Stoke-on-Trent School of Anaesthesia. CCT in Anaesthetics. Higher Level Training (ST Years 5, 6 and 7) Workplace Based Assessments.

Transcription

1 Stoke-on-Trent School of Anaesthesia CCT in Anaesthetics Higher Level Training (ST Years 5, 6 and 7) Workplace Based Assessments

2 Contents: 1. Guidance for using this document 2. Indicative times 3. Essential Units of Training 4. Optional Units of Training 5. List Management Assessment Form 6. Completion of Unit of Training Form 2

3 Guidance for using this document 1. Higher level training is divided up into Essential and Optional Units of Training. This document sets out the core learning objectives for each unit and the required assessments. 2. It is expected that for the Unit to be signed off as satisfactory then a minimum of one Anaes CEX, one DOPS and one CBD/Extended CBD should be completed as indicated for each unit. In addition a List Management Assessment should also be done. The core learning outcomes must have been achieved and the log book should show an appropriate case mix. 3. At the end of each Unit of Training a Completion of Unit of Training form should be signed by the Educational/Clinical Supervisor and the trainee. 4. Evidence in the form of a) a log book summary for that Unit and b) all completed assessment forms should be presented to the Educational/Clinical Supervisor. 5. In addition a Multi Source Feedback form should be completed annually. Additional Points 1. The Intensive Care Training Summary covers the two three month training periods i.e ST 3/4 and ST 5-7 and should be completed in years 5-7. A Unit of Training Completion form also needs to be signed for each three month period. 2. Copies of all forms required i.e. Anaes CEX, DOPS, CBD, Extended CBD, MSF and Completion of Unit of Training are attached herewith. 3

4 Indicative Times Listed below are the suggested times allowed to complete training in each unit. Time in Intensive Care Medicine must be three months. Unit of training Time in months Neuro 3 Cardiac 3 General Duties 12 (minimum) Intensive Care Medicine 3 Paediatrics 3 Optional units/advanced training can be of up to one year s duration 4

5 Essential Units of Training. 1. Anaesthesia for neurosurgery, neuroradiology and neurocritical care 2. Cardiac/Thoracic 3. General duties Airway management* Day surgery ENT. Maxillo-facial and dental* General, urological and gynaecological surgery* Management of respiratory and cardiac arrest* Non-theatre Obstetrics* Orthopaedic Regional Sedation Transfer medicine Trauma and stabilisation Vascular surgery * Essential for all trainees 4. Intensive care medicine 5. Paediatrics 5

6 Neuro Anaesthesia Core Clinical Learning Outcomes Deliver safe peri-operative anaesthetic care to complicated ASA 1-3 adult patients requiring complex elective intra-cranial and spinal surgery and neuroradiological investigations under direct supervision. Deliver peri-operative anaesthetic care to complicated ASA 1-3 adult patients for emergency non-complex intracranial and spinal surgery with indirect supervision [i.e. craniotomy for acute subdural / acute decompressive lumbar laminectomy] Lead the resuscitation, stabilisation and transfer of adult patients with brain injury [Cross reference Transfer section] (s) Acute decompressive craniectomy Index Skills: To be supported by DOPS form Index skill (s) Management of ICP & cerebral perfusion in neuroanaesthesia and/or neurocritical care Interventional neurological procedures including coiling Complex spinal surgery including patients with unstable cervical spine Acoustic neuroma and facial nerve monitoring Stroke, including SAH, ICH and ischaemic stroke 1 CBD/extended CBD as a minimum List Management assessment: To be supported by LMA form List Description 6

7 Cardiac Anaesthesia Core Clinical Learning Outcome Deliver perioperative anaesthetic care to complicated ASA 1-3 adult patients requiring elective aortic or mitral valve surgery under direct supervision Mitral or aortic valve surgery on cardiopulmonary bypass (s) Index Skills: To be supported by DOPS form Index skill Demonstrate the use of an appropriate cardiac output monitor including its set up Manages a patient for cardiopulmonary bypass, including appropriate myocardial protection, coagulation management, transfer to, and the weaning of patients from bypass with local supervision. (s) List Management assessment: To be supported by LMA form List Description 7

