General Goals for Resident Achievement of the Core Competencies in Athesthesiology at Ucsd

GENERAL GOALS FOR RESIDENT ACHIEVEMENT OF THE CORE COMPETENCIES IN ATHESTHESIOLOGY AT UCSD

The overall goal of the UCSD Anesthesiology Residency Program is to provide and environment for you to acquire excellence as you become a consultant in Anesthesiology. Your education will be organized according to the ACGME six core competencies: patient care, medical knowledge, practice based learning and improvement, interpersonal and communication skills, professionalism, and systems based practice. Throughout your residency, you will gain knowledge and expertise in these areas, and your progress will periodically be evaluated. As a UCSD resident, you will receive some of the finest education and training available in all the general and subspecialty areas of Anesthesiology.

Medical Knowledge

Medical knowledge in Anesthesiology is defined as the body of facts, principles, and theories which define the practice. Knowledge is acquired through didactic resources, which include information found in textbooks, journals and other written resources, and information conveyed by faculty and other medical practitioners. Throughout your residency your knowledge will be assessed using written examinations (ABA in-training examinations, AKT testing, practice oral board examination sessions and faculty evaluations from the clinical arena). You are urged to read aggressively and be attentive to other sources of knowledge, since your medical knowledge is the basis on which you will build your practice.

Patient Care

Excellence in patient care not only requires medical knowledge, but also good clinical judgment, dexterity, and experience. Both manual and intellectual skills are required. Monitoring, for example, requires the application of monitoring devices (e.g. arterial cannulation), the interpretation of the result (e.g. the arterial waveform), and judgement in applying the information to the patient management. Clinical judgment in Anesthesiology involves the ability to evaluate a patient, consider alternative diagnoses and modes of treatment, and determine and implement the correct ones. Clinical judgment, perhaps the attribute of the seasoned physician most difficult to acquire-and most valuable-develops through experience under the supervision of the attending faculty. Your progress in patient care will be monitored primarily in the clinical arena by your attending faculty, and you will receive periodic feedback on such via your faculty advisor. Practice Based Learning and Improvement

The practice of Anesthesiology is essentially a life-long learning and improvement project. As you progress in your career, you will use your own experience, the experience of others, and knowledge gained from the medical literature to make your clinical decisions. An important part of the UCSD Anesthesiology Residency is to prepare you to do this. Your faculty will do this by encouraging rigorous, logical clinical thought process, teaching the ability to go to the medical literature to obtain relevant information, and showing you how to evaluate that literature in an intelligent, thoughtful way. This will be done via journal club presentations/sessions, preoperative and intraoperative discussions with attendings, and review of management issues at the weekly morbidity and mortality conference. Your progress will be monitored both formally and informally-by your performance on written and oral examinations, and in the clinical arena.

Interpersonal and Communication Skills

The ability to interact and communicate with patients, families, and other members of the health care team is at the very core of competence in Anesthesiology. Although you may not spend as much time as practitioners in some other specialties directly communicating with patients, the time you do spend is often critical, very intense, and emotionally charged. Likewise, the operating and procedure rooms can be very tense, high-pressure environments. Your ability to be “the voice of reason”, peacemaker, and, occasionally even psychotherapist will be critical to the success of the healthcare team. During your residency you will develop your ability to create a therapeutic and ethically sound relationship with patients, as well as professional, often friendly interactions with surgeons, other physicians, and staff. Also, you will develop the ability to elicit and provide accurate information using nonverbal, questioning, explanatory, and writing skills.

Your progress will be monitored both by your attendings and other health care practitioners in the medical center. You will receive feedback both informally in the clinical arena and formally from your faculty advisor in periodic meetings.

Professionalism

As a UCSD Anesthesiology resident, you will be required to demonstrate the fundamental qualities of professionalism. You will be expected to 1. Demonstrate respect, regard, integrity and responsiveness to the needs of patients and society that supercedes self-interest. 2.Assume responsibility and demonstrate a commitment to excellence and ongoing professional development 3. Demonstrate a commitment to ethical principles including provision or withholding of care, confidentiality of patient information, informed consent etc. As it is a complex discipline, you will receive special didactic training in Bioethics as it relates to Anesthesiology, and receive a written “post-test” to assure basic competence. Also, your behavior in the clinical arena will be monitored by you faculty as and the other members of the health care team. You will receive feedback as part of your periodic meetings with your faculty advisor.

Systems based practice.

Anesthetic care is provided in the context of a much larger system of health care. A particular subset of skills is required to effectively call on system resources (e.g. blood bank, ancillary support, nursing care ) to support the anesthetic and surgical care of patients. As a UCSD Anesthesiology resident, you will be expected to 1. Understand how their patient care practices and related actions impact component units of the health care delivery system 2. Know system-based approaches for controlling health care costs and allocating resources and practice cost effective health care that does not compromise quality of health care. 3. Understand the financial, business, and medicolegal aspects of the practice of Anesthesiology, and how these aspects are related to the general delivery of health care.

Of particular note, the department provides a weekend day-long business seminar that you will be required to attend. This seminar, offered every 18 months, covers financial, business, legal, and other logistical aspects of anesthetic practice. Your understanding of the material will be tested with a written post-test. Your progress in the other areas of system based practice will be monitored by your faculty, and you will receive feedback directly and via your faculty advisor.

Again, we welcome you to what we believe will be an exciting, rewarding learning experience. If you have any questions or problems, you are strongly encouraged to contact our Education Director, the Program Director (Dr. Manecke), or the Departmental Well Being Officer (Dr. Seaberg). The residency and your wellbeing are the most important parts of our jobs. We will never be too busy to look after your concerns and educational needs.

Good Luck!

Gerry Manecke

Gerard R. Manecke Jr., M.D. Program Director UCSD Anesthesiology