OUTPATIENT/AMBULATORY ANESTHESIA ROTATION Medical Center Rotation Site Director: Dr. Mojca Konia Rotation Duration: 4 weeks in total Introduction: The goal of the Ambulatory Anesthesia Rotation at the is to introduce residents to basic concepts in assessment and management of outpatients for surgical procedures. This Ambulatory Anesthesia rotation is designed to enhance their overall knowledge, understanding and application of ambulatory anesthesia principles. Residents are expected to master anesthetic principles and techniques and understand current controversies as they relate to ambulatory surgery. The overall goal of this curriculum is to introduce residents to the concept of anesthesia for ambulatory surgery, emphasizing the different management strategies and challenges as compared with in-patient surgery. These primarily will involve rapid preoperative assessment, different ambulatory anesthesia techniques, and ensuring appropriate discharge to home on the day of surgery. GOALS: Gain the skills, knowledge and attitudes during CA-1 to be able to care for an outpatient: o To train residents who are capable of providing high quality anesthesia care based on principles of teamwork and collaboration for outpatient surgery procedures; o To train residents who use the bio-psychosocial model and life-long learning principles in providing high quality care to patients undergoing outpatient surgery procedures (ophthalmology, oto-rhino-laryngology, plastic, reconstructive, general, GU, GYN surgery, ECT). Approximate Training Level Assessment Methods/Tools OBJECTIVES (by ACGME Competency) Patient Care Clinical Skills and Reasoning: o Performs a thorough but expedient preoperative assessment of outpatient surgery patient (perception to mechanism or complex overt response) o Direct Observation o Chart- review Page 1 of 5
o Formulates a safe anesthetic management and monitoring plan for a outpatient procedure, including consideration of anesthetic medication and gases effects on postoperative duration of stay (perception to complex overt response) o Formulates safe and effective postoperative management plan for an outpatient procedure (perception to complex overt response) o Considers importance of timely patient discharge from postoperative unit including patient well-being and safety when discharged (perception to mechanism) Technical/Device Related Skills o Demonstrates skill in management and use of regional and neuraxial anesthesia/analgesia devices (perception to mechanism, complex overt response) o Case logs Patient Management o Skillfully places arterial, central line (perception to complex overt response) o Skillfully manages anesthetic induction, maintenance and emergence from anesthesia for patients undergoing outpatient surgery (perception to mechanism or complex overt response) o Demonstrates ability to manage anesthetic for a patient undergoing outpatient surgery including safe and protective positioning of the patient, providing anesthetic that does not interfere with patient fast recovery (perception to mechanism or complex overt response) o Follow-up of the patient discharged home and management of any anesthesia related side effects (complex overt response) Medical Knowledge o Direct Observation o Chart- review o Case logs o Discusses clinical assessment of patients in the outpatient surgery setting (knowledge to application) o Discusses pharmacology of medications used in ambulatory setting o Introductory lecture series test o Anesthesia (knowledge to application) o Discusses, analyzes and investigates clinical situations that arise in knowledge test o Annual in-training Page 2 of 5
ambulatory setting (knowledge to application) Practice Based Learning and Improvement 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 o Written essay describing an analysis of patient valuing) o Demonstrate ability to effectively search for literature (perception to management (areas of deficiencies, room for complex overt response) o Read, analyze and interpret the scientific literature improvement) o Immediate formative o Analyze own practice and determine ways in which you can improve your comprehensive anesthetic plan (analysis, valuing) feedback from attending o Direct observation o Journal club presentations and case presentations Interpersonal and Communication Skills o Teaches 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 (valuing to internalizing) o Effectively and efficiently communicates pertinent patient information to a secondary care provider (valuing to internalizing) o Skill in working as a member of a patient care team including other physicians, nurses, neuromonitoring personnel, other health care professionals (valuing to internalizing) o Direct observation with patient o Direct observation in simulation o 360 global rating o Learner classroom presentation Page 3 of 5
o Maintain comprehensive, timely, and legible medical records (internalizing) Professionalism o Awareness and management of his/her own values and attitudes, which might interfere with appropriate patient care specific to management of ambulatory patients (organizing, internalizing) o Responsiveness to and management of issues that relate to sociocultural aspects of family life, and social adjustment related to ethnicity, religion, culture, gender or sexual preference (internalizing) o Consistent compassion, honesty, integrity and respect for others in all professional activities (internalizing) System Based Practice o direct observation o 360 o Work in inter-professional teams to increase patient safety and quality of care (perception to complex overt response) o Coordinate patient care in the settings of cardiac surgery (perception o direct observation o 360 o M&M conference to complex overt response) o Discuss system-based problems as they pertain to patient care at M&M conferences (knowledge to analysis) presentation with system analysis Page 4 of 5
Scholarly/Research Activities Reading Requirements The resident should read the following chapters while taking the rotation: Text: Chapters: 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