8 Thoracic Anaesthesia Deliver perioperative anaesthetic care to complicated ASA 1-3 adult patients requiring open resection of lung tissue under local supervision (s) Evaluation of patient with borderline respiratory function for lung resection Anaesthetise a patient for thoracotomy and resection of lung tissue with local supervision. (s) Index Skills: To be supported by DOPS form Index skill Demonstrate correct management of chest drainage systems Fibreoptic assessment of DLT placement (s) List Management assessment: To be supported by LMA form List Description 8

9 General Duties 1. Airway management* 2. Day surgery 3. ENT, maxillo-facial and dental surgery* 4. General, urology and gynaecology* 5. Management of respiratory and cardiac arrest* 6. Non-theatre 7. Obstetrics* 8. Orthopaedic surgery 9. Regional 10. Sedation 11. Transfer medicine 12. Trauma and stabilisation 13. Vascular surgery * Essential for all trainees 9

10 Airway Management This may be completed as part of the ENT/Maxfax unit. Core Clinical Learning Outcome Able to perform elective fibreoptic intubation in patients without serious intra-oral/laryngeal pathology, safely and proficiently, in awake or anaesthetised patients under distant supervision Able to manage patients with complex airway disorders, safely and proficiently, in all situations, under local supervision Management of the airway in a patient with complex head/neck pathology (s) Index Skills: To be supported by DOPS form Index skill Fibreoptic intubation in the awake patient Use of an alternative airway device (s) List Management assessment: To be supported by LMA form List Description Attendance at theoretical Airway Course eg BASDART Course Venue Date Completed Anaesthesia for Day Case Surgery Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to ASA 1-3 patients having more extensive or specialized day surgery procedures with distant supervision 10

11 Day case surgery in ASA 3 patient (s) List Management assessment: To be supported by LMA form List Description 11

12 ENT, Maxfax and dental Anaesthesia Core Clinical Learning Outcomes Provides comprehensive safe perioperative anaesthetic care to ASA 1-4 adult patients requiring ENT, maxillo-facial and dental [where available] surgery of greater complexity with distant supervision Manage ENT, maxillo-facial and dental [where available] surgery lists with distant supervision (one required from options below) Undertake anaesthesia for major ENT or maxillo-facial surgery such as laryngectomy, thyroidectomy or major resection for cancer Supervise a more junior trainee undertaking uncomplicated ENT or maxillo-facial surgery (s) Index Skills: To be supported by DOPS form Index skill Conduct inhalational induction in a child or adult (s) List Management assessment: To be supported by LMA form List Description General surgery/gynaecology/urology Core Clinical Learning Outcomes Demonstrates the ability to provide safe and effective perioperative anaesthetic care to high risk emergency surgical cases, including those with potential for massive haemorrhage [e.g. the ruptured aortic aneurysm] 12

13 Demonstrates the ability to provide safe and effective perioperative anaesthetic care for patients requiring complex lower abdominal and/or bariatric surgery Working within a multi-disciplinary team, demonstrates the necessary communication, teamwork, leadership, professional and practical [anaesthetic] skills needed to manage patients on elective and emergency general surgery, urology and gynaecology lists, safely and effectively (E plus one other must be completed) E=essential (s) Anaesthesia for a major complex general surgery, urology or gynaecology case involving invasive monitoring E Anaesthesia for a patient with a BMI > 40 Emergency laparotomy Anaesthesia for complex laparoscopic procedure eg anti reflux surgery Index Skills: To be supported by DOPS form Index skill (s) Thoracic epidural List Management assessment: To be supported by LMA form List Description Management of respiratory and cardiac arrest Core Clinical Learning Outcome The management of patients requiring cardio-respiratory resuscitation [with distant supervision] by: 1. Demonstrating the ability to lead a multidisciplinary resuscitation team in the initial assessment and management through to definitive care in the Intensive Care Unit if successful [including necessary transfer] 2. Leading the debrief sessions for both staff and relatives in a sensitive, compassionate and constructive manner In order for this unit to be signed off adult and paediatric life support courses must have been completed and be in date. 13

14 Course Completion date ALS APLS/EPLS Management of cardiac arrest in an adult patient This may be completed during ICM training 14

