INDIANA UNIVERSITY DEPARTMENT OF ANESTHESIOLOGY
CORE--Ambulatory Anesthesia
Goals and Objectives
GOALS and OBJECTIVES:
The goal of the Ambulatory Anesthesia Rotation at the Indiana University School of Medicine is
to train physicians to be competent and compassionate practitioners of ambulatory anesthesia.
This Ambulatory Anesthesia rotation is designed to enhance their overall knowledge,
understanding and application of ambulatory anesthesia principles. This differs from the
advance rotation in Ambulatory anesthesia where emphasis is placed in the areas of analysis,
synthesis and evaluation of patient care needs.
Ambulatory Anesthesia Resident Duties:
1. Preoperatively evaluate and develop an anesthetic plan for the administration of a safe
Ambulatory Anesthetic
2. Intra-operatively maintain safe anesthetic care for the patient with specific consideration
of the impact of ambulatory status upon the delivery of anesthesia
3. Post-operatively understand potential complications associated with the administration of
anesthesia and potential sequelae of Ambulatory Anesthesia interventions
4. Attend didactic conferences
5. Take night call on a rotating schedule
6. Respond to requests for anesthesia consults in a timely fashion
7. Maintain a personal program of self-study and professional growth
8. Complete medical records promptly
9. Document all duty hours
10. Document all procedures
11. Monitor self for fatigue
12. Dress appropriately
13. Act in a professional and ethical manner
14. Complete the appropriate evaluation instruments used by the department, including QA
forms
Educational Strategy:
The Ambulatory Anesthesia Rotation is a one-month block. During the Ambulatory Anesthesia
Rotation residents will be will be supervised by various members of the anesthesia teaching
faculty. The Director of Ambulatory Anesthesia is Dr. Charles Harris. In his absence Dr. Robert
Byers is assigned to cover these responsibilities. When rotating at an institution which is not the
primary site of practice of the above mentioned faculty, please contact the below listed
individuals:
Dr. John Emhart—Riley
Dr. Mike Croner—Wishard
Dr. Ken Gwirtz—VA
During the rotation in ambulatory anesthesia, residents are expected to participate in journal
club, and morbidity and mortality conferences (QA).
Core Competencies:
The six core competencies are used as a template to evaluate residents during all Anesthesia
rotations. The terms used to define these competencies are similar to those used for other
rotations. The Goals and Objectives that follow have been specifically modified to meet the
needs of the specific teaching rotation in which you are to participate. These Goals and
Objectives are not intended to be comprehensive but have been developed to help you acquire
the core competencies in the area of Clinical Anesthesia. These core rotations should serve as
the foundation upon which the subspecialty anesthesia rotations are based. We ask you as the
learner to consider how each of the subcategories within these six competencies might relate to
cognitive, motor and affective characteristics of your education and your professional behavior.
If while reading this document you discover an area that requires revision or improvement please
bring these issues to the attention of either the Course Director or the Program Director. We seek
changes that will improve your educational experience.
EDUCATIONAL OBJECTIVES
Medical Knowledge:
After completing this rotation, residents will have gained knowledge and practical experience in
the care of ambulatory patients by:
1. Learning the indications and potential benefits of performing outpatient surgical
procedures
2. Learning the limitations related to performing outpatient surgery/anesthesia
3. Learning appropriate preoperative evaluation, patient preparation, and anesthetic plan
formulation for those undergoing outpatient surgery
4. Learning techniques for efficient OR time management
5. Understanding the postoperative care needs of outpatient
6. Understanding discharge criteria for leaving the hospital
7. Understanding follow-up techniques used for the outpatient population
Patient Care:
Using the above medical knowledge the resident is expected to:
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1. Evaluate ambulatory patient consults and developing a treatment plan
2. Plan a comprehensive approach to ambulatory problems
3. Plan a comprehensive plan for peri-operative assessment and management of the
ambulatory patient
4. Access and evaluate medical literature related to the field of anesthesia via utilization of
systems based practice models
5. Demonstrate the ability to function as an Ambulatory Anesthesia consultant
Interpersonal and Communication Skills:
After completing this rotation, residents will have gained experience and competence in:
1.
2.
3.
4.
Obtaining an accurate, useful patient history appropriate for ambulatory anesthesia
Completing an informative, legible medical record
Communicating skillfully with patients and family members
Communicating information about anesthetic procedures with other colleagues
including referring physicians, nurses, and workers on ancillary services
5. Effective counseling of patients and families regarding methods of ambulatory
anesthesia, alternatives, and risks and benefits of treatment options
6. Obtaining informed consent for ambulatory anesthesia procedures
7. Answering questions from the patient and/or family members regarding the ambulatory
anesthesia issues in a fashion that is readily understood
Professionalism:
After completing this rotation, residents will have gained experience and competence in:
1.
2.
3.
4.
