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Revised: April 24, 2011

Stanford University Anesthesiology Residency Program

Rotation Goals and Objectives for Residents

Core Curriculum for Post Anesthesia Care Unit (PACU)

Duration: 2 weeks

Rotation Director: Suma Ramzan MD

 

Description:

The Post Anesthesia Care Unit (PACU) at Stanford University Medical Center offers a broad experience in postoperative care for inpatients and outpatients recovering from colorectal, orthopedic, neurosurgical, urologic, plastic, head and neck, thoracic, and gynecologic surgery. Both senior (CA 2 and 3) and junior (CA 1) level residents are eligible for this 2 week rotation.  Residents will work in the Main OR PACU.  Supervision will be provided by the general OR attending who was part of the patient’s primary anesthesia team and also the attending who is in charge of the schedule for the day. Residents will be responsible for management of emergencies in the PACU, and assessment and management of postoperative pain and PONV.  Other goals include achieving proficiency in the management of other common and less common post anesthetic complications, and understanding the roles of the nursing and physician staff in the care of postoperative patients.             

The 3 domains of learning - cognitive knowledge, technical or psychomotor skills, and affective behavior lead to a consultant anesthesiologist.  In the PACU rotation, residents learn technical and decision-making skills that lead to expertise in postoperative anesthetic management.  Resident attendance at the departmental afternoon weekly lecture series and morning grand rounds is expected.  It is also expected that residents spend time outside of clinical work for independent reading. Journal articles related to PACU medicine will be provided for review.  Residents will also be asked to provide a brief and focused in-service presentation to the PACU nursing staff on a topic relevant to the PACU, chosen by each resident.  In addition, residents will fill out a self assessment form related to the management of a PACU patient and complete the six teaching modules.

              Residents will be evaluated in the 6 core competencies (medical knowledge, patient care, interpersonal and communication skills, professionalism, practice based learning and improvement, and systems based practice) using specific web-based evaluation forms completed by supervising faculty. Evaluation will occur at the end of the 2-week rotation. Residents must keep an accurate online log of procedures performed in the PACU.

An outline of core competencies with rotation objectives, instructional activities, and evaluations is outlined below in more detail.

 

Modality for Resident Performance Assessment in PACU:

A. Self Assessment

The resident checks off each criterion below as the material is mastered.  Self reflection on your own competencies is expected.

B. Faculty Assessment

The rotation director faculty will review your self assessment, your written projects and your evaluation by the nurses.

Specific Goals and Objectives For PACU Residents

 

|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |

|Core Competencies | | | |ASSESSMENT |

|Medical Knowledge: |♣       Gain understanding of PACU complications such |♣       Journal Articles |♣       Faculty Rotation Evaluations  |♣       Complete the reading and answer |

|  |as airway obstruction, hypoxia, hypotension, |♣       In-Service Talk |) |questions related to 6 modules on PACU topics.|

|To acquire and apply knowledge|hypoventilation, pneumothrorax, pulmonary embolism, |♣       Teaching modules |♣       Review of Self-Assessment form | |

|of established and evolving |hypovolemia, arrhythmias, cardiac arrest, EKG changes,|♣       PostOp Note |♣       Review of In-service Report |♣       Complete 20 board-type PACU questions |

|basic, cognative and applied |incomplete reversal of muscle relaxants, over dose of |♣       Weekly, Resident Lectures |♣       AKT 6 |prior to the rotation and after the rotation |

|clinical sciences that relate |opioids, nausea and vomiting, hyper and hypothermia, |♣       Grand Rounds |♣       Practice oral exams |♣       Complete the self assessment form. |

|to the practice of adult |glucose derangements, pain, complications of blood |♣       Journal Club |♣       Annual in-training exam |♣       Complete 10 postoperative notes on |

|anesthesia in the |transfusion, emergence delirium, prolonged recovery |♣       Annual Stanford Anesthesia |  |patients with complications in PACU |

|postanesthesia care unit |and discharge criteria. |Resident Refresher Course (ASARRC) | | |

|(PACU). | |♣       CME Conference chosen by resident| | |

| | | | | |

| | | | | |

| | | | | |

|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |

|Core Competencies | | | |ASSESSMENT |

|Patient Care: |♣       Develop skills related to management of airway|♣       Journal articles |♣       Faculty Rotation Evaluations  |♣       Successfully troubleshoot five |

|  |obstruction, stridor, emergency intubation, |♣       In-Service Talk |♣       PACU Nursing Staff Evaluation |epidurals that are perceived “not to be |

|To provide compassionate, |interpretation of chest radiographs and EKGs, |♣       Teaching Modules | |working”. |

|appropriate, and effective |placement of peripheral nerve blocks, peripheral nerve|♣       Teaching in PACU by OR attending | |♣       List three pros and cons to each of |

|anesthetic management of |and plexus catheters and epidural catheters to provide|♣       Grand Rounds | |the following postoperative pain management |

|adults in the PACU. |postoperative pain relief, set up and trouble shoot |♣       ASARRC | |techniques: patient controlled IV opiate |

| |epidural and PCA pumps. |♣       CME conference chosen by resident| |infusions, epidural analgesia, and peripheral |

| |♣       Assess readiness for PACU discharge based on | | |nerve blocks  |

| |medical criteria. | | |♣       Assess 5 patients for meeting PACU |

| |♣       Understand when, how and who to call for help.| | |discharge criteria to home and 5 patients |