15 Non Theatre Core Clinical Learning Outcome To deliver safe peri-procedure anaesthesia/sedation to adult patients outside the operating theatre, including remote sites, under distant supervision Anaesthesia for adult patient undergoing interventional imaging, ECT, cardioversion or radiotherapy (s) List Management assessment: To be supported by LMA form List Description 15

16 Obstetric Anaesthesia Core Clinical Learning Outcomes To be able to provide the appropriate anaesthetic management for any patient who requires emergency obstetric anaesthesia To be able to provide elective anaesthetic services to the obstetric unit (excepting those patients with unusual problems who would normally be referred to a specialist centre). (s) Undertake the management of caesarian section in a complex obstetric case such as twin delivery, pre-ecampsia, placenta praevia, obstetric haemorrhage Supervises a more junior trainee in obstetric anaesthetic duties such as instituting epidural analgesia and anaesthetising for caesarian section Index Skills: To be supported by DOPS form Index skill (s) Induce anaesthesia in a very obese obstetric patient Manages the patient with a failed or partly effective epidural List Management assessment: To be supported by LMA form List Description 16

17 Orthopaedic Anaesthesia Core Clinical Learning Outcomes Provide comprehensive safe perioperative anaesthetic care to all ASA 1-4 adult patients for all types of elective and emergency orthopaedic/trauma surgery to the limbs, pelvis and spine [excluding scoliosis surgery] with distant supervision (s) Undertake anaesthesia for major orthopaedic surgery (spinal, scoliosissugery, pelvic surgery, hip revision arthroplasty Supervise a more junior colleague undertaking routine or emergency orthopaedic surgery Index Skills: To be supported by DOPS form Index skill (s) Undertake anaesthesia for a patient in whom massive haemorrhage is expected Establish appropriate peripheral nerve blockade for orthopaedic surgery on upper or lower limb List Management assessment: To be supported by LMA form List Description 17

18 Regional Anaesthesia Core Clinical Learning Outcomes Demonstrates ability to perform both lower and upper limb plexus/regional blocks with distant supervision Always considers the option of regional anaesthesia in appropriate clinical contexts (s) Manage surgery with regional anaesthesia and sedation for a complex or lengthy procedure. Teach a junior colleague how to do a peripheral nerve block. Index Skills: To be supported by DOPS form E = essential and must be completed by end of year 7 for sign off Index skill (s) Brachial Plexus Block (E) Deep cervical plexus block Thoracic epidural anaesthesia (E) Simple ultra sound guided nerve blocks including, but not exclusively, Femoral nerve and axillary brachial plexus Blocks (E) List Management assessment: To be supported by LMA form List Description 18

19 Sedation Core Clinical Learning Outcomes Demonstrates the ability to provide safe and effective sedation to any patient using whatever drugs required, by whatever route Use of sedation in an adult patient with significant co-morbidities (s) List Management assessment: To be supported by LMA form List Description 19

20 Transfer Medicine Core Clinical Learning Outcomes Demonstrates the ability to lead a multidisciplinary team undertaking the initial assessment and stabilisation of patients, prioritising their early treatment Demonstrates the leadership and clinical management skills needed to lead teams delivering safe and effective intra-/inter hospital transfer of any patient, however complex, and for prolonged journeys within the UK if required, by either land or air. Demonstrates an understanding of the roles and responsibilities of teaching and supervising those undergoing training in the transfer of patients Attendance at Transfer Training Course Course Location Date A log book of transfer cases must accompany this unit Index Case: To be supported by Anaes CEX form Inter or intra hospital transfer of adult patient (s) Case description 20

21 Trauma and stabilisation Core Clinical Learning Outcomes The safe management of patients with multiple injuries from arrival in hospital and onwards through definitive treatment with distant supervision by: 1. Demonstrating the ability to lead a multidisciplinary trauma team in the initial assessment and stabilisation of the multi-trauma patient and prioritise early further treatment 2. Delivering safe anaesthetic management for all multiply injured patients for ongoing assessment and early/definitive treatment (s) Anaesthesia for multiply injured patient Lead initial resuscitation in multitrauma patient Index Skills: To be supported by DOPS form Index skill (s) Airway management with facial/head & neck trauma Identify common abnormalities on CT scans in patients with head injury List Management assessment: To be supported by LMA form List Description Attendance at ATLS or equivalent course Course name and location Date Vascular Anaesthesia Core Clinical Learning Outcomes To anaesthetise patients for carotid endarterectomy and aortic aneurysm surgery with indirect supervision 21

