Specific Educational Goals and Education

Level: PGY-1

Service: Anesthesia

Supervision: PGY-1 → Supervising Resident → Attending

All management decisions will be discussed with the senior resident and faculty.

Duty Hours:

Hours are to be logged into GMEOne on a weekly basis and will be reviewed weekly by the Program Director for ACGME violations and reviewed weekly for delinquencies by the Program Coordinator. Over a four week period; you will not average more than 80 hours a work week, you will have one day in seven free of clinical duty, in-house call will be no more frequent than one in three nights, you should receive 10 hours free between all duty periods and after in-house call and you will not be on duty for more than 30 consecutive hours. If you are assigned more hours than mentioned heretofore or have patient care duties that are extending you beyond these limits, it is your responsibility to notify your supervising resident or faculty so arrangements can be made to relieve you.

Educational Activities:

  1. Recommended Reading
    1. Schwartz's Principles of Surgery
    2. SCORE curriculum modules 
    3. Basics of Anesthesia Stoelting and Miller
    4. Clinical Anesthesiology Morgan et al.
  2. Conferences
    1. Wednesday Resident Educational Curriculum

Competency Based Performance Objectives:

Patient Care:

Goal: The resident will be able to use acquired skills and knowledge of anesthesia principles in the management of surgical patients

Objective: The resident will be able to:

  1. Perform pre-operative assessment of patients
  2. Demonstrate management of the airway in adults and children, employing appropriate
    1. Physical maneuvers
    2. Oral/nasal support devices
    3. Suctioning techniques to maintain clear airway
  3. Demonstrate correct performance of nasal and oral intubation techniques
  4. Recognize the stages of general anesthesia and their implications, particularly in regard to airway management
  5. Recognize and treat the signs and symptoms of complications due to anesthetic agents such as
    1. Cardiovascular collapse
    2. Acute metabolic disturbances
    3. Malignant hyperthermia
  6. Recognize risks and possible side effects of drugs used for pain control.

Competency Based Knowledge Objectives:

Medical Knowledge:

Goal: Demonstrate an understanding of the pathophysiology of pain and its management and pharmacology and principles of regional and general anesthesia and analgesia.

Objectives: The resident will be able to:

  1. Summarize the essential elements of the pre-anesthesia assessment, including:
    1. Targeted history and physical examination (review of systems, emphasizing cardiovascular and pulmonary disease)
      1. Effects of chronic medications (anticoagulants, insulin, and antiarrhythmics)
      2. Effects of pre-operative medications (narcotics, anxiolytics, and atropine)
      3. Effects of post-operative medications (including antihypertensives and antiemetics)
    2. Anatomic and physiologic variables germane to anesthetic success:
      1. Airway anatomy, including the Mallampati classification
      2. Skeletal deformities
      3. Neuromuscular diseases
      4. Aspiration risk (pregnancy, scleroderma, hiatal hernia)
    3. Assigned Anesthesia Society of America class and physical status:
  2. Outline the major characteristics of the pharmacokinetics and pharmacodynamics of anesthetic agents (local, volatile, oploid), considering; lipid solubility, protein binding, partition coefficients
  3. Summarize the use and monitoring of drugs for sedation and analgesia to include:
    1. Minimum anesthetic monitoring (pulse oximetry, electrocardiogram, blood pressure)
    2. Advantages of scheduled post-operative analgesia versus intermittent dosing
    3. Indications for patient controlled anesthesia (PCA)
    4. Importance of periodic assessment to determine level of consciousness and pulmonary status in sedated patients
  4. Summarize the principles of administration for and compare the effectiveness of the different methods of anesthesia
  5. Describe the potential benefits and complications of regional and local anesthesia
  6. Discuss the indications for the use of muscle relaxants.
  7. Analyze use of anesthetic monitoring techniques, such as:
    1. Swan-Ganz catheters
    2. Arterial lines
    3. Transvenous pacemakers
    4. End-tidal carbon dioxide monitoring
    5. Temperature monitoring
    6. Transesophageal echocardiography
  8. Describe the techniques and potential complications of managing an airway, including endotracheal and nasotracheal intubation.
  9. Describe and explain the most common immediate post-operative anesthetic issues:
    1. Airway stability
    2. Ventilation and oxygenation
    3. Pain control
    4. Nausea and vomiting
    5. Temperature regulation
    6. Homodynamic stability
  10. Analyze therapeutic options for patients with chronic pain

Interpersonal and Communication Skills:

Goal: Counsel patients and obtain informed consent for anesthesia procedures

Objectives: The resident will demonstrate the ability to obtain informed consent, outlining the risks and benefits

Goal: Communicate effectively to discharge patients after surgery.

Objectives: The resident will demonstrate the ability to instruct patients regarding monitoring for anesthetic complications:

Goal: Communicate effectively as a member of the healthcare team.

Objectives: The resident will demonstrate the ability to communicate effectively by:

  1. Providing appropriate check out when handing patients to another team member
  2. Requesting consults from other services with appropriate information
  3. Dictating operative reports in a timely fashion

Professionalism:

Goal: Maintain patient confidentiality

Objectives: The resident will demonstrate

  1. The ability to protect health-related patient information per HIPAA compliance
  2. List and be aware of sites in the hospital and clinic where loss of privacy for the patient may occur

Goal: Maintain appropriate professional relationships

Objectives: The resident will demonstrate professional interactions with:

  1. Medical students
  2. Nursing and support staff
  3. Supervising faculty
  4. Consulting residents
  5. Physician peers
  6. Patients and their families

Practice-Based Learning and Improvement

Goal: Identify personal and practice improvement strategies

Objective: The resident will demonstrate:

  1. Receptiveness to faculty instruction and feedback
  2. Ability to use medical information with the ability to access information through traditional and online sources to support their educational experience

Goal: Use medical evidence to evaluate Anesthesia practices

Objective: The resident will demonstrate the ability to:

  1. Discuss studies regarding anesthesia procedures
  2. Discuss studies regarding pain management

Systems-Based Practice

Goal: Provide safe patient care

Objective: The resident will:

  1. Attend Crew Resource Management courses as required by the hospital
  2. Follow recommended protocols in the OR for patient safety
  3. Demonstrate compliance with Medical Center policy for surgical site identification
  4. Demonstrate compliance with Medical Center policy for patient identification

Duties/Responsibilities:

  1. Serve as PGY-1 on the Anesthesia service
  2. Appropriate, professional supervision of student teaching in light of educational goals
  3. Attend Anesthesia clinic as assigned
  4. Manage OR patients with supervision
  5. Assist with consultations to the Anesthesia service as assigned by the Chief Resident
  6. Round on post surgical service patient's as instructed.
  7. Attend educational conferences
  8. Complete surgical case logs
  9. Dictate in a timely fashion
  10. Take night call as assigned

Evaluation:

  1. Performance feedback will be given to the resident as appropriate for educational events and mid-term progress will be discussed
  2. Global evaluation will be performed by the Anesthesia attending physicians at the completion of each rotation. Surgical case logs will be evaluated for the appropriate number and breadth of procedures and will be present in the resident's portfolio to be reviewed at the Program Evaluation meeting held twice yearly.
  3. At the completion of this rotation, the resident is required to complete a rotation evaluation form assessing the quality of the rotation. The resident should also address the teaching undertaken by the attending physicians on the rotation at the conclusion of this rotation.

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