Advanced Clinical Track CA3 Revised 01/05
UNIVERSITY OF WASHINGTON ANESTHESIOLOGY RESIDENCY PROGRAM
ROTATION SPECIFIC GOALS & OBJECTIVES
CA3 / R4 Year
Description of the Rotation
The general design of the CA-3 Advanced Clinical Track (ACT) involves 3 required advanced
clinical anesthesia months and 9 elective months. The order in which the resident completes
these twelve months of anesthesia will be determined by a preference selection process during
which the resident will be able to choose the month of the year he/she will do the required or
elective rotations.
The rotations are as follows:
Required
Elective
1 month Pediatrics
Gen OR UWMC / HMC / VA
1 month UWMC CT
Acute/Chronic Pain
1 month Independent Study
Neuroanesthesia HMC
CT UW
Ambulatory UW
Difficult Airway UW
2 months at Virginia Mason Hospital (predominantly
regional anesthesia experience)
2 weeks obstetric anesthesia (combined with UWMC Gen OR)
Every effort will be made to assign the CA-3 (ACT) residents to the most difficult and challenging
cases available at their particular hospital on any particular day. In addition, as the CA-3
residents identify those cases from their case logs for which they need additional numbers, efforts
will be made to assign them to such cases.
Goals:
By the end of the CA3 year the anesthesia resident will:
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develop a body of knowledge concerning the physiological and pharmacological
effects of the uncommonly or rarely used medications used in anesthesia.
become proficient in the preoperative assessment, preoperative preparation and
medication, intraoperative management, and post-surgical care of patients with
complicated multi-system medical conditions and patients presenting for complex
surgery.
become proficient in advanced anesthesia skills including use of complex monitoring
systems and invasive monitors.
become proficient in the management and leadership of intraoperative resources
including nurses, anesthesia technicians, and ancillary personnel.
Education Objectives
The following objectives are relevant to the whole CA3 year and the General OR rotations
at UWMC, HMC & VAMC. The individual subspecialties objectives are defined separately.
Residents will be able to demonstrate competency in the following areas:
1 Medical knowledge
2 Patient Care
3 Interpersonal & Communication skills
4 Professionalism
5 Practice-based learning
6 Systems based practice
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MEDICAL KNOWLEDGE:
Cognitive objectives:
Residents will develop knowledge in all the anesthesia subspecialities – these are defined in
the individual rotation goals and objectives.
Other conditions that residents will study during their 3rd clinical year will include complex and
uncommon conditions such as:
Pheochromocytoma, Malignant Hyperthermia, Porphyria, Myasthenia gravis, Thyrotoxicosis,
Addison’s disease, Marfan’s syndrome, Muscular dystrophy, Valvular heart disease, Severe
Ischemic heart disease, cardiomyopathy, vascular disease, aortic aneurysms, major vascular
bypass procedures, circulatory arrest and anesthesia for organ transplantation
Residents will become familiar and skilled with the use of specialized equipment;
transcutaneous, esophageal, and intravenous pacers, transesophageal echocardiography,
cardiac pacemakers, complex neurophysiologic monitors, fiberoptic bronchcoscopy, jet
ventilation.
Psychomotor objectives:
Residents will further develop the technical skills learned during the CA1 an CA2 years
including: Placement of thoracic epidural catheters, placement of central venous catheters;
management of the difficult airway; placement of special catheters used in monitoring
techniques for cardiac and neurosurgery such as Swan Ganz catheters, jugular bulb
catheters; use of special ventilation techniques such as jet ventilation and intensive care
ventilation techniques.
Affective objectives:
Residents will develop an active role as consultants in anesthesia and understand the
importance of interacting with other members of the surgical and OR team to fully understand
the nature of the patient’s surgical condition and procedures being undertaken.
PATIENT CARE
Cognitive Objectives:
Residents will develop an understanding of how to manage a variety of complex situations
such as: management of patients for transplant surgery including liver, kidney, lung and heart
transplants; management of the geriatric patients; management of patients with rare and
complicated anesthetic complications such as epidural hematoma / abscess, cauda equina
syndrome, peripheral nerve and nerve root injuries; management of anesthesia in ‘out-ofoperating’ locales such as MRI, CT, Invasive radiology, Radiation oncology; management of
patients who are moribund; patients who are multi-organ donors; patients with complex, multisystem disease
Psychomotor objects:
Residents will develop a range of technical skills necessary to provide optimal patient care (see
above). Residents will also develop the necessary problem solving techniques for intraoperative
events such as; anaphylaxis, myocardial ischemia, autonomic dysreflexia, malignant
hyperthermia, venous embolism (air, amniotic, thrombotic) major equipment failures
Affective objectives:
Residents will develop an appreciation of their own abilities and limitations with regards
specialized patient care; residents will learn to take responsibility for their own patients with
minimal supervision.