22 Anaesthesia for open repair of abdominal aortic aneurysm with indirect supervision Carotid endarterectomy general or regional anaesthesia (s) Index Skills: To be supported by DOPS form Index skill CVP/cardiac output measurement e.g. oesophageal Doppler, TOE Thoracic epidural/cse Management of effects of crossclamping (s) List Management assessment: To be supported by LMA form List Description Intensive Care Medicine Training Objectives At the completion of Intermediate level ICM training [i.e. after a total of nine months ICM training comprising three months Basic ICM [at CT 1/2] and six months ST training which should normally be completed in two three month blocks one in ST 3/4 and the other in ST 5/6] a trainee should: Recognise and manage the factors which may lead to deterioration in sick patients Be able to undertake post-resuscitation management and be able to manage the initial resuscitation of more complex specialist patients. Have an understanding of the pathology, clinical features and prognosis of the majority of problems presenting to ICU, and be able to initiate management of them, with distant supervision. 22

23 Be able to appropriately request and interpret (in discussion with appropriate specialists) investigations such as CT, ultrasound, and microbiology. Be able to make a critical appraisal of the evidence for treatment and investigations. Appreciate that ICUs are complex systems which require management and leadership skills. Be able to lead a ward round, planning care for the next 24 hours. Please note: The term Anaes CEX is used in the Intensive Care Training Summary for simplicity. This is the same type of assessment as an ICEX i.e a clinical evaluation exercise. The management assessments set out should also be done using the CEX form. Intensive Care Medicine Training Summary ST Years 3 and 4 Date of training Hospital Unit details Number of beds Casemix Number of supervised consultant sessions Number of on call sessions 23

24 ST Years 5-7 Date of training Hospital Unit details Number of beds Casemix Number of supervised consultant sessions Number of on call sessions Intensive Care Medicine Training Summary At least 6 completed in 6 months (s) Pneumonia Aortic aneurysm Major trauma/major burns Non traumatic bowel perforation Acute MI Septic shock Acute renal failure Exacerbation of COPD Acute pancreatitis Head injury resuscitation, stabilisation and transfer. (This is essential for Neuro sign off in years 3/4) Obstetric ICU admission 24

25 Brain stem death testing Index Skills: To be supported by DOPS form (E = essential) Index skill (s) Safe establishment of mechanical ventilation E Fibreoptic bronchoscopy E Transthoracic pacing Management of renal replacement therapy Appropriate use of inotropes with appropriate cardiac output monitoring E Abdominal paracentesis Intensive Care Medicine Training Summary Case Based Discussion: To be supported by CBD form Year of training Case description ST3/4 ST5-7 Management Anaes CEX Leading daily ward round As a minimum one in years 3/4 and one in years 5-7 Discharge of patients from ICU Management of treatment withdrawal Discussion with relatives Practical Procedures Undertaken Procedure ST3/4 total number ST5-7 total number Arterial line CVP line Internal Jugular Subclavian Femoral CVVH line 25

26 NG tube Chest drain Percutaneous tracheostomy Pulmonary artery catheter Bronchoscopy Transvenous pacing Compliance with local infection control measures: Satisfactory/unsatisfactory Signature (senior nurse on ICU): Intensive Care Medicine Training Summary Name: Transfers Date of transfer Description of case An ACEX assessment of the transport of a ventilated, critically ill patient outside ICU must also be completed : ICM Syllabus The following aspects of knowledge, skills, attitudes and behaviour should be achieved during the six months of ICM training. Self assessment (tick) Resuscitation and initial management of the acutely ill patient Triages and prioritises patients appropriately, including timely admission to ICU Assesses and provides initial management of the trauma patient Assesses and provides initial management of the patient with burns Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation Obtains a history and performs an accurate clinical examination Undertakes timely and appropriate investigations Performs electrocardiography [ECG / EKG] and interprets the results Obtains appropriate microbiological samples and interprets results Obtains and interprets the results from blood gas samples 26