| | | | |discharge to inpatient ward |

| | | | |♣       Explain to 5 patients what they can |

| | | | |expect in the days to weeks following surgery |

| | | | |♣       Write call back tree algorithm when |

| | | | |urgent help needed in PACU. |

| | | | |♣       Maintain a log of procedures or |

| | | | |problems dealt with during the PACU rotation |

| | | | |and enter the etiology, treatment and result |

| | | | |(minimum of 20 entries). |

| | | | |♣       Write appropriate PACU orders in EPIC |

| | | | |for IV PCA, epidural infusions, and peripheral|

| | | | |nerve blocks |

| | | | | |

 

|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |

|Core Competencies | | | |ASSESSMENT |

|Effective Interpersonal and |♣       Understand the role of post anesthesia care in|♣       Modeling by Faculty |♣       Faculty Rotation Evaluations  |♣       Deliver 10 minute presentation on |

|Communication skills: |patient’s overall hospitalization. |♣       In-Service Talk |♣       PACU Nursing Staff Evaluation   |topic of interest to the nurses, applying |

|  |♣       Describe the pertinent facts that must be |♣       Grand Rounds |   |knowledge of study design and statistical |

|To demonstrate interpersonal |conveyed when transferring patient care to another |♣       Anesthesia Crisis Resource |  |methodology to critically analyze clinical |

|and communication skills that |provider. |Management (ACRM) | |studies.  |

|result in effective |♣       Know how to complete PACU assessment forms. |  | | |

|information exchange and |♣       Learn to maintain good interactions and | | | |

|teaming with patients, their |effective communication with all members of PACU team.| | | |

|families, and other health |♣       Be readily available within 5-10 mins when | | | |

|professionals |called by PACU staff. | | | |

|  |♣       The resident should introduce him/her self to | | | |

| |the nursing staff in PACU as appropriate throughout | | | |

| |the rotation. | | | |

| |♣       Demonstrate the ability to work effectively | | | |

| |with all members of the PACU | | | |

| |♣       Take report from the primary anesthesia team | | | |

| |on most patients and give verbal report when | | | |

| |transferring care. | | | |

|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |

|Core Competencies | | | |ASSESSMENT |

|Practice based learning and |♣       Learn to reflect on their own performance and |♣       1:1 Teaching by PACU Faculty |♣       Faculty Rotation Evaluations |♣       Summarize 3 aspects of anesthesia care|

|improvement: |improve. |♣       Journal articles |♣       Review of Self assessment form |provided by PACU resident that can be improved|

|  |♣       Understand evidence – based medicine. |♣       Teaching modules |♣       Review of In-Service Talk |upon by the resident following the PACU |

|To demonstrate practice-based |♣       Take an active role in furthering knowledge by|♣       In-Service Talk |  |rotation. |

|learning and improvement that |attending organized educational activities. |♣       Grand Rounds |  |♣       Provide a list of PACU related journal|

|involves investigation and |♣       Develop data collection tool to describe |  |  |articles that were read (min 1 paper/day) |

|evaluation of their own |adverse events. | | |  |

|patient care, appraisal and |♣       Use information technology to evaluate and | | | |

|assimilation of scientific |assimilate current PACU literature | | | |

|evidence, and improvement in |♣       Use information technology to locate 3-5 | | | |

|patient care |scientific studies relevant to one specific patient | | | |

| |management problem encountered in PACU. | | | |

|Professionalism: |♣       Understand HIPAA regulations as they pertain |♣       Modeling by PACU faculty |♣       Faculty Rotation Evaluations |♣       Write medical notes in EPIC on 10 |

|  |to patient data. |♣       Self-Directed Reading |♣       Attendance at Lectures |patients requiring active PACU management by |

|To demonstrate a commitment to|♣       Describe role of anesthesiologist in PACU |♣       In-Service Talk |♣       Updating Case Logs |the resident. |

|professional responsibilities,|care. |♣       Grand Rounds |♣       Complete documentation |♣       Describe in two written paragraphs one|

|adherence to ethical |♣       Demonstrate respect for staff. |  |♣       PACU Nursing Staff Evaluation |difficult ethical dilemma encountered in PACU.|

|principles, and sensitivity to|♣       Act with sensitivity and responsiveness to |  |  | |

|diversity. |patient’s culture, age, gender, and disabilities. |  | |♣       Obtain feedback from nurses and their |

| |♣       Become life long learner. | | |360 evaluation |

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|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |

|Core Competencies | | | |ASSESSMENT |

|Systems-based Practice: |♣       Know the flow of patients through PACU and how|♣       Modeling by Faculty |♣       Faculty Rotation Evaluations |♣       Describe three aspects of the overall |

|  |bottlenecks in different areas of hospital affect PACU|♣       Collaboration with nurses and |  |system of care at the hospital that can be |

|To demonstrate an |♣       Discuss Phase 1 and Phase 2 recovery, |nursing management | |improved upon with emphasis for example on |

|awareness of and |“fast-tracking” and “home readiness” |♣       Grand Rounds | |PACU to phase 2 flow, ICU overflow, efficient |

|responsiveness to the |♣       Facilitate patient flow through PACU. |  | |flow during high volume.  |

|larger context and system |  | | |♣       Describe the Aldrete recovery score. |

|of health care and the | | | |♣       Discuss how to decide when to consult |

|ability to effectively | | | |with other medical specialties for PACU |

|call on system resources | | | |patients |

|to provide care that is of| | | |♣       List 3 common reasons for unexpected |

|optimal value | | | |hospitalization of ambulatory surgical |

| | | | |patients. |

| | | | |♣       Define the concepts of fast-tracking” |

| | | | |and “home readiness” |

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