GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR ANESTHESIOLOGY ROTATION,
UMC AND SUBSPECIALTY CLINIC
Rotation Coordinator:
Samson Otuwa, M.D.
2450 W Charelston
Las Vegas , NV 89102
Phone: (702) 877-8661
Fax: (702) 383-0727
OVERVIEW
Educational Purpose
A four-week elective in anesthesiology is offered once during residency to internal
medicine residents under the direct supervision of University Medical Center’s
Department of Anesthesia staff.
The goals and objectives of this rotation are to provide the resident with a general
introduction to the field of Anesthesiology, with emphasis on general anesthesia, airway
management and exposure to critical care procedures.
Teaching Methods
The resident will be assigned to work with one of the attending anesthesiologists. The
resident will be free from call responsibilities except sick call, allowing additional
reading opportunities. The resident will be responsible for making pre-operative rounds
on patients to whose cases he or she is assigned, and will observe and assist in the
operating room as permitted by the anesthesiologist. Didactic teaching will be casebased
Mix of Diseases
Patients will be those whose diseases cause a need for elective and emergency surgery,
with specialties including general surgery, vascular surgery, obstetrics and gynecologic
surgery, cardiovascular surgery, orthopedic surgery, and neurosurgery.
Patient Characteristics
The patient population is diverse, male and female, of all ages from adolescent to
geriatric, representing most ethnic and racial backgrounds, from all social and economic
strata. The hospital serves primarily the indigent population of the city of Las Vegas.
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Types of Clinical Encounters
Patient encounters occur in the hospital during pre-operative anesthesia evaluation, in the
operating room, and in the post-operative recovery room. Patients will also be seen and
cared for in the post-surgical cardiovascular care unit.
Close interaction with various other healthcare team members including surgeons, nurse
anesthetists, scrub and circulating nurses, inpatient nurses, respiratory therapists, and
patient care technicians occurs daily.
Procedures
Elective endotracheal intubation
Placement of peripheral and central venous catheters
Arterial blood gas sampling
Ventilator management
Resident Supervision
Residents have constant supervision in the operating room as well as daily personal
supervision patient care pre- and post-operatively. The supervision will be under the
attending anesthesiologist.
Didactic Teaching
Curricular topics included in the curriculum include:
Anatomy
A
Head and Neck: The resident will learn the anatomy of the airway, larynx,
pharynx, trachea; anatomy of the brain and spinal cord and the 12 cranial nerves,
cervical plexus and stellate ganglion; thyroid and parathyroid innervation and
blood flow.
B.
Thorax: The resident will learn the anatomy of the heart, coronary arteries and
valves and arterial and venous branches; lungs, tracheobronchial tree and alveoli.
C.
Abdomen: The resident will earn about the anatomy of the stomach and intestines;
abdominal aorta, mesenteric, renal and iliac arteries; kidneys, liver and hepatic
blood flow; sympathetic ganglions - celiac and lumbar; lumbar spine anatomy.
D.
Extremities: The resident will learn the anatomy of the brachial plexus, axillary
sheath, median, radial, and ulnar nerves; axillary, brachial, radial, and ulnar
arteries, brachiocephalic and subclavian venous systems; lumbo-sacral plexus,
sciatic, femoral, peroneal and sural nerves, femoral, popliteal, dorsalis pedis and
posterior tibial arteries, saphenous, superficial and deep femoral and iliac veins.
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Physiology
A.
Cardiovascular: The resident will learn the concept of Starling’s law of
contractility, afterload and preload; the use of pulmonary artery catheter,
arterial line and pressure transducers.
B.
Respiratory: The resident will understand pulmonary functions, respiratory
physiology, dead space ventilation and shunting.
C.
Neurological: The resident will learn about neuronal conduction, the bloodbrain barrier, brain and spinal cord reflexes; evaluation of the comatose
patient; neuromuscular junction physiology.
D.
Genitourinary: The resident will learn about uterine contractility, stages of
labor and delivery, fetal circulation, fetal resuscitation, management of the
pregnant patient; renal physiology.
E.
GI-Hepatic: The resident will learn about GI motility and blood flow; hepatic
metabolism and blood flow; pancreatic and gall bladder function.
Pharmacology
A.
Anesthetics: The resident will learn about inhalational agents such as nitrous
oxide, isoflurane, sevoforane, enflurane, and halothane; about intravenous
agents such as pentathol, propofol, etomidate and other muscle relaxants such
as succinylcholine, vecuronium, mivacurium and others; conscious sedation
with benzodiazepines and narcotics.
B.
