical specialties: vascular, outpatient, orthopedic, plastic, gynecologic, neurologic, otorhinolaryngologic, urologic, cardiac, thoracic, and transplant surgery. The overriding goal is to provide increasing autonomy in their final year of training to prepare the CA-3 resident to apply previous CA-1 / CA-2 skills in independent practice.

CURRICULUM / GOALS

Residents rotating as the Senior OR resident are expected to build on both the basic / general OR skills learned as a CA-1 / CA-2, but also to include skill sets learned in the specialty rotations as they may be handling any number of specialty cases from day to day. The main emphasis is increased ability for independent and safe practice. Some specific goals include:

1. Participate in advanced clinical cases of the many subspecialties of anesthesia 2. Develop skills in supervising / teaching medical students 3. Discussing issues regarding operating room management 4. Discuss in greater detail issues regarding the preoperative assessment 5. Discuss the concepts of risk management, quality assurance and malpractice 6. Expand on the concept of cost containment and its applications to anesthesia 7. Participate in human stimulation scenarios, especially crisis management scenarios 8. Gain an understanding of JCAHO and how compliance issues are handled

MEDICAL KNOWLEDGE

The knowledge units described in the CA-1 / CA-2 General Surgical Anesthesia sections will apply for this section. Additional knowledge objectives include:

1. Management of patients requiring one-lung ventilation techniques, either for thoracic or general surgery case management. Techniques using double lumen tubes, bronchial blockers and specific ventilation management of each. 2. Full knowledge of specific airway management tools, including decision making process in awake vs. asleep intubations. 3. Indications / contraindications for invasive monitoring including PAC, arterial lines, central lines and TEE. 4. Comprehensive knowledge for crisis management including: o Hypertension / Hypotension (pre, intra and post operatively) o Bronchospasm o Hypoxemia o Tachycardia / bradycardia o Management of pacemakers / AICD during surgery o Malignant hyperthermia o Shock (hemorrhagic, septic, cardiogenic) 5. Airway management in remote locations including ICU, Burn ICU, ED, MRI.

PATIENT CARE

The patient care units described in the CA-1 / CA-2 General Surgical Anesthesia sections apply here. The focus is on development of more complex skills in patient management and decision making with the goal for independent practice.

1. The preoperative evaluation (including history physical exam and special investigations) for the patient undergoing elective surgery 2. Execute and manage the anesthetic plan in a facile, well-prepared, and skilled manner, including induction, maintenance and emergence from anesthesia of medically simple and complex cases undergoing simple and complex surgical procedures 3. Perform basic and more advanced procedures: including airway management, insertion of peripheral and central lines, arterial catheters, and spinal, epidural, regional, and peripheral nerve blocks 4. The preoperative consultations for seriously ill patients undergoing surgery 5. The role of the medical consultant in the care of complex patients; interpret and use medical specialty consultations in the care of complex patients 6. The nature of medical problems, their order of priority, and how they affect the anesthetic plan Counsel and educate patient and families as to the risks and benefits of anesthesia care 7. The issues surrounding airway management, insertion of peripheral and central lines, arterial catheters, and spinal, epidural, regional, and peripheral nerve blocks 8. Select, apply, and consider the efficacy and accuracy of monitoring techniques

INTERPERSONAL AND COMMUNICATION SKILLS

The units listed under the CA-1 / CA-2 sections also apply here. In addition, at the conclusion of the rotation the CA-3 resident will:

1. Gain an understanding of root causes for communication failures and mishaps 2. Gain an understanding of the various communication stereotypes 3. Gain an understanding of various techniques to improve communication skills 4. Gain an understanding of causes for operating room tension 5. Reflection on abilities and techniques to improve effective communication with patients, peers and health care team for the patient’s interest 6. Perform a detailed preoperative visit, assessment, anesthetic plan and implementation, communicating risks / benefits to patient and family 7. Displaying effective communication skills to health care team 8. Documenting medical records in a complete, accurate and legible manner

2 9. Giving assorted lectures to fellow residents (including Grand Rounds), medical students, faculty and nursing staff PROFESSIONALISM

The CA-3 resident will learn / demonstrate:

1. What constitutes professional ethics 2. Recognizing what defines strong personal character 3. Understanding the culture of medical ethics 4. Exhibiting examples of medical professionalism 5. Understanding the problems surrounding chemical dependence in anesthesiology 6. Understanding the role of pharmaceutical industry exposure and its implications to medical care 7. Understanding the essential nature of diversity in the workplace and in regards to patient care 8. Understanding the role of spirituality and prayer in certain patient populations 9. Wearing professional attire where appropriate 10. Following hospital, departmental protocol 11. Documenting medical records with care 12. Taking care of oneself so as to be able to continue to take care of patients well

PRACTICE BASED LEARNING AND IMPROVEMENT

In addition to the skills outlined in the CA-1 / CA-2 sections the CA-3 resident will gain an understanding of the following:

1. Reflective practice experience 2. Identifying individual strengths and weaknesses in how one learns 3. Understanding the role of criticism for self improvement 4. Understand the value of evidence based medicine as it applies to anesthesiology 5. Learning to become a critical thinker and integrate sound scientific literature appropriately 6. Self awareness of abilities and limitations 7. Performing a literature search for didactic sessions during their CA3 year 8. Participating actively in journal clubs

SYSTEMS BASED PRACTICE

The CA-3 resident will gain an understanding of the following regarding systems based practice:

1. Understanding the health care team approach to patient care 2. How the health care system works to investigate patient illness and optimize care 3. Utilizing system optimization of patient 4. Utilizing system risk to patient 5. Managing health care team 6. Safe patient transport 7. Delivering cost effective care 8. Understanding the issues regarding the JCAHO national patient safety goals

3 9. Understanding how the operating room is managed 10. Understanding how to organize an operating room schedule 11. Understanding the issues regarding medical liability 12. Understanding the issues regarding anesthesia billing and compliance

Evaluation Tools:

1. ITE exam 2. Self – evaluation process 3. “Mock” Oral Board exams 4. Direct observation by faculty with monthly written performance evaluations. 5. 360° Evaluations by nursing/OR staff.

4 Rev. 7/2009