SURGICAL ANESTHESIOLOGY-UCH
GOALS AND OBJECTIVES
CA 3 Level
DEFINITION
During the CA-3 year, residents may elect to take between 1-4 months of the Advanced Surgical
Anesthesiology rotation. The CA-3 resident is identified as the senior resident and will be
assigned to the most advanced cases in the OR for a given day. This may include several surgical
specialties: vascular, outpatient, orthopedic, plastic, gynecologic, neurologic,
otorhinolaryngologic, urologic, cardiac, thoracic, and transplant surgery. The overriding goal is
to provide increasing autonomy in their final year of training to prepare the CA-3 resident to
apply previous CA-1 / CA-2 skills in independent practice.
CURRICULUM / GOALS
Residents rotating as the Senior OR resident are expected to build on both the basic / general OR
skills learned as a CA-1 / CA-2, but also to include skill sets learned in the specialty rotations as
they may be handling any number of specialty cases from day to day. The main emphasis is
increased ability for independent and safe practice. Some specific goals include:
1.
2.
3.
4.
5.
6.
7.
8.
Participate in advanced clinical cases of the many subspecialties of anesthesia
Develop skills in supervising / teaching medical students
Discussing issues regarding operating room management
Discuss in greater detail issues regarding the preoperative assessment
Discuss the concepts of risk management, quality assurance and malpractice
Expand on the concept of cost containment and its applications to anesthesia
Participate in human stimulation scenarios, especially crisis management scenarios
Gain an understanding of JCAHO and how compliance issues are handled
MEDICAL KNOWLEDGE
The knowledge units described in the CA-1 / CA-2 General Surgical Anesthesia sections will
apply for this section. Additional knowledge objectives include:
1. Management of patients requiring one-lung ventilation techniques, either for thoracic or
general surgery case management. Techniques using double lumen tubes, bronchial blockers
and specific ventilation management of each.
2. Full knowledge of specific airway management tools, including decision making process in
awake vs. asleep intubations.
3. Indications / contraindications for invasive monitoring including PAC, arterial lines, central
lines and TEE.
4. Comprehensive knowledge for crisis management including:
o Hypertension / Hypotension (pre, intra and post operatively)
o Bronchospasm
o Hypoxemia
o Tachycardia / bradycardia
o Management of pacemakers / AICD during surgery
o Malignant hyperthermia
o Shock (hemorrhagic, septic, cardiogenic)
5. Airway management in remote locations including ICU, Burn ICU, ED, MRI.
PATIENT CARE
The patient care units described in the CA-1 / CA-2 General Surgical Anesthesia sections apply
here. The focus is on development of more complex skills in patient management and decision
making with the goal for independent practice.
1. The preoperative evaluation (including history physical exam and special investigations) for
the patient undergoing elective surgery
2. Execute and manage the anesthetic plan in a facile, well-prepared, and skilled manner,
including induction, maintenance and emergence from anesthesia of medically simple and
complex cases undergoing simple and complex surgical procedures
3. Perform basic and more advanced procedures: including airway management, insertion of
peripheral and central lines, arterial catheters, and spinal, epidural, regional, and peripheral
nerve blocks
4. The preoperative consultations for seriously ill patients undergoing surgery
5. The role of the medical consultant in the care of complex patients; interpret and use medical
specialty consultations in the care of complex patients
6. The nature of medical problems, their order of priority, and how they affect the anesthetic
plan Counsel and educate patient and families as to the risks and benefits of anesthesia care
7. The issues surrounding airway management, insertion of peripheral and central lines, arterial
catheters, and spinal, epidural, regional, and peripheral nerve blocks
8. Select, apply, and consider the efficacy and accuracy of monitoring techniques
INTERPERSONAL AND COMMUNICATION SKILLS
The units listed under the CA-1 / CA-2 sections also apply here. In addition, at the conclusion of
the rotation the CA-3 resident will:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Gain an understanding of root causes for communication failures and mishaps
Gain an understanding of the various communication stereotypes
Gain an understanding of various techniques to improve communication skills
Gain an understanding of causes for operating room tension
Reflection on abilities and techniques to improve effective communication with patients,
peers and health care team for the patient’s interest
Perform a detailed preoperative visit, assessment, anesthetic plan and implementation,
communicating risks / benefits to patient and family
Displaying effective communication skills to health care team
Documenting medical records in a complete, accurate and legible manner
Giving assorted lectures to fellow residents (including Grand Rounds), medical students,
faculty and nursing staff
2
PROFESSIONALISM
The CA-3 resident will learn / demonstrate:
1.
2.
3.
4.
5.
6.
What constitutes professional ethics
Recognizing what defines strong personal character
Understanding the culture of medical ethics
Exhibiting examples of medical professionalism
Understanding the problems surrounding chemical dependence in anesthesiology
Understanding the role of pharmaceutical industry exposure and its implications to medical
care
7. Understanding the essential nature of diversity in the workplace and in regards to patient care
8. Understanding the role of spirituality and prayer in certain patient populations
9. Wearing professional attire where appropriate
10. Following hospital, departmental protocol
11. Documenting medical records with care
12. Taking care of oneself so as to be able to continue to take care of patients well
PRACTICE BASED LEARNING AND IMPROVEMENT
In addition to the skills outlined in the CA-1 / CA-2 sections the CA-3 resident will gain an
understanding of the following:
1.
2.
3.
4.
5.
6.
7.
8.
Reflective practice experience
Identifying individual strengths and weaknesses in how one learns
Understanding the role of criticism for self improvement
Understand the value of evidence based medicine as it applies to anesthesiology
Learning to become a critical thinker and integrate sound scientific literature appropriately
Self awareness of abilities and limitations
Performing a literature search for didactic sessions during their CA3 year
Participating actively in journal clubs
SYSTEMS BASED PRACTICE
The CA-3 resident will gain an understanding of the following regarding systems based practice:
1. Understanding the health care team approach to patient care
2. How the health care system works to investigate patient illness and optimize care
3. Utilizing system optimization of patient
4. Utilizing system risk to patient
5. Managing health care team
6. Safe patient transport
7. Delivering cost effective care
8. Understanding the issues regarding the JCAHO national patient safety goals
9. Understanding how the operating room is managed
10. Understanding how to organize an operating room schedule
3
11. Understanding the issues regarding medical liability
12. Understanding the issues regarding anesthesia billing and compliance
Evaluation Tools:
1.
2.
3.
4.
5.
ITE exam
Self – evaluation process
“Mock” Oral Board exams
Direct observation by faculty with monthly written performance evaluations.
360° Evaluations by nursing/OR staff.
Rev. 7/2009
4