Anesthesia Elective Curriculum Outline

Transcription

1 Department of Internal Medicine Texas Tech University Health Sciences Center Odessa, Texas Anesthesia Elective Curriculum Outline Revision Date: July 10, 2006 Approved by Curriculum Meeting September 19, 2006 I. Educational Purpose and Background: The first anesthetics were given to relieve the pain of dental extractions and minor surgery. As the fields of anesthesia and surgery matured new skills were required of the anesthesiologist. These include expertise in resuscitation, fluid replacement, oxygen transport, operative stress reduction, and postoperative pain control. The purpose of this elective is to familiarize the resident with appropriate preoperative, intra-operative, and early postoperative evaluation and management of patients undergoing surgical procedures involving anesthetic agents. This rotation is for senior residents. II. Rational: It is imperative that the resident familiarize him/herself with the preoperative evaluation of a patient who is going to have surgery, identify high risk patients, high risk surgeries and take appropriate actions to avoid intra-operative and post-operative complications. III. Objectives: Residents will demonstrate the ability to safely and effectively perform invasive procedures and interpret invasive monitoring. The resident will understand the types of anesthesia: inhalation, local and regional, spinal, epidural, and intravenous anesthesia. Adverse respiratory events are responsible for death and coma. The resident will learn and these events: inadequate ventilation, esophageal intubation, difficult tracheal intubation, and inadequate oxygenation. The resident will learn to do a preoperative evaluation to assess the patients anesthesia and surgical risks. Patient related risks include advanced age, peri-operative conditions such as vascular disease, anesthesia technique, and the use of invasive monitors. IV. Patient Population: The patients will be patients from the Texas Tech resident continuity and faculty clinics. They also will belong to the private physicians in the community. The gender mix will vary. The disease mix is quite broad due to the varied ages, socioecononomic backgrounds, disease conditions and severity. V. Teaching Methods: A. Supervised Direct Patient Care i. Residents will evaluate and manage patients in the preoperative holding area, operating room, and post-anesthesia care unit. Residents will learn the basic approaches to preoperative care, including mental preparation of a patient for surgery, prediction of a difficult airway, and medical management of common disorders in the preoperative period. ii. The resident will start IV s, central lines, intubate patients, mask ventilate patients, and will learn the indications and complications of invasive lines. Residents will learn the different anesthesia techniques used for different kinds of surgeries, pharmacology and management of emergency conditions such as excessive blood, intra-operative cardiac arrest, and hypertensive emergency. 1

2 VII. VI. iii. The resident will present each new patient to an anesthesiologist as a part of teaching rounds. Bedside teaching occurs within the surgical suite and on post-operative rounds. Discussions focus on anatomy, physiology, pathophysiology, pharmacology, management, and complications when relevant. B. Assigned reading reading assignments will be assigned through out of the rotation. Procedures A. Airway management, intubation and ventilation B. Peripheral intravenous catheters C. Arterial lines D. Central venous catheters E. Pulmonary artery catheters F. Lumbar puncture Educational Goals by Relevant ACGME Competency: Legend for learning activities (see above for a description of each activity) DPC Direct Patient Contact ID Formal Lectures and Individual Discussions LR Literature Review RR Review of X-Rays BR Board Review ME Monthly Exam Patient Care Develops skills of comprehensive patient interview and adequate, timely use of other available data sources Improve skills of patient examination Define and prioritize patient s problems in a timely and accurate manner Generate and prioritize pertinent differential diagnosis Develop rational, evidence-based management strategies, in accordance with patient s preferences and values Implement and oversee accurate and timely delivery of management plan, including procedural skills Actively assure effective continuity of patient care Capable of timely, accurate and focused verbal and written communication with all members of the health care team DPC, BR DPC DPC, BR DPC, ID, LR,BR, RR DPC, ID, ME DPC DPC, RR, ID DPC 2

3 Medical Knowledge Progressively expand clinically applicable knowledge base of the basic and clinical sciences underlying the care of the patient with medical disorders Demonstrate initiative and capability to access and critically evaluate current medical information and scientific evidence relevant to patient care Show comprehensive understanding of complex relationships, mechanisms of disease DPC, ID, LR, RR, ME DPC, RR DPC, ID, BR, ME Practice-Based Learning Constantly evaluates own performance and incorporates feedback into improvement activities Identify and readily acknowledge gaps in personal knowledge and skills in the care of patients with endocrine disorders Develop and implement strategies for filling gaps in knowledge and skills Effectively uses technology to manage information for patient care and self-improvement, RR, ME, RR, RR, ID, RR,ID Interpersonal Skills and Communication Establish a highly effective and timely therapeutic relationship with patients and families Communicate effectively with physician colleagues at all levels Communicate effectively with all non-physician members of the health care team to assure comprehensive and timely care of patients Present patient information concisely and clearly, verbally and in writing Demonstrate excellent education and counseling of patients, families, and colleagues Demonstrate excellent education and counseling of patients, families, and colleagues, RR, ID, RR, ID 3

