Rotation: Obstetrical Anesthesiology – Junior Rotation Director: Michael G. Richardson, MD (m.richardson@vanderbilt.edu) Overview: The month one, introductory subspecialty rotation is designed to teach fundamental competencies required for routine anesthesia care of women during pregnancy and delivery, including those with common medical, obstetric, and anesthetic complications. Residents will develop working knowledge of foundational physiologic, pathophysiologic, pharmacologic, anesthetic, and obstetric content, will apply this in the daily management of analgesic and anesthetic care, and will become proficient in technical / regional procedural skills. The resident will develop interpersonal / team skills that are unique to the dynamic, inter‐professional maternal care unit environment. Learning Objectives [*I.O.M. Quality Dimensions: Safe, Effective, Patient‐/Family‐centered, Timely, Efficient, Equitable] Objective Patient Care: Provides High Quality Patient Care #1 #2 #3 #4 #5 #6 #7 #8 Conduct complete pre‐anesthetic assessments (data from chart, obstetrician/midwife, nurse; patient history & physical exam); conduct informed consent; and document this process (StarPanel; consent form) Formulate anesthetic plans that include consideration of common underlying clinical conditions, past medical history, fetal status, and medical or surgical risk Conduct and manage quality* neuraxial labor analgesia (epidural, CSE) in routine, non‐complex parturients, efficiently, safely, with minimal complications – including preventing, recognizing, and managing complications (hypotension, side effects). Initiate, manage, and assess effectiveness of nitrous oxide analgesia Block assessment: Accurately assess effectiveness of labor analgesia, and with supervisor guidance, propose corrective interventions (top‐up, or reduced dose) appropriate to patient’s needs, preferences, stage of labor, and anticipated obstetric interventions for delivery. Conduct and manage quality* neuraxial anesthesia (spinal; CSE; extension of labor epidural anagesia) for cesarean delivery in routine, non‐complex parturients, of high quality*, with minimal complications – including preventing, recognizing, and managing complications (hypotension, side effects). Participate in conduct of general anesthesia care for emergency cesarean delivery, following supervisor direction Perform timely post‐partum post‐analgesia/‐anesthesia follow‐
up per division protocol; documents findings; communicate [Typetext]
Evaluation Methods  Direct Observation/Feedback  LPCA 
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#9 #10 #11 #12 #13 complications to team leaders (senior, fellow, attending). Participate as a responding member of the OB Emergency Team (OBET), following supervisor (senior, fellow, attending) direction. Respond with flexibility to direction of team leader (senior, fellow, attending), despite rapidly dynamic conditions and priorities. Identify factors predisposing parturients to adverse outcomes (medical or obstetric risk factors; limited resources [personnel; space]; limited knowledge [need for consultants, tests]; communication barriers) Recognize clinical deterioration or significant illness, and apprise supervisor, and participate in diagnosis and clinical intervention. Recognize and initiate treatment of common complications and adverse events attributed to neuraxial anesthesia.  Direct Observation/Feedback  Direct Observation/Feedback  Direct Observation/Feedback  LPCA  Direct Observation/Feedback  Direct Observation/Feedback Objective Medical Knowledge: Obstetric Anesthesiology #1 #2 #3 With supervisor assistance, demonstrate understanding, and apply clinically, foundational concepts (18 core topics) – normal & complicated mat/ fetal/ placental physiol; maternal co‐
morbidities; OB mgmt practices; implications for OB anesthesia management With supervisor assistance, demonstrate understanding, and apply clinically, basic fetal /neonatal concepts – EFM patterns & categories, routine neonatal physiol & assessment (Apgar) Recognize and demonstrates understanding, legal & ethical concepts (informed consent, autonomy, patient rights, treatment refusal, vulnerable pop’ns, emancipated minor). Evaluation Methods  Direct Observation/Feedback  Daily morning conference attendance  Direct Observation/Feedback  Direct Observation/Feedback Objective #1 #2 Practice‐based Learning and Improvement: Self‐directed learning and scholarly activity Completes assigned/recommended readings, and evidence related to specific patient problems, sharing insights with team members With assistance of supervisor, analyze own performance and patient outcomes, and implement changes to improve #3 Actively pursues post‐anesthesia follow‐up (patient feedback) to assess quality & seek improvement #4 Receives feedback and advice from supervisors  uses it to improve Evaluation Methods  Direct Observation/Feedback  Daily morning conference attendance  Direct Observation/Feedback  LPCA  Direct Observation/Feedback  LPCA  Direct Observation/Feedback  LPCA Objective Interpersonal and Communications Skills: Communication with patients and families [Typetext]
