Goals and Objectives, Main Operating Room Anesthesia, VAMC, CA-3 year UCSD DEPARTMENT OF ANESTHESIOLOGY OPERATING ROOM CLINICAL ANESTHESIA AT VAMC GOALS AND OBJECTIVES, CA-3 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 Independently conduct an efficient, focused, and comprehensive preprocedure/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, without assistance, when appropriate subspecialty consults are needed, (i.e., cardiology, pain management) clinic, Postoperative care unit, Operating room Recognize, without assistance, when additional studies to establish a diagnosis or evaluate severity are appropriate clinic, Postoperative care unit, Operating room Without 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, Defend management plans using EBM clinic, Preoperative holding area, Simulation Lecture, Skill, Practice and, Without assistance, perform safe, efficient, timely and accurate pre-anesthetic checks of all pertinent equipment and supplies (such as anesthetic machines, compressed gas cylinders, airway management supplies, monitors, suction, medications, invasive devices, etc.) Simulation, Skill Without assistance, demonstrate competent advanced airway management techniques, including "difficult airway algorithm", fiberoptic-guided intubation, and lung isolation techniques Simulation, 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 Without 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 Simulation, Skill Without assistance, demonstrate competence in placing central lines, including IJ/femoral/subclavian approaches efficiently, safely and accurately, under ultrasound guidance Simulation, Skill, simulation Without assistance, demonstrate competence in placing and managing arterial lines and Swan-Ganz catheters Simulation, Skill Without 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) Simulation, Without 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.) Simulation, Critique the choice for blood product and fluid management Simulation, Without 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, Skill,
MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the management of the surgical. Critique alternative anesthetic plans using an understanding of pathophysiology Journal club, Case based Critique perioperative/peripartum management plans for OB/Gyn s based on the physiologic changes Critique perioperative management plans for infants, children and adults based on the physiologic differences Critique anesthetic plans based on risk factors and perioperative considerations with all co-morbid conditions (e.g. CAD, COPD, GERD, DM, RAD, obesity) identified in preoperative examination Critique choices of drugs, including induction agents, opioids, inhalational agents, neuromuscular blocking agents, pressors, beta-blockers, vasodilators Journal Club, Case based Synthesize information obtained from invasive or advanced non-invasive monitoring and apply it to care Journal club, Case based Debate fluid management options including the risk and benefits of perioperative transfusion Journal club, Case Based
MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the management of the surgical. Debate and defend treatment approaches for intraoperative events, such as hypotension, hypoxia, tachycardia and oligouria Journal club, Case cased Debate and defend choices in approaches to regional blockade of each region of the upper extremity, lower extremity, torso and neuraxis Journal club, Case based Evaluate perioperative management of cardio-pulmonary bypass based on physiologic changes Critique, based on physiological changes, methods for treating hypoxemia during one-lung ventilation Journal club, Case based Critique approaches to treatment of perioperative pain in relation to the mechanisms of acute pain
PRACTICE BASED : To be able to investigate and evaluate their own care practices, appraise and assimilate scientific evidence, and improve their care practices. Critique EBM in clinical decision making Conference, Independent Study, Operating room Case based discussion Case based discussion and evaluation, Critique articles at Journal club presentations Conference, Journal club Journal club presentation Discussion, Discuss and research relevant literature to support decision-making processes Preoperative Evaluation Clinic, Conference Case based discussion Case based discussion and evaluation Evaluate and critique quality improvement practices pertaining to care. Conference, Case review Case based discussion, Review of a practice case referred for QI review Evaluation of presentation and review, Teach self-assessments of knowledge, skills and attitudes to develop plans for addressing areas for improvement Conference, Operating room, Simulation Debriefing after case or simulation, Case based discussion, Simulated, Skill Participate in academic projects Conference, Independent Study, Laboratory Presentation, Discussion, Mentoring Evaluation of presentation,, Review of data
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-3 residents must identify, explain and demonstrate all the characteristics listed below. They will show mastery of these skills, exhibit leadership and act as role models to educate others. 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 Simulation 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-3 residents must identify, explain and demonstrate all the characteristics listed below. They will show mastery of these skills, exhibit leadership and act as role models to educate others. 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-3 residents must identify, explain and demonstrate all the characteristics listed below. They will show mastery of these skills, exhibit leadership and act as role models to educate others. Answer pages promptly clinic, Postoperative Demonstrate respect, compassion or responsiveness to 's concerns or needs clinic, Postoperative, Skill 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-3 residents must identify, explain and demonstrate all the characteristics listed below. They will show mastery of these skills, exhibit leadership and act as role models to educate others. Practice cost-effective health care Operating room Lecture and discussion, Case based discussion Rely on information technology tools related to care clinic, Classroom, Conference, Case based discussion, Journal Club presentation Case based discussion and evaluation, Rely on consultations with other specialties (i.e., cardiology, pain management, ethics, etc.) clinic, Classroom, Conference, Case based discussion Case based discussion and evaluation, 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,