4 Professionalism Honesty/ Integrity: Is truthful with patients, peers, etc., and in professional work (documentation, communication, presentations, research) Reliability/ Responsibility: Is accountable to patients, families, and colleagues. Can be counted on to complete assigned duties and tasks in a timely manner. Accepts responsibility for errors Respectful of others: Talks about and treats all persons with respect and regard for their individual worth and dignity; is fair and non-discriminatory. Routinely inquires about or expresses awareness of the emotional, personal, family, and cultural influences on patient well-being and their rights and choices of medical care; is respectful of the other members of the health care team. Maintains confidentiality. Compassion/ Empathy: Listens attentively and responds humanely to patient s, family members, and colleagues concerns; provides appropriate relief of pain, discomfort, and anxiety Self-Improvement: Regularly contributes to patient care or educational conferences with information from current professional literature; seeks to learn from errors; aspires to excellence through self-evaluation and acceptance of the critiques of others Self-Awareness/ Knowledge of Limits: Recognizes need for guidance and supervision when faced with new or complex responsibility; is insightful of the impact of one s behavior on others and cognizant of appropriate professional boundaries Communication/ Collaboration: Works cooperatively and communicates effectively to achieve common patient care and educational goals of all involved health care providers Altruism/ Advocacy: Adheres to best interest of the patient; puts best interest of the patient above self-interest and the interest of other parties 4

5 System-Based Practice Principle Educational Goals Understand and utilize the multidisciplinary resources necessary to care optimally for patients Collaborate effectively with other members of the health care team to assure comprehensive patient care Use evidence-based, cost-conscious strategies in the care of patients with endocrine disorders Utilize systems-based approaches to reduce errors Assist in development of systems improvement, ID,, ID, BR VIII. Rotation Specific Competency Objectives Although the performance of procedures is an integral daily function of the practicing anesthesiologist, this represents only a fraction of the practice of anesthesia. The resident is expected to achieve knowledge and skills relevant to the practice of anesthesia beyond simply performing procedures. The resident should develop an appreciation for the anatomy, physiology, and pharmacology of anesthesiology as well as an understanding of how patient variability and disease processes affect anesthesiology decisions. A. Patient Care i. Procedural skills: Develop techniques for insertion and learn the indications for and the complications of arterial lines, central venous lines, pulmonary artery catheters, intravenous lines, airway management, and lumbar punctures. ii. Residents will develop management plans for all patients such that they will always have an alternate plan of action. iii. Residents must fill in all anesthesia documentation, leaving no gaps in the anesthesia chart. B. Medical Knowledge By completion of the block rotation, residents will demonstrate knowledge of the following: i. Types of anesthetics: general, spinal, epidural, IV, regional, nerve blocks, and conscious sedation ii. Pharmacology: narcotics, hypnotics, neuromuscular blocking agents, volatile agents, etc. iii. Physiology: autonomic nervous system, hemodynamics, and disease process iv. Anatomy: larynx, vasculature, and nervous system v. Medical disease and anesthesia: coronary artery disease, cerebrovascular disease, diabetes mellitus, obesity, coagulopathy, shock, etc. vi. Procedural knowledge, including indications, techniques, and potential complications. C. Interpersonal and Communication Skills The resident will actively work with the nursing staff and demonstrate the ability to work in a team setting. The resident will demonstrate the ability to communicate effectively and demonstrate a caring, compassionate, and respectful behavior. D. Professionalism The resident will demonstrate respect, compassion, and integrity. The resident will be committed to excellence and continuous professional development. 5

6 E. Practice Based Learning and Improvement The resident will be able to locate, critically appraise, assimilate evidence from scientific studies to apply to patient management under anesthesia. The resident will be able to use information technology to manage information, access on-line medical resources to support selfeducation, patient care decisions and patient education. F. System Bases Practice The resident will be able to function efficiently and effectively in the anesthesia units. IX. References A. Miller s Anesthesia, 6 th edition. Ronald D. Miller. Elsiver B. Airway Management, Principals and Practice. Edited by Jonathan L. Benumof. Mosby C. Manual of Complications During Anesthesia. D. American Society of Anesthesiologists: E. The Internet Journal of Anesthesiology: 6