INTERPERSONAL AND COMMUNICATION SKILLS
Cognitive objectives:
Residents will develop an understanding of the role of effective communication as it applies to
the development of a therapeutic relationship with the patient and particularly with more
complicated patients; residents will gain knowledge of means to ensure effective
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communication members of the operating room team including nurses, technicians and
surgeons
Psychomotor objectives:
Residents will be able to demonstrate effective communication with their patients; particularly
patients with complex medical and surgical conditions; to demonstrate appropriate methods of
communicating with these patients to ensure patient understanding; residents will develop
effective listening skills; residents will be able to communicate effectively with other members
of the health care team as demonstrated by accurate and legible documentation of preoperative information, intraoperative record keeping and post operative orders;
Affective objectives:
Residents will appreciate the importance of effective communication with patients their families
and other health care providers; residents will develop behaviors that contribute to effective
communication.
PROFESSIONALISM
Cognitive objectives:
Residents will be able to define the basic domains of medical professional behavior including;
altruism, honor and respect, caring and compassion, responsibility and accountability, excellence
and scholarship; residents will learn the more complex ethical principals involved in taking care of
patients for organ transplantation and patients in moribund conditions; including the principles of
justice and self determination.
Psychomotor objectives:
Residents will demonstrate a commitment to professionalism in their day-to-day interactions with
both patients and co-workers by showing respect for their patients’ wishes; interacting with
nursing and other staff in a polite and respectful way; observing patient confidentiality practices at
all times; dressing appropriately; arriving for work on time; answering pagers in a timely way;
attending and participating in departmental conferences and education activities; complying with
departmental policies and procedures.
Affective objectives:
Residents will show an appreciation of the importance of professional behavior and how it
impacts on patient care and the smooth functioning of the health care system. Residents will
complete all preoperative, intraoperative and post operative documentation according to
departmental requirements.
PRACTICE BASED LEARNING
Cognitive objectives:
Residents will understand the importance of life long learning and the various modalities
available for practice based learning including; didactic lectures; conferences and grand
rounds; morbidity & mortality and quality improvement (QI) conferences; journal clubs; local,
national and international meetings; journals and web-based educational material; use of “real
time” and web-based simulation in anesthesia education; residents will learn advanced
statistical methods for evaluating research; the principles of evidence based medicine; the
importance of learning from their experience.
Psychomotor objectives:
Residents will attend and also contribute to various educational conferences available to them
in the anesthesia department; residents will undertake an active role in the preparation of
presentations for local and national meetings.
Affective objectives:
Residents will demonstrate behaviors that show a commitment to practiced based learning;
they will be expected to take an active part in all the educational activities organized by the
anesthesia department.
SYSTEMS BASED PRACTICE
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Cognitive objectives:
Residents will gain understanding of the boarder aspects of the health care system and how
the care they offer patients influences, and is influenced by and other parts of the health care
system; residents will learn about quality improvement programs; control of health care costs;
the importance of working as part of a team; practice management; patient flow through the
operating room system including the pre-anesthesia clinic and post-anesthesia care unit.
Psychomotor objectives:
Residents will be able to demonstrate anesthetic practices that include systems issues such
as reducing costs; working as a member of an interdisciplinary team member in the obstetric
unit, on interdisciplinary pain rounds and taking part in post operative rounds; managing
patients with post anesthesia complications; facilitating case turn over.
Affective objectives:
Residents will show considerations for the broader aspects of the health care system when
working in the operating room; residents will show interest in improving the health care system
and assisting their patients in navigating the system.
Achieving the Educational Objectives for CA3 year in Anesthesiology
The following opportunities are available to residents to achieve the goals and objectives for the
CA3 year.
Wednesday morning resident symposia on a variety of topics (see lecture schedule).
Hospital resident conferences
Wednesday morning Grand rounds
Resident Specials
Journal clubs
CQI and M&M conferences
Day to day operating room experience.
Residents will learn most of their technical skills, decision-making and judgment by working in the
operating rooms with their faculty supervisors. Faculty will be available at all times to supervise
residents as they perform their clinical tasks, residents will be encouraged to ask questions of
their faculty. Residents in their final year will be expected to work with minimal supervision and
exercise their own judgment, although residents are encouraged to discuss their anesthetic
management plans with their faculty supervisors. Residents will receive individual tutoring during
their time in the operating room and each resident will be assigned an advisor to oversee their
progress.
Other clinical areas.
Residents will work on the wards, in the pre-aesthesia clinic, post anesthesia care unit, intensive
care units. They will be supervised by faculty in all these areas and will have the opportunity to
management patients directly.
Simulation lab.
In this area residents will have the opportunity to work with simulated scenarios and develop
leadership and team building skills for problem solving in an umber of critical incident scenarios.
EVALUATION
Residents will be evaluated on the 6 core competencies (Medical knowledge, Patient care,
Interpersonal communication skills, Professionalism, Practiced based learning and Systems
based practice) at the end of each month using specific web-based evaluation forms.
Daily evaluations may also be performed.
Some rotations have knowledge tests (see individual rotation Goals and Objectives)
Residents are required to take the final boards exam at 36 months. Residents will also receive
mock oral exams to help them prepare for the final oral boards.
Residents must keep an accurate logbook of all cases and submit the number of cases
performed to the residency secretary every 6 months to allow evaluation of progress.
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