INDIANA UNIVERSITY DEPARTMENT OF ANESTHESIOLOGY
Advanced CA2 and CA3 Transplant Anesthesia
Goals and Objectives
GOALS and OBJECTIVES:
This advanced rotation is meant to provide you with the competencies required to meet the
expectation for a Board Certified (Consultant) Anesthesiologist.
The goal of the Advanced Transplant Anesthesia Rotation at the Indiana University School of
Medicine is to train physicians to be competent and compassionate practitioners of
Transplantation Anesthesia. We expect the residents to be able to more readily evaluate and
develop treatment plans regarding patient care issues then during their previous experience in the
Transplant Anesthesia. This rotation is designed to enhance your overall knowledge,
understanding and application of anesthesic principle for transplantation. However, given the
advanced nature of this rotation emphasis will be placed upon enhancing your skill in the areas
of analysis, synthesis and evaluation of the patient. We would again reemphasis that this rotation
is meant to provide the competencies required to meet the expectations of a Board Certified
(Consultant) Anesthesiologist.
Basic Transplant Anesthesia Resident Duties:
1. Preoperatively evaluate patients and develop a plan for the safe administration of a
transplant anesthetic
2. Inter-operatively maintain safe anesthetic care for the patient with specific
consideration to the impact of end-stage organ failure on: anesthetic agents,
vasoactive drugs, fluid administration, and metabolic/hematologic abnormalities.
3. Post-operatively evaluate the patient for potential complications associated with the
administration of anesthesia and potential sequelae of transplant anesthesia
interventions
4. Attendance at didactic conferences
5. Taking night call on a rotating schedule
6. Responding to requests for transplant anesthesia consults in a timely fashion
7. Maintaining a personal program of self-study and professional growth
8. Completing medical records promptly
9. Documenting all duty hours
10. Documenting all procedures
11. Monitoring self for fatigue
12. Dressing appropriately
13. Acting in a professional and ethical manner
14. Completing the appropriate evaluation instruments used by the department,
including QA forms
Educational Strategy:
The Transplant Anesthesia rotation is based upon one-month (4 week rotations) blocks. During
their Transplant Anesthesia Rotation residents may work with multiple members of the teaching
staff, but their educational experience will be supervised by the Director of Transplant
Anesthesia, Dr. Sandra Kinsella. In her absence Dr. Leighan Bye (Dr. Robert Byers) will fulfill
these responsibilities. Residents during their rotation in Transplant Anesthesia are expected to
participate in journal clubs, and morbidity and mortality conferences (QA). Additionally, a
packet of materials has been compiled by the Director of Transplant Anesthesia and is provided
as a means of enhancing their educational experience.
When rotating at Riley Hospital for Children’s please contact Dr. Scott Walker (Jackie Allison)
if any questions arise regarding this rotation.
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 transplant patients by:
1. Understanding the pathophysiology of disease states and co-morbidities commonly
present in transplant patients
2. Studying the normal anatomy of the liver, kidney, pancreases, lung and heart. Be
able to explain the various techniques used in organ preservation
3. Understanding the metabolic events associated with solid organ transplantation and
their management
2
4. Determining the ramifications of the dissection phase, anhepatic phase, and
reanastomosis phases of liver transplantation - including management of
hematological/coagulation abnormalities, metabolic events, and fluid management.
5. Identifying the considerations associated with multi-visceral transplantation/small
bowel, including the disease state and the co-existing complications associated with
this complex procedure
6. Understanding complications associated with renal and pancreatic transplantation
7. Understanding the anesthetic considerations related to heart and lung transplantation
8. Understanding and interpreting information from Swan Ganz catheter
9. Understanding and applying pharmacological principles to the care of the transplant
patient
10. Understanding the physiological effects of pulmonary embolism, especially during
administration of anesthesia
11. Recognizing the basic function and be able to interpret information available via the
utilization of Aspect-BIS monitor
12. Understanding and interpreting information obtained from the Transesophageal Echo
13. Understanding the benefits/risks involved with the use of medications (aprotinin,
recombinate factor VII, etc ) used to control the potential coagulopathy associated
with liver transplantation
14. Understand the benefit and appropriate use of blood products
Patient Care:
Using the above medical knowledge the resident is expected to:
1. Evaluate the transplant patient and develop a plan for the administration of a safe
transplant anesthetic
a. Resident is expected to appraise and make recommendations about the
impact of the patients co-existing diseases and the impact that these will have
on the safe administration of anesthesia
b. Resident is expected be able to verbalize an appropriate anesthetic plan
c. Resident is expected to be able to manage all aspects of perioperative
anesthetic delivery from the preoperative evaluation, inter-operative
management and post-operative care of all patients
2. Anticipate and manage problems commonly encountered during transplant anesthesia
a. Resident is expected inventory available resources in order to assure that
appropriate care can be provided
b. Resident is expected to determine the appropriate level of subspecialty
consultation
3. Formulate a systematic approach to transplant anesthesia problems
4. Develop a comprehensive plan for peri-operative assessment and management of the
transplant patient
5. Demonstrate the ability to function as a transplant anesthesia consultant
3
6. Understand the administration/complications/benefits of the various pharmacologic
agents, including anti-rejection medications sufficiently to make sound medical
judgments appropriate for transplant anesthesia
7. Prepare patients for surgery and invasive transplant anesthesia procedures
8. Skillfully perform procedures and evaluate the data obtained from both noninvasive
and invasive monitors, including, but not limited to:
a. Placement of central venous lines
b. Placement of arterial lines
c. Placement of Swan Ganz catheters
d. Placement of Transesophageal Echo
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 transplant 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 transplant
anesthesia, alternatives, and risks and benefits of treatment options
6. Obtaining informed consent for transplant anesthesia procedures
7. Answering questions from the patient and or family members regarding transplant
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
4
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 transplant anesthesia
5. Transferring knowledge about transplant 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 transplant 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 transplant 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.
5
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.
17.
18.
19.
20.
21.
22.
23.
24.
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
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:






Anesthetic Principles for Organ Transplantation – Cook
Anesthesia and Transplantation – Sharpe
Transplant Anesthesia - Raj
Hepatic Transplantation – Winter
Anesthesia and Organ Transplantation – Gelman
Pharmacology and Physiology in Anesthetic Practice-Stoelting & Hillier
6

Annual Refresher Course Lectures and Basic Science Reviews of the ASA
(published annually)
Review articles on transplant anesthesia topics in the following peer reviewed journals provide
useful reading:




Anesthesiology
Anesthesia and Analgesia
British Journal of Anesthesia
Liver Transplantation
7