27 Interprets imaging studies Monitors and responds to trends in physiological variables Integrates clinical findings with laboratory investigations to form a differential diagnosis Disease Management Recognises life-threatening maternal peripartum complications and manages care under supervision Therapeutic interventions / Organ system support in single or multiple organ failure Initiates, manages and weans patients from renal replacement therapy Practical procedures Performs difficult and failed airway management according to local protocols Performs fibreoptic bronchoscopy and BAL in the intubated patient under supervision Performs transthoracic cardiac pacing describes transvenous Describes how to perform pericardiocentesis Manages the administration of analgesia via an epidural catheter Performs abdominal paracentesis Describes Sengstaken tube (or equivalent) placement Peri-operative care Manages the care of the patient following craniotomy under supervision Manages the pre- and post-operative care of the trauma patient under supervision Comfort and recovery Manages the safe and timely discharge of patients from the ICU End of life care Manages the process of withholding or withdrawing treatment with the multidisciplinary team Manages palliative care of the critically ill patient Performs brain-stem death testing Manages the physiological support of the organ donor Paediatric care Describes the recognition of the acutely ill child and initial management of paediatric emergencies Describes national legislation and guidelines relating to child protection and their relevance to critical care Transport Undertakes transport of the mechanically ventilated critically ill patient outside the ICU Patient safety and health systems management Leads a daily multidisciplinary ward round Organises a case conference Professionalism Involves patients (or their surrogates if applicable) in decisions about care and treatment Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making Supports clinical staff outside the ICU to enable the delivery of effective care Appropriately supervises Paediatric Anaesthesia 27

28 Core Clinical Learning Outcomes Be able to resuscitate and stabilise a sick baby or child prior to transfer to a specialist centre Provide perioperative anaesthetic care for common surgical conditions, both elective and emergency, for children aged 3 years and older with distant supervision Emergency surgery aged 3 years and older e.g. ORIF fracture, appendicectomy, bleeding tonsil (s) Index Skills: To be supported by DOPS form A minimum of 2 need to be completed Index skill (s) Fluid management perioperatively Peripheral nerve/regional anaesthesia blocks Use of opioids (incl PCA/NCA), adjuvant NSAIDs & simple analgesics Intubation in infant Ex prems for hernia/ppv repair Management of airway emergencies e.g croup, epiglottitis, inhaled foreign body, laryngospasm Management of septic child prior to transfer to PICU List Management assessment: To be supported by LMA form List Description Optional Units of Training 1. Pain medicine 2. Ophthalmic 3. Plastics/burns 28

29 4. Anaesthesia in developing countries 5. Conscious sedation in dentistry 6. Military anaesthesia 7. Remote and rural anaesthesia If you wish to complete any of these units, please refer to the 2010 curriculum document and discuss with your clinical/educational supervisor the necessary assessments required. 29

30 List Management Assessment Form Trainee Name: Date of Assessment: Surgical specialty: Pre-operative assessment Satisfactory Unsatisfactory Comments Management of bed issues, sending, communication with theatre staff Preparation for case: equipment, drug checks Pre-operative checks: WHO guidelines followed Conduct of anaesthesia; situational awareness, vigilance Management of patient turnaround Communication and management in recovery Overall efficiency and time management General comments Consultant Trainer Signature: Trainee signature: 30

31 The Royal College of Anaesthetists Completion of Unit of Training Trainee: GMC number College Reference Number Unit of Training: Assessments Has the trainee completed successfully an appropriate number of WPBA? Yes No Log book Review Is the case mix, complexity and numbers appropriate for the level of training? Yes No Multi- source Feedback Has a MSF been satisfactorily completed? (Only for units of training requiring MSF) Yes No Minimum clinical learning outcomes Has the trainee demonstrated achievement of the minimum clinical learning outcomes? Yes No Comments Signed: Name (Print): Date: (Clinical Supervisor, Educational Supervisor or College Tutor) Signed: Name (Print): Date: (Trainee)