Goals and Objectives. Assessment Methods/Tools
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1 CA-2 OBSTETRIC ANESTHESIA ROTATION FAIRVIEW RIVERSIDE Medical Center - Fairview Rotation Site Director: Dr. Susanne Rupert Rotation Duration: 4 weeks Introduction: Building on the knowledge, skills and attitudes gained during initial Obstetric Anesthesia rotation, advanced obstetric anesthesia rotation provides resident with the in-depth knowledge, and the opportunity to attain experience with the anesthetic management of complicated obstetrical patient. Through continuous reading, discussions, lectures, and hands on experience the resident will be expected to gain the knowledge, technical skills, and organizational skills necessary to provide obstetrical anesthesia patient care at the consultant level in a tertiary care center. GOALS: o To train residents who are capable of providing independent high quality anesthesia care based on principles of teamwork and collaboration for obstetric patients; o To train residents who independently apply principles of life-long learning principles in providing high quality care to obstetric patients including preoperative assessment and preparation of patients for neuraxial analgesia, neuraxial or general anesthesia, provision of anesthesia for cesarean section and stat cesarean section, clinical management and teaching of physiologic changes related to pregnancy, and management of high risk pregnancy patients with different co-morbidities. Approximate Training Level Assessment Methods/Tools OBJECTIVES (by ACGME Competency) Patient Care Clinical Skills and Reasoning: o Effective use of clinical skills of interviewing and physical examination to perform a thorough preoperative assessment of obstetric patient (perception to mechanism or complex overt response) o Independently formulates a safe anesthetic management plan for an o Direct Observation o Simulation o Chart- review o Case logs Page 1 of 6
2 obstetric patient (perception to mechanism or complex overt response) o Independently formulates and discusses postoperative management plan for an obstetric patient (perception to mechanism or complex o Formulates and discusses a safe anesthesia plan for a patient with complicated pregnancy or a patient with medical conditions complicating pregnancy (perception to complex o Expertly formulates a plan for management of neuraxial anesthesia complications (perception to mechanism or complex overt response) Technical/Device Related Skills o Independently prepares anesthesia work area in an obstetric operating room in an organized, systematic fashion (perception to mechanism or complex o Independently prepares for neuraxial analgesia/anesthesia in an organized, systematic fashion (perception to mechanism or complex Patient Management o Expertly determines and administers the appropriate doses of analgesic/anesthetic agents needed to induce neuraxial analgesia/anesthesia or general anesthesia for a standard and complicated obstetric patient (perception to mechanism or complex o Independently performs standard tracheal intubation in an average and complicated obstetric patient (perception to mechanism or complex o Expertly manages emergence from anesthesia including postoperative pain management after general surgery in an obstetric patient (perception to mechanism or complex o Skillfully and safely performs neuraxial anesthesia spinal, epidural, combined spinal-epidural (perception to mechanism or complex o Direct Observation o Simulation o Chart- review o Case logs Page 2 of 6
3 o Skillfully and safely uses epidural pumps (perception to complex o Expertly manages an obstetric patient undergoing general surgical procedure for non-pregnancy related procedures (perception to complex o Maintains orderly patient medical records (perception to mechanism or complex o Effectively transfers care to a secondary provider (perception to mechanism or complex o Effectively manages complications of neuraxial and general anesthesia specific and non-specific to obstetric patient (perception to complex Medical Knowledge o Discusses and teaches maternal physiology during pregnancy, maternal-fetal pharmacology, physiologic events/changes that occur during labor and delivery (application, analysis) o Discusses and teaches epidural and spinal analgesia for labor pain and vaginal delivery, monitoring principles in obstetric anesthesia including maternal, fetal monitoring during labor, delivery and cesarean section (application, analysis) o Discusses and teaches neuraxial and general anesthesia for cesarean section, principles of circulatory and respiratory resuscitation in an obstetric patient (application, analysis) o Discusses anesthesia for non-obstetric procedures in a pregnant patient (application) o Expertly discusses and teaches anesthesia for postpartum tubal ligation (application, analysis) o Expertly manages neuraxial anesthesia complications (application, analysis) o Introductory lecture series test o Anesthesia knowledge test o Annual in-training examination o Informal oral questioning o Simulation o Oral case presentations Page 3 of 6
4 Practice Based Learning and Improvement o Independently and consistently identifies own learning deficits, develops a learning plan and carries it out, respond appropriately to constructive feedback, demonstrates ability to effectively search for literature, reads, analyzes and interprets the scientific literature and analyzes own practice and determines ways in which you can improve your comprehensive anesthetic plan (valuing to internalizing) Interpersonal and Communication Skills o Written essay describing an analysis of patient management (areas of deficiencies, room for improvement) o Immediate formative feedback from attending o Direct observation o Journal club presentations and case presentations o Independently and intentionally uses effective listening, questioning, and explanatory skills in gathering information from patients and in providing information to patients, families, the public, and other health care providers (organizing, internalizing) o Effectively and efficiently communicates pertinent patient information to a secondary care provider (valuing to internalizing) o Incorporates skills of working as a member of a patient care team including other physicians, nurses, other health care professionals, social workers, and volunteers into everyday practice (receiving to valuing) o Consistently and intentionally maintains comprehensive, timely, and legible medical records (receiving to valuing) o Direct observation with patient o Direct observation in simulation o 360 global rating o Learner classroom presentation Professionalism o Teaches awareness and management of his/her own values and o direct observation Page 4 of 6
5 attitudes, which might interfere with appropriate patient care specific to management of obstetric patient (valuing to internalizing) o Promotes responsiveness to and management of issues that relate to socio-cultural aspects of family life, and social adjustment related to ethnicity, religion, culture, gender or sexual preference (valuing to internalizing) o Consistently provides compassionate, honest, and respectful care for others in all professional activities (receiving to valuing) System Based Practice o 360 o Efficiently and effectively works in inter-professional teams to increase patient safety and quality of care (complex o Expertly coordinates patient care in the settings of obstetric o direct observation o 360 o M&M conference department and obstetric OR (complex o Analyzes system-based problems as they pertain to patient care at M&M conferences (analysis) presentation with system analysis Scholarly/Research Activities Reading Requirements The resident should read the following chapters while taking the rotation: Text: MILLER S ANESTHESIA Suggested Reading 1. A PRACTICAL APPROACH TO OBSTETRIC ANESTHESIA CHESTNUT'S OBSTETRIC ANESTHESIA: PRINCIPLES AND PRACTICE. 4th edition OBSTETRIC ANESTHESIA AND UNCOMMON DISORDERS. 2nd edition SHNIDER AND LEVINSON'S ANESTHESIA FOR OBSTETRICS. 4th edition Reading assignments from the textbooks as well as articles are ONLINE and also linked from the Resident WIKI page CA1 page is CA2-3 page is Page 5 of 6
6 Assessments The resident will receive a summative written evaluation form at the end of the rotation from the Site Director, as well as verbal feedback informally throughout the rotation. The case-logs of the resident will also be evaluated periodically by the clinical competency committee for the number and type of procedures and anesthetic techniques entered to ensure they are obtaining adequate experience. Notes Page 6 of 6
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