GOALS & OBJECTIVES
TU Advanced Clinical Anesthesia Rotation
Rotation Director:
Learners:
Philip Kalarickal, MD
CA-3 Residents
Goals:
The advanced clinical anesthesia rotation affords the third year anesthesiology residents
the opportunity to participate in cases of increased complexity and with more
independence as compared to the prior years of training. The resident will be presented
with patients of more complex pathophysiology whose anesthetic considerations will be
more difficult and challenging than those encountered in earlier training years. The
resident will be provided with clinical experience and didactic instruction to help
facilitate the acquisition of skills to needed to provide anesthetic care to a diverse cohort
of seriously ill patients. During this rotation the resident will:

Develop capabilities of perioperative evaluation and management of patients with
complex presentations and multiple organ system failure requiring various
surgical interventions

Develop a corpus of knowledge reflecting deep understanding of pharmacologic
and physiologic anesthetic considerations

Develop advanced anesthesia skills including use of routine and advanced
monitors

Develop increasing maturity and independence in practice of anesthesiology
Objectives:
During this rotation the resident will progress toward attainment of the following core
competencies:
PATIENT CARE

Provide compassionate, respectful, appropriate and effective care

Manage analgesic and anesthetic needs of ASA III-IV patients, including those
with complex and relatively uncommon conditions, undergoing a variety of
procedures

Communicate effectively with patients, their families and significant others in a
more independent manner than in prior years of training
Goals and Objectives of the
Advanced Clinical Anesthesia

Independently perform preoperative history and physical examinations, and
evaluation of laboratory data

Provide anesthetic care utilizing specialized equipment and techniques including,
but not limited to: double lumen endotracheal tubes, various fiberoscopes, various
complex neurophysiologic monitors, transesophageal echocardiography, various
cardiac output monitors, transcutaneous and intravenous cardiac pacemakers

Develop an anesthetic plan in an increasingly independent manner for the
spectrum of uncomplicated to complex, ill patients

Effectively manage patients with difficult airways

Manage patients with coagulopathies with increasing independence

Perform regional anesthetic techniques in a competent and efficient manner

Perform placement of peripheral and central venous, arterial, and pulmonary
artery catheters in an independent manner

Manage complex patients in post anesthesia care and intensive care units
MEDICAL KNOWLEDGE

Demonstrate advanced understanding of anesthetic considerations for patients
with a variety of medical illnesses including but not limited to those referable to
cardiac, pulmonary, renal, hepatic, neurologic, and endocrinologic etiologies

Demonstrate advanced knowledge of pharmacology including knowledge of
volatile and intravenous anesthetic agents, opioids, local anesthetics, muscle
relaxants and reversal agents

Demonstrate advanced understanding of aspects of cardiorespiratory, renal,
hepatic, and neurologic physiology

Demonstrate advanced understanding of fluid balance and transfusion
requirements of patients presenting with complex pathophysiology

Demonstrate knowledge of routine and complex monitoring devices and
techniques

Demonstrate advanced understanding of acid-base balance and positioning
requirements of various complex surgical cases
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Goals and Objectives of the
Advanced Clinical Anesthesia

Demonstrate an understanding of management of postoperative and postprocedural pain in a variety of seriously ill patients

Demonstrate an understanding of the theoretical and practical management of
cardiopulmonary arrest
PROFESSIONALISM
The residents will demonstrate increasing levels of commitment to professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
populations. Residents are expected to:

Demonstrate a commitment to ethical principles pertaining to confidentiality of
patient information, and the obtainment of informed consent

Demonstrate proper sensitivity to patient needs and concerns

Demonstrate sensitivity and responsiveness to the cultural, age, gender, and
ethnicity considerations of patients, their families and significant others

Develop behaviors engendering polite and respectful interactions with patients,
families and all members of the health care team

Understand importance of responding in a timely and appropriate manner to
pages, requests for assistance, scheduling and departmental policies

Understand the importance of the impact of non-professional comportment on
various aspects of patient care and the health care environment

Demonstrate an understanding of the requirements of life-long learning and
excellence in scholarship

Develop an understanding of the impact of business practices

Understand importance of attendance and participation in varying departmental
conferences and meetings
SYSTEMS-BASED PRACTICE
The residents will acquire an understanding of the necessity to appreciate the larger
context of the health care system and the allocation of resources in a manner that
promotes responsible patient care.

Develop an understanding of how patient care is influenced by other components
of the health care system
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Goals and Objectives of the
Advanced Clinical Anesthesia

Develop and understanding of quality improvement programs

Understanding the significance and ramifications of cost control strategies

Understand the mechanism by which seriously ill patients enter the health care
system and the experience the various components of the perioperative process

Participate in processes leading to a greater appreciation of anesthesiology as it
interacts with other aspects of health care

Develop skills required to function in interdisciplinary environment
PRACTICE-BASED LEARNING AND IMPROVEMENT
The resident will learn to evaluate and improve patient care practices by application of
the following:

Demonstration of an understanding of avenues available to improve knowledge
base and capabilities to treat complex patients

Develop an understanding of desirability and necessity for life-long learning and
the various options for achieving this goal

Develop an appreciation of the importance of attendance of conferences, didactic
lectures, morbidity and mortality conferences, journal clubs, local, regional and
national meetings

Develop an understanding of literature review and research design

Develop an appreciation of how patient care may be continuously improved by
acquisition of didactic and clinical knowledge and the application of constructive
criticism

Demonstrate behaviors that manifest an understanding of the above by willing
and active participation in educational opportunities
INTERPERSONAL AND COMMUNICATION SKILLS
The resident will acquire and refine increasingly advanced interpersonal and
communication skills through the following:

Relationship establishment with patients, their families and significant others

Appreciate the importance of effective communication with support staff to
ensure maintenance of proper medication, equipment and supplies
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Goals and Objectives of the
Advanced Clinical Anesthesia

Function effectively as a component of the patient care team

Effectively exchange information with other health professionals involved in the
care of the patient while remaining cognizant of patient confidentiality mandates

Obtain information necessary for medical care of the patient from a variety of
sources

Develop effective listening skills

Learn to recognize potential barriers to effective communication and develop
strategies for proactive prevention of communication, interpersonal problems
The acquisition of the above-elaborated core competencies will be facilitated by clinical
assignments made by the attending faculty. As a result of these ongoing rotations, the will
progressively demonstrate an incremental understanding of the principles of
anesthesiology and demonstrate increasing competencies in performance of the technical
requirements of patient care. As the resident progresses, an appropriate understanding of
self-limitations will be a component of development of the requisite judgment required of
a consultant in anesthesiology. The resident will be expected to complete reading
assignments and other academic endeavors as mandated by the faculty. Independent
study in addition to required readings is both desirable and recommended. The evaluative
process for this rotation will be undertaken in concert with departmental evaluative
policies. Residents will receive evaluations from faculty with whom they have
worked and these evaluations include all core competencies. The evaluations are
reviewed by the rotation director with the resident. The evaluations are signed by the
resident and made available to the Clinical Competency Committee. The faculty are also
encouraged to give residents ongoing verbal feedback about their performance of the core
competencies on a daily or as needed basis. The departmental standardized evaluation
form includes the six essential components of the core competencies: patient care,
medical knowledge, professionalism, interpersonal and communication skills, practicebased learning and systems-based practice. The resident will evaluate the rotation as a
component of the formal evaluative program process and will be encouraged to supply
ongoing feedback on the rotation to the faculty and staff. They will likewise evaluate the
faculty as part of the formal evaluative process of the teaching program.
P. Kalarickal
July 2009
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