ENVIRONMENT Preoperative evaluation clinic. Preoperative evaluation clinic. Preoperative evaluation clinic. clinic. clinic. Preoperative evaluation

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1 Goals and Objectives, Preoperative Evaluation Clinic Rotation, CA-1 and CA-2 year UCSD DEPARTMENT OF ANESTHESIOLOGY PREOPERATIVE EVALUATION CLINIC ROTATION GOALS AND OBJECTIVES, CA-1 and CA-2 YEAR PATIENT CARE: To provide the resident with al experience in the preoperative evaluation and perioperative management of adult and pediatric surgical s that is compassionate, appropriate, and effective. Coordinate the pre-operative care of s admitted to undergo surgery including the assessment and management of cardiac, pulmonary, neurologic, renal, hepatic, hematological and endocrine risk factors., Practice and Function as a consultant in perioperative medical management and anesthetic planning., Practice and Effectively obtain and document a focused and accurate history and physical exam., Practice and Formulate and implement a plan to optimize comorbid conditions., Practice and, Practice oral exam Order and interpret indicated testing., Practice and, Practice oral exam Manage s medications perioperatively, including blood pressure, diabetes, pulmonary, Parkinson s, myasthenia gravis, herbal, antibiotic, and pain medications., Practice and Develop an anesthetic and postoperative analgesia plan., Practice and, Practice oral exam

2 PATIENT CARE: To provide the resident with al experience in the preoperative evaluation and perioperative management of adult and pediatric surgical s that is compassionate, appropriate, and effective. Demonstrate cost-effective health care and not compromise quality of care., Practice and Evaluate and implement priorities in care., Practice and, Practice oral exam

3 MEDICAL KNOWLEDGE: To acquire the al and applied science knowledge pertinent to the perioperative management of the surgical. Discuss factors that increase the risk of anesthesia., Independent study Discuss the importance of information gathered regarding a s previous anesthesia history, focusing on types of surgery, anesthetic technique, and any adverse reactions., Independent study Discuss the importance of familial anesthetic complications., Independent study Discuss surgical factors affecting outcomes including hemodynamic consequences, respiratory effects, stress response and pain., Independent study Discuss the ASA classification., Independent Study Discuss and apply the ACC/AHA guidelines for perioperative cardiovascular evaluation for noncardiac surgery including the management of s with recent percutaneous coronary intervention., Independent study Discuss the indications and value of noninvasive cardiac testing., Independent study

4 MEDICAL KNOWLEDGE: To acquire the al and applied science knowledge pertinent to the perioperative management of the surgical. Discuss the indications and value of myocardial revascularization., Independent study Discuss the importance of beta-blocker, statins and other medications in cardiac risk reduction., Independent study Demonstrate the ability to assess exercise tolerance., Independent study Discuss the impact of various cardiac conditions on anesthetic planning and perioperative morbidity., Independent study Describe the differences in pharmacologic properties of drugs within each drug class., Independent Study Be able to interpret ECG., Independent study Discuss and explain risk factors and perioperative considerations in s with common medical problems in adults (e.g. CAD, COPD, GERD, DM, RAD, obesity), Independent study Discuss indications for SBE prophylaxis., Independent study

5 MEDICAL KNOWLEDGE: To acquire the al and applied science knowledge pertinent to the perioperative management of the surgical. Discuss anesthetic implications of smoking, reactive airway disease, COPD, respiratory infections., Independent study Be able to interpret pulmonary function testing and ABG., Independent study Discuss the impact of various neurological conditions on anesthetic planning and perioperative morbidity., Independent study Discuss the anesthetic implications of gastroenterological diseases and risks associated with aspiration., Independent study Discuss NPO guidelines., Independent Study Identify s at risk for postoperative nausea and vomiting., Independent study Discuss the impact of various hematological conditions on anesthetic planning and perioperative morbidity., Independent study Discuss the anesthetic implications of renal diseases., Independent study

6 MEDICAL KNOWLEDGE: To acquire the al and applied science knowledge pertinent to the perioperative management of the surgical. Discuss the impact of various endocrine conditions on anesthetic planning and perioperative morbidity., Independent study Discuss the anesthetic implications of pregnancy., Independent study Demonstrate the ability to evaluate the airway., Independent study Discuss the indications for preoperative testing., Independent study Patient Discuss preoperative management of medications., Independent Study Demonstrate the ability to formulate an appropriate anesthetic plan and be able to discuss types of anesthesia: General (airway management, induction, maintenance, and emergence)., Independent study Demonstrate the ability to formulate an appropriate anesthetic plan and be able to discuss types of anesthesia: Local or regional (techniques and agents)., Independent study Demonstrate the ability to formulate an appropriate anesthetic plan and be able to discuss types of anesthesia: Monitored Anesthesia Care (supplemental oxygen, sedation, and agents)., Independent study

7 MEDICAL KNOWLEDGE: To acquire the al and applied science knowledge pertinent to the perioperative management of the surgical. Demonstrate the ability to formulate an appropriate anesthetic plan and be able to discuss intraoperative management: Monitoring, positioning, fluid management, and special techniques., Operating room, Independent study In-training exam, practice oral exam, case based discussion Demonstrate the ability to formulate an appropriate anesthetic plan and be able to discuss postoperative management: Pain control, antiemetic management, supplemental oxygen, hypoxia, hypotension, and hypertension., PACU, Independent study In-training exam, practice oral exam, case based discussion Demonstrate the ability to formulate an appropriate anesthetic plan and be able to discuss postoperative ICU management: Hemodynamic control and postoperative ventilation., PACU, ICU Independent study In-training exam, practice oral exam, case based discussion