Cardiovascular Drips: The resident will learn about inotropes such as
dopamine, dobutamine and epinephrine; vasoconstrictors such as ephedrine,
phenylephrine and norepinephrine; vasodilators such as nitroglycerine,
nitroprusside and apresoline; use of short acting beta blockers such as
labetalol and esmolol.
C.
Respiratory: The resident will learn the use of bronchodilators, aerosols and
antisialogogues.
D.
GI: The resident will learn the use of antiemetics and antacids to reduce the
risk of aspiration in anesthesia.
Core Reading Materials
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Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper DL, ed. McGraw
Hill
The Washington Manual of Medical Therapeutics, 32nd ed.
Anesthesiology, Longnecker DL, ed. McGraw-Hill
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they
have performed anesthesia and to follow the hospital care of those patients. If a patient
for whom the resident has provided care should die and have an autopsy, the resident is
encouraged to attend the post-mortem session.
Training Sites
University Medical Center
All of the anesthesia experience occurs at University Medical Center (UMC)
under the supervision of one of the full-time anesthesiology attendings.
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Competency-based Goals and Objectives
Anesthesiology Rotation
Learning Venues
Evaluation Methods
1. Operating Room
2. PACU (Pre/Post op)
3. Hospital Wards
4. Self-Study
Competency-Patient Care
1. Effectively intubate patient
2. Complete pre-operative patient
evaluation
3. Observe pharmacological management
in Operating Room
4. Assist in post—operative management
of patient under attending supervision
Competency-Medical Knowledge
Level Specificity
A. Attending Evaluation
B. Procedure
Certifications
C. Nursing Evaluation
D. Patient Evaluation
E. Objective Testing
Learning
Evaluation
Venues
Methods
1
A,B
2, 3
A
N/A
N/A
N/A
N/A
N/A
Level
N/A
N/A
1
A
N/A
2, 3
A,C
N/A
Learning
Venues
Evaluation
Methods
Level
1. Anatomy (See text overview)
2. Physiology (See text overview)
3. Pharmacology (See text overview)
1, 2, 3, 4
1, 2, 3, 4
1, 2, 3, 4
A,D
A,D
A,D
Competency-Interpersonal
Communication Skills
Learning
Venues
Evaluation
Methods
N/A
N/A
N/A
N/A
Level
Show understanding for different patient
preference
Maintain accurate medical records
Communicate effectively to patient and
medical support staff
Communicate patients problems clearly
with patients family
Treat patients and families with
respect/empathy
Treat colleagues with respect
Respect patient confidentiality
1, 2, 3
A,C,D
N/A
1, 2, 3
1, 2, 3
A,C,D
A,C,D
N/A
N/A
1, 2, 3
A,C,D
N/A
1, 2, 3
A,C,D
N/A
1, 2, 3
1, 2, 3
A,C,D
A,C,D
N/A
N/A
5
Competency-Professionalism
Learning
Venues
1, 2, 3
Treat team members, primary caregivers, and patients with respect and
empathy
Understand, practice and adhere to a code 1, 2, 3
of medical ethics
1, 2, 3
Participate actively in preoperative
Evaluation
Methods
Level
A,C,D
N/A
A,C
N/A
A,C
N/A
N/A
evaluation, the operating room, and in
post-operative care
Attend and participate in all scheduled
conferences
Anesthesia
and internal
medicine
department
A, attendance
Competency-Practice-Based Learning
Learning
Venues
Evaluation
Methods
Identify two adverse patient care
outcomes and propose improvements in
care
Identify limitations of anesthesia
knowledge and take corrective action via
the medical literature
1, 2, 3,4
1
N/A
1,2,3,4
1
N/A
Competency - System Based Practice
Learning
Venues
Evaluation
Methods
Understand the multi-disciplinary
approach to operating room care
1, 2, 3
A,C
Level
Level
N/A
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the
standard ABIM resident evaluation form. All clinical faculty are encouraged to
provide face-to-face feedback with the residents. The night-float resident is
evaluated by one of the three service attendings. In addition, residents may
receive interim feedback utilizing the ABIM’s Praise and Early Warning cards.
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B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty
member, at the completion of the rotation. This evaluation form is included at the
end of this document. These evaluations are then converted to type and shared
anonymously with the clinical faculty.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction.
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Anesthesia Rotation Intern/Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty
member and resident.
2. Completed assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required case report abstracts and/or posters if assigned by the supervising
faculty member.
5. Demonstrated understanding of the basic principals of intra- and peri-operative
management.
6. Submitted signed procedure logs to Program Coordinator. Followed up procedures
performed on this rotation.
7. Has acquired competence in endotracheal intubtion.
8. Received verbal feedback from attending.
Intern/Resident Signature_________________________
Date___________________
Supervising Anesthesiologist______________________
Date___________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the month’s end.
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