CA-2 PEDIATRIC ANESTHESIA ROTATION Minneapolis Children s Hospital and Clinics (MCHC) Rotation Site Director: Dr. Chris Altman Rotation Duration: 6 weeks Introduction: In the CA-2 year residents have the opportunity to continue to develop their knowledge, skills and attitudes at the Childrens Hospital. The experience differs from the basic rotation in pediatric anesthesia by providing a different patient population. Emphasis is placed in the areas of analysis, synthesis and evaluation of patient care needs along with patient management during more complex surgical procedures and care of the patient who is medically more complex. GOALS: o To train residents who are capable of providing high quality anesthesia care based on principles of teamwork and collaboration for newborns, infants and children; o To train residents who prove high quality care to pediatric patients, including preoperative assessment and preparation of patients and parents for induction of anesthesia, intraoperative, postoperative care and clinical management, and understanding of anatomical and physiologic differences of pediatric patients. Approximate Training Level Assessment Methods/Tools OBJECTIVES (by ACGME Competency) Patient Care Clinical Skills and Reasoning: o Formulates and discusses postoperative management plan for pediatric patients including pain and PONV management plan o Correctly interprets vital signs in different age groups (perception to complex overt response) o Uses safe principles of sedation and monitoring for pediatric patients having procedures outside the operating room (perception o Direct Observation o Chart- review o Case logs Page 1 of 5
to complex overt response) Technical/Device Related Skills o Prepares anesthesia work area for a pediatric patient specifically prepares medications in size appropriate syringes, knows specific doses of medications for the weight, prepares appropriate airway equipment, de-airs the IV tubing and uses size appropriate intravenous lines and tubing, uses appropriate ventilator settings for the size of the child o Sets and uses syringe pumps, intravenous pumps with drips appropriate for the patient size in an organized, systematic fashion o Demonstrates skill in use of blood warming devices and body warming devices to prevent hypothermia (perception to complex overt response) Patient Management o Performs safe placement of appropriate size endotracheal tube o Monitor pediatric patients with appropriate size monitoring equipment o Performs placement of intravenous catheter in newborn, infant and child with skill o Performs placement of arterial line and central line in a pediatric patient and is familiar with different sizes of available catheters (perception and complex overt response) o Provide safe anesthetic management for patients undergoing procedures such as general, urologic, orthopedic, ENT, neurosurgical, ambulatory and other surgical procedures o Performs appropriate for child size fluid administration, is skillfull in determining volume status, and performs appropriate volume resuscitation in a newborn, infant and child with an appropriate size intravascular access o Direct Observation o Chart- review o Case logs Page 2 of 5
o Safely and efficiently transports and transfers care of neonate, infant and child to a secondary provider (perception to complex overt response) Medical Knowledge o Discusses anatomy and physiology of pediatric patients (knowledge to application) o Introductory o Discusses fluid management of newborn, infant and child (knowledge to application) o Discusses appropriate IV access for a pediatric patient in a bleeding patient (knowledge to application) o Discusses pathophysiologic processes involved in pediatric surgical conditions and their interactions with anesthetics (knowledge to application) o Discusses pharmacology of anesthetic agents and their effects on newborns, infants and children (knowledge to application) o Discusses principles of temperature regulation for newborns, infants and children (knowledge to application) o Discusses risks, benefits, indications and contraindications for commonly performed nerve blocks caudal, ilioinguinal, popliteal, femoral, sciatic, axillary, epidural catheter placement (knowledge to application) o Discusses anesthetic management of conditions such as pyloric stenosis, tracheoesophageal fistula, diaphragmatic hernia, gastroschisis, omphalocele, PDA ligation, ASD, VSD repair and others (knowledge to application) Practice Based Learning and Improvement lecture series test o Anesthesia knowledge test o Annual in-training examination o Informal oral questioning o Oral case presentations o Identify own learning deficits, develop a learning plan and carry it out (receiving to valuing) o Respond appropriately to constructive feedback (receiving to valuing) o Immediate formative feedback from attending o Direct observation Page 3 of 5
o Demonstrate ability to effectively search for literature (perception to complex overt response) o Read, analyze and interpret the scientific literature o Analyze own practice and determine ways in which you can improve your comprehensive pediatric anesthetic plan (analysis, valuing) o Journal club presentations and case presentations Interpersonal and Communication Skills o Use of 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 (receiving to valuing) o Uses effective age appropriate communication skills with the pediatric patients and family including preparation of parent or caregiver for induction experience (receiving to valuing) o Effectively and efficiently communicates pertinent patient information to a secondary care provider (receiving to valuing) o Skill in working as a member of a patient care team including other physicians, nurses, other health care professionals, social workers, and volunteers (receiving to valuing) o Maintain 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 Awareness and management of his/her own values and attitudes o direct observation o 360 o Responsiveness to and management of issues that relate to sociocultural aspects of family life o Consistent compassion System Based Practice o Work in inter-professional teams to increase patient safety and o direct observation Page 4 of 5
quality of care o 360 o Coordinate patient care in the settings of pediatric surgery Discuss system-based problems as they pertain to patient care at M&M conferences (knowledge to analysis) o M&M conference presentation with system analysis Scholarly/Research Activities Reading Requirements The resident should read the following chapters while taking the rotation: Text: Chapters: 1. SMITH S ANESTHESIA FOR INFANTS AND CHILDREN 6 th Edition (there is a copy in the library) 2. PEDIATRIC ANESTHESIA, Editor George Gregory 4 th Edition 3. A PRACTICE OF ANESTHESIA FOR INFANTS AND CHILDREN, Editor Charles J. Cote, 3 rd Edition. 4. MANUAL OF PEDIATRIC ANESTHESIA, Editor David J. Steward, Jerold Lerman. 5 th Edition. 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 5 of 5