8 PRACTICE BASED : To be able to investigate and evaluate their own care practices, appraise and assimilate scientific evidence, and improve their care practices. Use information technology, on-line resources, expert consultation, and primary texts to expand their knowledge base. Conference, Independent study, Preoperative evaluation Case based discussion, Journal club, Independent study Evaluate, analyze and debate articles at Journal club presentations Conference, Journal Club Journal club presentation Be able to efficiently obtain reliable information. Case based discussion, Independent study Discuss and research relevant literature to support decision-making processes., Conference Case based discussion Teach junior colleagues or peers. Conference, Preoperative evaluation Case based discussion, Simulated, Skill, Present and actively participate in quality improvement practices pertaining to care. Conference Case based discussion Evaluation of presentation, Compare evidence-based practice to commonly taught experience based decision making to develop a personal practice strategy., Independent study, Conference with faculty advisor Case based discussion, Simulated Demonstrate use of available resources, under the guidance of the attending, to make informed decisions about diagnostic and therapeutic interventions based on information, up-to-date scientific evidence, and al judgment. Case based discussion Seek and respond to constructive criticism to improve performance in the six core competencies., Conference, Conference with faculty advisor Case based discussion, Simulated, Discussion and review of evaluations

9 INTERPERSONAL AND COMMUNICATIONS SKILLS: Be able to demonstrate communication skills that result in effective information exchange and appropriate interaction with colleagues, surgeons, s, and ancillary personnel. CA-1 and CA-2 resident must be able to identify and explain all and demonstrate competence in the characteristics and skills listed below. Maintain comprehensive, timely, and legible medical records Review of anesthesia records Convey ideas and points effectively, Conference, Practice oral exam Demonstrate and be able to discuss importance of effective communication with s and their families, nurses, nurse practitioners and physician colleagues. Clearly explain the need for testing or consultation to s and members of the health care team. Establish and maintain eye contact., Practice oral exam Be approachable. Encourage questions. Listen and allows others to feel heard. Demonstrate communication techniques during periods of stress in order to decrease and family anxiety.

10 INTERPERSONAL AND COMMUNICATIONS SKILLS: Be able to demonstrate communication skills that result in effective information exchange and appropriate interaction with colleagues, surgeons, s, and ancillary personnel. CA-1 and CA-2 resident must be able to identify and explain all and demonstrate competence in most of the characteristics and skills listed below Make others feel comfortable in conversation Preempt/ prevent disputes Practice team approach Demonstrate communication techniques during periods of stress in order to decrease and family anxiety.

11 PROFESSIONALISM: Be able to demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population. CA-1 and CA-2 resident must be able to identify and explain all and demonstrate competence in most of the characteristics and skills listed below. Answer pages promptly. Practice and Demonstrate compassionate and respectful behaviors when interacting with s and their families. Practice and, Skill checklist and criteria Demonstrate independence and initiative. Practice and Be punctual and reliable. Practice and Demonstrate superior work ethic. Practice and Demonstrate commitment to professional development. Case based discussion, Case presentation, Journal Club presentation, Conference, Conference with faculty advisor, Case presentation evaluation Adhere to departmental and university policy and procedures. Lecture and discussion, Handouts, Practice and Exhibit accuracy and integrity in medical record keeping., Practice and Anesthesia record review

12 PROFESSIONALISM: Be able to demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population. CA-1 and CA-2 resident must be able to identify and explain all and demonstrate competence in most of the characteristics and skills listed below. Learn communication techniques with s and families of different cultural backgrounds who possibly speak little English. Practice and, Skill Demonstrate sensitivity to s of various age, gender, ethnic, and religious backgrounds. Practice and, Skill Understand the legal and ethical issues involved in consent., Conference Lecture, Case-based discussion, Handouts, Case based discussion Demonstrate a commitment to advocating care that is appropriate for their individual needs., Conference Practice and, Skill Demonstrate ability to appropriately take on, share and delegate care responsibilities. Practice and, Skill Demonstrate the ability to effectively balance one s own personal affairs with al and educational duties as outlined in this document., Conference, Independent study, Conference with advisor, Journal club Practice and

13 SYSTEMS-BASED PRACTICE: Be able to demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide health care that is of optimal value CA-2 resident must be able to identify and explain all and demonstrate competence in most of the characteristics and skills listed below Practice cost-effective health care. Lecture and discussion, Case based discussion Rely on information technology tools related to care., Classroom, Conference Practice and, Case based discussion, Journal Club presentation Rely on consultations with other specialties (i.e., cardiology, pain management, ethics, etc.)., Classroom, Conference Practice and, Case based discussion Able to discuss how health delivery systems differ and how this impacts care in the perioperative period Conference, Classroom, Lecture, case-based discussion Case-based discussion and evaluation Understand how their care and other professional practices affect other health care professionals and other medical services, and how these elements of the system affect anesthesiology/pain/critical care practices., PACU, ICU Practice and, Case based discussion Understand the complex systems that form the foundation for care of s suffering from a variety of surgical diseases. Practice and, Case based discussion Learn how to effectively use information management in the preoperative evaluation. Practice and, Case based discussion Appreciate the complex interactions that go on between primary care teams, consulting services, surgeons and anesthesiologist in the overall hospital management of complex s. Practice and, Case based discussion

ENVIRONMENT Preoperative evaluation clinic, Preoperative holding area. Preoperative evaluation clinic, Postoperative care unit, Operating room

ENVIRONMENT Preoperative evaluation clinic, Preoperative holding area. Preoperative evaluation clinic, Postoperative care unit, Operating room Goals and Objectives, Main Operating Room Anesthesia, VAMC, CA-3 year UCSD DEPARTMENT OF ANESTHESIOLOGY OPERATING ROOM CLINICAL ANESTHESIA AT VAMC GOALS AND OBJECTIVES, CA-3 YEAR PATIENT CARE: To provide