INDIANA UNIVERSITY DEPARTMENT OF ANESTHESIOLOGY
CORE--Cardiac Anesthesia
Goals and Objectives
GOALS and OBJECTIVES:
The goal of the Cardiac Anesthesia Rotation at the Indiana University School of Medicine is to
train physicians to be competent and compassionate practitioners of cardiac anesthesia. This
Core-Cardiac Anesthesia rotation is designed to enhance your overall knowledge, understanding
and application of cardiac anesthesia principle. This differs from the advance rotation in cardiac
anesthesia where emphasis is placed in the areas of analysis, synthesis and evaluation of patient
care needs.
Basic Cardiac Anesthesia Resident Duties:
1. Preoperatively evaluate and develop an anesthetic plan for the safe administration of a
safe Cardiac Anesthetic
2. Inter-operatively maintain safe anesthetic care for the patient with specific consideration
of the impact of: coronary artery and valvular disease
3. Post-operatively understand potential complications associated with the administration of
anesthesia and potential sequelae of Cardiac Anesthesia interventions
4. Attendance at didactic conferences
5. Taking night call on a rotating schedule
6. Develop a personal program of self-study and professional growth
7. Complete medical records promptly
8. Document all duty hours
9. Document all procedures
10. Monitor self for fatigue
11. Dress appropriately
12. Act in a professional and ethical manner
13. Complete the appropriate evaluation instruments used by the department, including QA
forms
Educational Strategy:
The Cardiac Anesthesia Rotation is a one-month (4 week) block. During the Cardiac Anesthesia
Rotation residents may work with multiple members of the teaching faculty, but their educational
experience will be supervised by the Director of Cardiac Anesthesia, Dr. Johnny Hobbs.
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. Johnny Hobbs--Methodist
Dr. Jerry Young—University
Dr. Scott Walker—Riley
Dr. Sanjay Gupta—VA
During the rotation in cardiac 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 cardiac patients by:
1. Defining the disease entities leading to the need for Cardiac Anesthesia
2. Understanding the normal anatomy of the heart including the coronary arterial
system, chambers, valves, great vessels and pericardium
3. Understanding the principles behind Transesophageal Echocardiography (TEE)
i. List the Indications and Contraindications for TEE
ii. Have the technical skill and knowledge to evaluate both the quantitative
and qualitative aspects of ventricular function
iii. Have the technical skill and knowledge to obtain basal short-axis view,
four chamber view, transgastric short axis view
iv. Understand the principles and indications for color flow Doppler
4. Explaining the various techniques used in providing anesthesia care to the cardiac
patient
5. Obtaining a working knowledge of the metabolic events associated with Cardiac
Anesthesia and their management
6. Understanding the various drugs utilized in the administration and care of the cardiac
patient
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7. Understanding the impact of ischemic heart disease, valvular heart disease, rhythm
disorders, heart failure, cardiomyopathies, cardiac tamponade, pulmonary embolism
on the administration of anesthesia
8. Being able to understand the functions of the cardiopulmonary bypass pump
9. Understand the indications for placement of Pulmonary Artery Catheters
10. Identifying the interpretation of Pulmonary Artery Catheter information including
cardiac output and index
11. Understand how the Aspect-BIS monitor works and be able to interpret the
information it generates
12. Understand the appropriate utilization and basic function of other cerebral monitoring
devices such as cerebral oximetry
Patient Care:
Using the above medical knowledge the resident is expected (after completion of the cardiac
anesthesia rotations) to:
1. Evaluate cardiac patients and develop a treatment plan
2. Anticipate and manage problems commonly encountered during cardiac anesthesia
3. Formulate a comprehensive plan for peri-operative assessment and management of
the cardiac patient
4. Demonstrate the ability to function as a cardiac anesthesia consultant
5. Understand the administration/complications/benefits of the various pharmacologic
agents sufficiently to make sound medical judgments appropriate for cardiac
anesthesia
6. Skillfully perform invasive interventional procedures, including, but not limited to:
a. Placement of central venous lines
b. Placement of arterial lines
c. Placement of pulmonary artery catheters
d. Post-operative spinal analgesia for pain control
e. Pre-operative placement of epidurals for post-operative pain control
f. Basic Transesophageal Echocardiography
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 cardiac 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 cardiac anesthesia,
alternatives, and risks and benefits of treatment options
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6. Obtaining informed consent for cardiac anesthesia procedures
7. Answering questions from patient and or family members regarding the cardiac
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
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 acute pain
3. Reviewing the medical literature related to the field of acute pain 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 acute pain
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5. Transferring knowledge about acute pain 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 cardiac 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 provide them real-time feedback concerning their performance in
the delivery of anesthesia services. Informal discussions with the cardiac 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:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
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
Demonstrates respect for the dignity of patients and colleagues
Has no restriction, condition, limitation or revocation of license to practice
medicine
Understands anatomical, physiological, and pathophysiological concepts of organ
disease that culminates in the need for solid organ transplant
Collects and uses clinical data
Recognizes the psychological factors modifying pain experience
Communicates/works effectively with patients/colleagues
Demonstrates appropriate concern for patients
Demonstrates commitment to life long learning
Adapts and is flexible
Is careful and thorough
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17.
18.
19.
20.
21.
22.
23.
24.
Generates complete, legible, and accurate medical record
Possesses business skills for effective practice management
Uses information technology to optimize patient care
Is an advocate for quality care
Recognizes gaps in knowledge and expertise
Demonstrates continuous practice improvement
Uses appropriate technical skills in diagnostic and therapeutic procedures
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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Clinical Anesthesia-Barash
Cardiac Anesthesia – Kaplan, Reich, & Konstadt
Cardiac, Vascular, and Thoracic Anesthesia - Youngblood, Lake, Roizen, Wilson
Common Problems in Cardiac Anesthesia – Reves, Hall
Heart Disease - Braunwald
Heart and Heart-Lung Transplantation – Baumgartner, Reitz, & Achuff
Pharmacology and Physiology in Anesthetic Practice – Stoelting
Clinical Monitoring – Lake, Hines, & Blitt
Atlas of Regional Anesthesia – Brown
Annual Refresher Course Lectures and Basic Science Reviews of the ASA
(published annually)
Review articles on cardiac anesthesia topics in the following peer reviewed journals provide
useful reading:
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Anesthesiology
Anesthesia and Analgesia
British Journal of Anesthesia
Journal of Cardiothoracic and Vascular Anesthesia
Regional Anesthesia and Pain Medicine
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