GOALS AND OBJECTIVES
Obstetrical Anesthesia Rotation
Rotation Director:
Learners:
Robert Hansen, MD
CA-1 and CA-2 Residents
Goals:
The rotation in obstetrical anesthesia serves to expose the resident to the discipline of
obstetrical anesthesiology through didactic instruction and participation in the care of
parturients requiring both routine and emergency anesthetic care. Through this rotation, the
resident will make progress towards being enabled to:

Provide obstetrical anesthetic care to low risk parturients presenting in the obstetric
unit for uncomplicated labor and delivery

Diagnose and effectively treat routine obstetrical anesthetic complications

Understand the appropriate management of varying obstetrical anesthetic
emergencies

CA-2 residents will be introduced to the care of high-risk obstetrical patients on the
maternal and fetal medicine service
Objectives:
During this rotation the resident will progress toward attainment of the following core
competencies:
PATIENT CARE
CA-1’s

Residents will learn the basic principles of caring for patients undergoing procedures
for labor and delivery. Residents will be enabled to plan for and manage spinal,
general and epidural anesthetics for uncomplicated vaginal deliveries and emergency
cesarean sections for low-risk parturients.

Residents will learn to do an appropriate evaluation of the parturient prior to
formulating an anesthetic plan. The acquisition of this information will enable the
resident to work with the obstetrical team to deliver safe, timely, effective and
compassionate care for the parturient.

The resident will, by utilizing knowledge of the altered circumstances of maternal
physiology with pregnancy, provide safe obstetrical anesthetic care under the
direction of the faculty.
Goals and Objectives of the
Obstetrical Anesthesia Rotation

The resident will, under the direction of the faculty, devise safe and effective plans
for management of post-partum or postoperative pain.
CA-2’s will be expected to progress toward a more advanced and independent standard
of practice as described below:

Perform pre-anesthetic history and physical examination and laboratory data
evaluation in an increasingly independent manner

With increasing independence, formulate an obstetrical anesthetic plan

Effectively interact with patients, their families and significant others in a manner
which demonstrates compassion, respect and integrity

Demonstrate the ability to modify anesthetic plans to meet changing, urgent or
emergency considerations

Technically perform obstetrical anesthetic mandates with competence and increasing
independence

Assume an increasingly responsible role as a member of the health care team
providing care to the obstetrical patient

Independently devise safe and effective plans for treatment of post-partum pain
MEDICAL KNOWLEDGE
CA-1’s

Residents will acquire basic knowledge of physiologic changes of pregnancy
including those referable to the cardiorespiratory, gastrointestinal, renal, hepatic, and
endocrine systems.

Residents will learn to appreciate potential airway concerns in dealing with the
parturient including development of management strategies for airway emergencies.

Residents will acquire knowledge of the pharmacology of drugs used in care of the
parturient.

The resident will be introduced to potential complications of pregnancy including
eclampsia, pre-eclampsia, pregnancy induced hypertension, gestational diabetes,
hemorrhagic events both pre and post partum, and issues relating to attendant comorbidities.
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Goals and Objectives of the
Obstetrical Anesthesia Rotation

The resident will acquire knowledge of requirements and techniques for resuscitation
of the newborn.

Residents will develop knowledge and understanding of indications, risks, benefits,
and potential complications associated with various obstetrical anesthetic procedures
and practices.

Residents will acquire knowledge referable to performance of such procedures as
lumbar epidurals, spinals and general anesthesia for labor and vaginal delivery,
cesarean sections, and postpartum tubal ligation.

They will acquire an understanding for both routine and invasive monitoring that are
required in delivery of obstetrical anesthetic care.
CA-2 residents are expected to build the deeper understanding of the medical issues
associated with labor and delivery as described below:

Demonstrate an understanding of pathophysiologic considerations of the high risk
parturient

Demonstrate an understanding of evaluation and management of the parturient
presenting for both elective and emergency care having concurrent airway challenges

Demonstrate an understanding of the pharmacologic management of the high-risk
obstetrical patient

Demonstrate an appreciation for the indications, contraindications and potential
complications of varying anesthetic techniques used to manage high-risk
parturients

Demonstrate an advanced familiarity with scientific literature pertaining to the care of
the obstetrical anesthetic patient

Demonstrate an advanced familiarity with tenets of maternal and fetal physiology
and demonstrate an advanced understanding of how these impact analgesic and
anesthetic care

Demonstrate an understanding of principles and rationale of fetal assessment
including stress and non-stress tests, and fetal monitoring

Demonstrate an understanding of neonatal resuscitation

Demonstrate an advanced understanding of the management of peripartum
hemorrhage
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Goals and Objectives of the
Obstetrical Anesthesia Rotation
Residents are expected to continue to develop the skills described below as they
progress from CA-1 through the CA-2 year. Therefore the CA-2 resident will be
expected to possess a proficiency with practice-based learning and improvement,
interpersonal and communication skills, professionalism, and systems based practice
that represents advancement along the continuum of skill toward mastery.
PRACTICE-BASED LEARNING AND IMPROVEMENT

Residents will be better enabled to evaluate published literature in specialty journals
and textbooks as applicable to the practice of obstetrical anesthesia; they will also
understand the importance of adherence to basic ethical principles.

Through presentation to the faculty, medical and other health care students and
members of the extended health care team, the resident will learn to facilitate the
learning and improvement in practice of others.

Residents will learn to evaluate their own performance in caring for the parturient and
thereby potentially enhance their own therapeutic capabilities in providing obstetrical
anesthetic care.
INTERPERSONAL AND COMMUNICATIONS SKILLS

Residents will learn the techniques and skills needed for effective communication
with obstetrical patients and their families.

Residents will perfect their communication skills through daily interaction with the
varying members of the health care team.

Residents will learn to present their cases to the faculty in a clear, concise and
coherent manner, with plans specific to each patient’s stages of labor.

Residents will show commitment to their patients and demonstrate a professional,
ethical, and responsible demeanor while interacting will colleagues and other health
care professionals.

The residents will learn to work as an effective member of the healthcare team.
PROFESSIONALISM

Residents will learn to be attentive to ethical issues and individualized requirement
for care of their obstetrical patients.

Residents will learn to develop leadership skills that will enable them to assume
responsibilities necessary for integration of anesthetic care with the totality of care
required for the parturient.
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Goals and Objectives of the
Obstetrical Anesthesia Rotation

Residents will be proficient and respectful when interacting with patients, family
members, significant others and other members of the healthcare team.

The resident will develop an understanding of the importance of principles of ethics,
requirements of confidentiality, and of informed consent.

The resident will learn aspects of business practices of obstetrical anesthesia.
SYSTEMS-BASED PRACTICE

Residents will be made aware of the necessity of cost-effective obstetrical anesthetic
care. They will become conversant with issues pertaining to resource allocation.

Residents will develop an understanding of how the various components of the health
care system utilized in care of the parturient have an impact on each other.

Residents will become involved in practices and initiatives that interact with other
areas of the health care system. Residents will also be expected to work as a team
member with other staff and professionals to improve patient care.
Residents will develop behaviors that show an appreciation for the impact of their
practices on overall delivery of care to the obstetrical anesthetic population.

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
resident 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 is 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, practice-based learning and improvement, 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. Primeaux
2009
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