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#1 Communicates routine information to mother & support persons in respectful, responsive, effective, & culturally sensitive manner #2 Obtains informed consent for routine procedures using language appropriate to mother and family’s level of understanding Recognizes need for interpreter services – identifies need, recruits services, uses effectively #3 #4 With guidance, communicates & collaborates effectively with inter‐professional team (nurses, techs, OBs, CNMs, consultants) #5 Writes clearly & effectively (consults, chart notes, clinical orders, CBAs) With guidance, discerns conflict or misunderstanding (actual; potential); #6 #7 Communicates routine information to mother & support persons in respectful, responsive, effective, & culturally sensitive manner 
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Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Objective Professionalism Evaluation Methods Demonstrates awareness of & complies with expectations & policies (rotation, dept, L&D, institution… clinical, educational, duty hours, etc.) Timely completion of documentation (StarPanel; GasChart; consents) & reading/written assignments (educational; evaluations) Actively participates in conference & discussion; mindful of “law of fractions”; respects others’ contributions Seeks to understand alternative perspectives; promotes open‐
mindedness/ non‐judgment Seeks and accepts constructive feedback.  Direct Observation/Feedback #6 Conducts all work with honesty & integrity, participating fully in clinical care and educational activities. Direct Observation/Feedback LPCA #7 Demonstrates awareness of barriers to care; advocates for vulnerable patients #8 With supervisor assistance and guidance, discloses errors & complications to patients and team members. #1 #2 #3 #4 #5 [Typetext]
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#9 Balances learning with patient/clinical care needs; responsive to pt’s needs over self‐interest #10 Demonstrates commitment to maintaining own personal emotional, physical, and mental well‐being #11 Demonstrates awareness of & complies with expectations & policies (rotation, dept, L&D, institution… clinical, educational, duty hours, etc.) 
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Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Objective Systems‐based Practice #1 Collaborates effectively with L&D teammates (nurses, techs, OB res/attgs, midwives, MFMs) #2 Is attentive, and contributes to care transitions to participate in ensuring continuity & safety #3 Demonstrates awareness of costs and resource limitations as relevant to devising care plans #4 Actively participates as contributing member of OB Emergency Response Team, taking direction from supervisor #5 Reflects on complications and demonstrates understanding of the role of systems and communication factors play as threats to safety. Incorporates patient safety principles into clinical practice with prompting #6 Evaluation Methods 
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Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA Direct Observation/Feedback LPCA TEACHING METHODOLOGIES Students on this rotation will be expected to learn and achieve the learning objectives through the following methodologies and activities: 
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Attendance & Active Participation in Daily Morning Conference Complete Required Daily Reading Assignments Clinical Experience providing ante‐/intra‐/post‐partum care for pregnant women Live Performance Competency Assessments Informal & Formal Feedback / Team Debrief sessions Modeling, guidance, and direct supervision by Senior Residents /Fellow/ Attendings Participation in transitions of care o Daily morning and afternoon/evening OB Anesthesiology team hand‐over o When possible, L&D Board Rounds (evenings; weekends) and twice daily L&D Mid‐Shift Briefings  Supplemental readings that are relevant to cases or impromptu topics [Typetext]
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PATIENT ENCOUNTERS Residents on this rotation will be expected to work up and/or manage the minimum number of patients/cases with the specified conditions as listed below: (e.g., 10 craniotomies, 20 vaginal deliveries with CLE, etc.) Number Patient Condition / Case 20 Pre‐anesthetic evaluation/informed consent 20 Post‐analgesic/‐anesthetic evaluation (post‐partum) 8 Nitrous Oxide Analgesia 20 Continuous Epidural Labor Analgesia 15 Extension of Epidural Labor Analgesic block for Cesarean Delivery 15 Spinal / CSE Anesthesia for Cesarean Delivery 10 Use of Language Line Interpreter Services for pre‐anesthetic evaluation/informed consent, and for performance of anesthetic care/procedures (labor analgesia; block assessment; cesarean delivery) FEEDBACK Please identify when and how the student will receive feedback on his/her performance. Daily  Verbal Final  Written  Verbal Michael G. Richardson, MD 16 October 2014 [Typetext]
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