Acting in a professional manner while providing patient care
Demonstrating reliability and dependability
Exemplifying compassionate and appropriate patient care
Acquiring teaching skills essential for creating a positive learning environment,
including involvement in the education of medical students
5. Showing respect for patients
6. Providing for the emotional needs of patients
Systems-Based Practice
After completing this rotation, residents will have gained experience and competence in:
1. Understanding their role as a patient care advocate
2. Becoming familiar with the costs associated with the delivery of anesthesia care
3. Incorporating the concepts of cost-benefit analysis when considering therapeutic
options
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4. Interpreting the constraints associated with management of the operating room and be
able to integrate this understanding into best patient care practices
5. Emphasizing safety for the patient as well as operating room personal
6. Obtaining a better understanding of the tools that are being utilized to assess best
practices in anesthesia by organizations such as Magnet and Leapfrog
7. Working towards developing team building skills
Practice Based Learning and Improvement:
After completing this rotation, residents will have gained experience and competence in:
1. Self-directed learning
2. Becoming more efficient at locating medical information associated with Ambulatory
Anesthesia
3. Reviewing the medical literature related to the field of Ambulatory Anesthesia and
integrating this information with the care of the patient
4. Learning to better utilize information technology to access on-line medical
information pertaining to innovative diagnostic and therapeutic modalities in the area
of Ambulatory Anesthesia
5. Transferring knowledge about Ambulatory Anesthesia to other members of the
healthcare team (medical students, ancillary care personal and nursing staff)
Trainee Evaluations:
The Clinical Competency Committee (CCC) meets every other month to evaluate the progress of
the trainees. Specifically addressed are the six basic competencies and the ambulatory anesthesia
specific competencies outlined above. The instruments used to assess their progress include an
evaluation form which utilizes a scaled five point Likert scoring system which assesses each of
the six competencies. In house testing is also performed twice yearly to insure that the trainees
are acquiring the knowledge associated with the provision of a safe anesthetic. Residents are
expected to take the in-training examination administered by the American Society of
Anesthesiologists/American Board of Anesthesiology (ASA/ABA).
On a more informal (and potentially more important) level, members of the teaching faculty
evaluate our trainees daily and are provide them real-time feedback concerning their
performance in the delivery of anesthesia services. Informal discussions with the ambulatory
anesthesia residents address any deficiencies in patient care or knowledge base. Additionally,
we try to know our trainees personally to better understand and/or address underlying stressors or
personal issues that may interfere with learning and performance.
Every six months, the American Board of Anesthesiology requires that the Clinical Competency
Committee submit a Resident Training and Evaluation Report. In addition to the basic
competencies, we submit our evaluation of a trainee’s progress in the following areas:
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1.
2.
3.
4.
5.
6.
Demonstrates ethical/moral behavior
Is reliable, conscientious, responsible and honest
Learns from experience; knows limits
Reacts to stressful situations appropriately
Has no documented abuse of alcohol or illegal use of drugs during this report period
Has no cognitive, physical, sensory or motor impairment that precludes individual
responsibility for any aspect of anesthetic management
7. Demonstrates respect for the dignity of patients and colleagues
8. Has no restriction, condition, limitation or revocation of license to practice medicine
9. Understands anatomical, physiological, and pathophysiological concepts of organ
disease that culminates in the need for solid organ transplant
10. Collects and uses clinical data
11. Recognizes the psychological factors modifying pain experience
12. Communicates/works effectively with patients/colleagues
13. Demonstrates appropriate concern for patients
14. Demonstrates commitment to life long learning
15. Adapts and is flexible
16. Is careful and thorough
17. Generates complete, legible, and accurate medical record
18. Possesses business skills for effective practice management
19. Uses information technology to optimize patient care
20. Is an advocate for quality care
21. Recognizes gaps in knowledge and expertise
22. Demonstrates continuous practice improvement
23. Uses appropriate technical skills in diagnostic and therapeutic procedures
24. Completes study of management of acute pain, cancer pain, and chronic pain
Suggested Readings:
Suggested reading assignments to expand knowledge and patient care for this rotation include
but are not limited to the most recent editions of the following textbooks:
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Ambulatory Anesthesia Handbook – Rebecca Twersky
Ambulatory Anesthesia & Surgery – Paul White
Ambulatory Anesthesia the Requisites – Scott Springman
Ambulatory Anesthesia and Perioperative Analgesia – Susan Steele
Anesthesia for Ambulatory Surgery – Bernard Wetchler
Manual of Office-Based Anesthesia Procedures – Fred Shapiro
Anesthesia and Perioperative Complications – Jonathan Beneumof
Adult Perioperative Anesthesia: The Requisites in Anesthesiology –Daniel Cole,
Michelle Schlunt
Perioperative Care: Anesthesia, Medicine, and Surgery – David Bogdonoff
Annual Refresher Course Lectures and Basic Science Reviews of the ASA
(published annually)
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For guidance regarding regional analgesia for ambulatory surgery the most recent editions for the
following textbooks are recommended:
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Atlas of Regional Anesthesia – Brown
Neural Blockade – Cousins
Peripheral Nerve Blocks: Principles and Practice—Hadzic and Vloka
Regional Block – Moore
Review articles on ambulatory anesthesia topics in the following peer reviewed journals provide
useful reading:
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Anesthesiology
Anesthesia and Analgesia
British Journal of Anesthesia
Regional Anesthesia and Pain Medicine
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