Goals and Objectives, Main Operating Room Anesthesia, VAMC, CA-2 year UCSD DEPARTMENT OF ANESTHESIOLOGY OPERATING ROOM CLINICAL ANESTHESIA AT VAMC GOALS AND OBJECTIVES, CA-2 YEAR PATIENT CARE: To provide the resident with clinical experience in the anesthetic management of adults and pediatric surgical s that is compassionate, appropriate, and effective With occasional assistance, conduct an efficient, focused, and comprehensive pre-procedure/pre-anesthetic evaluation, including history, physical exam, and review available studies, under both elective and emergent conditions, for adult s clinic, Preoperative holding area Lecture, Skill, Practice and feedback Recognize, with occasional assistance, when appropriate subspecialty consults are needed, (i.e., cardiology, pain management) clinic, Postoperative care unit, Operating room Recognize, with occasional assistance, when additional studies to establish a diagnosis or evaluate severity are appropriate clinic, Postoperative care unit, Operating room With occasional assistance, develop a -specific management plan, with a reasonable alternate plan, for all levels of ASA classification for s in all age groups, for both elective and emergent procedures; the plan should include consideration of pre-existing medical issues and requests, anticipate possible intraoperative difficulties and pursue strategies to prevent possible postoperative complications clinic, Preoperative holding area Lecture, Skill, Practice and, Compare different management plans using EBM clinic, Preoperative holding area, Simulation Lecture, Skill, Practice and, With occasional assistance, perform safe, efficient, timely and accurate preanesthetic checks of all pertinent equipment and supplies (such as anesthetic machines, compressed gas cylinders, airway management supplies, monitors, suction, medications, invasive devices, etc.) With occasional assistance, demonstrate competent advanced airway management techniques, including "difficult airway algorithm", fiberopticguided intubation, and lung isolation techniques Simulation
PATIENT CARE: To provide the resident with clinical experience in the anesthetic management of adults and pediatric surgical s that is compassionate, appropriate, and effective With occasional assistance, demonstrate competence in placement of peripheral IV s in awake and anesthetized s, including external jugular IV s and large caliber lines for rapid infusion With occasional assistance, demonstrate competence in placing central lines, including IJ/femoral/subclavian approaches efficiently, safely and accurately under ultrasound guidance, Simulation With occasional assistance, demonstrate competence in placing and managing arterial lines and Swan-Ganz catheters With occasional assistance, demonstrate competent, effective and efficient care during induction of anesthesia, as well as during periods of instability in the course of the anesthetic care (i.e., surgical bleeding, co-existing disease exacerbation, drug reaction, or other crisis), Without assistance, demonstrate bag-mask ventilation, conventional laryngoscopy and endotracheal intubation, insertion and use of LMA s, and safe use of the anesthesia machine and or ventilators, Simulation With occasional assistance, interpret and responds appropriately to the information from monitors and laboratory data (including ECG, CO 2 waveform, CVP, PAC, I/O, ABG, Coagulation Panel, etc.), Compare choices for blood product and fluid management, With occasional assistance, transfer care of the after anesthesia/procedure to responsible party (PACU or ICU nurse, etc.) in a manner that ensures s safety and comfort and continuity of care Postoperative, ICU, Without assistance, effectively manage malignant hyperthermia, including asking for immediate assistance and delegating tasks in order to ensure rapid and coordinated treatment Simulation Lecture, Simulation
MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the management of the surgical. Discuss the physiologic differences in infants, children and and adults, and their impact on perioperative management Discuss anesthetic-induced changes in physiology and anesthetic implications of common medical problems in adults and children Discuss the physiologic changes of pregnancy and their impact on perioperative/peripartum management Defend choices among anesthetic plans Patient Describe the differences in pharmacologic properties of drugs within each drug class Independent Study discussion, Simulation Defend choices and doses of drugs, including induction agents, opioids, inhalational agents, neuromuscular blocking agents, pressors, beta blockers, vasodilators Discuss and explain risk factors and perioperative considerations in s with common medical problems in adults (e.g. CAD, COPD, GERD, DM, RAD, obesity) Discuss and interpret the information obtained from invasive or advanced non-invasive monitoring
MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the management of the surgical. Compare different intravenous fluid management options Identify key anatomy of the brachial plexus, lumbar plexus, sciatic nerve, epidural space, and subarachnoid space model Discuss and defend decisions involving neuraxial anesthesia and peripheral nerve blocks Discuss pulmonary physiology, including pulmonary shunt, dead space, V/Q mismatch, and changes associated with one-lung ventilation Discuss the physiologic changes during cardio-pulmonary bypass and their impact on perioperative anesthetic management Discuss the pathophysiological and surgical indications for critical level of care
PRACTICE BASED : To be able to investigate and evaluate their own care practices, appraise and assimilate scientific evidence, and improve their care practices. Locate, appraise, and assimilate evidence from scientific studies related to s' health and care Conference, Independent study, Operating room Case based discussion, Journal club Evaluate EBM in clinical decision making Conference, Independent Study, Operating room Case based discussion Evaluate, analyze and debate articles at Journal club presentations Conference, Journal Club Journal club presentation Use self-assessments of knowledge, skills and attitudes to develop plans for addressing areas for improvement Conference with faculty advisor Debriefing after case or simulation, Written self-evaluation Daily debriefing, Discussion and review of written selfevaluation Discuss and research relevant literature to support decision-making processes Preoperative Evaluation Clinic, Conference Case based discussion evaluation Teach junior colleagues or peers Conference, Operating room, Simulation Case based discussion, Simulated, Skill, Present and actively participate in quality improvement practices pertaining to care. Conference Case based discussion Evaluation of presentation,
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-2 resident must be able to identify and explain all and demonstrate competence in most of the characteristics and skills listed below Maintain comprehensive, timely, and legible electronic medical records Operating room Lecture and discussion, skill Review of anesthesia records Convey ideas and points effectively Conference, Simulation Simulation, Practice oral exam Convey urgency but not panic in urgent/emergent situations Simulation Simulation, Practice oral exam Encourage questions Preoperative Evaluation Clinic, Preoperative room Establish and maintain eye contact Preoperative Evaluation Clinic, Preoperative room Be approachable Preoperative Evaluation Clinic, Preoperative room, Postoperative care unit Know role in crisis Postoperative, Simulation Suite Skill Listen and allows others to feel heard clinic, Preoperative room, Postoperative care unit
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-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 clinic, Preoperative room, Postoperative care unit, Simulation Simulation Preempt/ prevent disputes clinic, Preoperative room, Postoperative care unit, Simulation Simulation Practice team approach Postoperative, Simulation Suite Simulation
PROFESSIONALISM: Be able to demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population. 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 clinic, Postoperative Demonstrate respect, compassion or responsiveness to 's concerns or needs clinic, Postoperative checklist and criteria Demonstrate independence and initiative clinic, Postoperative Be punctual and reliable clinic, Postoperative Demonstrate superior work ethic clinic, Postoperative Demonstrate commitment to professional development Preoperative Evaluation Clinic, Conference Case based discussion, Case presentation, Journal Club presentation, Case presentation evaluation Adhere to departmental and (university)va policy and procedures clinic, Postoperative Lecture and discussion, Handouts, Exhibit integrity in record keeping and medical records Operating room Lecture, Skill, Anesthesia record review
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, Operating room Case based discussion Rely on information technology tools related to care clinic, Classroom, Conference Case based discussion, Journal Club presentation Rely on consultations with other specialties (i.e., cardiology, pain management, ethics, etc.) clinic, Classroom, Conference Case based discussion Considers cost-benefit analysis and cost awareness in care Able to discuss how health delivery systems differ and how this impacts care in the operating room Conference, Classroom Lecture, case-based discussion Case-based discussion and evaluation Participate in systems safeguards such as huddle, timeout and blood product transfusion protocol Operating room Skill Demonstration,