Revised: January 22, 2010 - Resources for Anesthesia ...
revised: April 13, 2011
Stanford University Anesthesiology Residency Program
Rotation Goals, Objectives and Assessment for Residents
Core Curriculum for Ambulatory Anesthesia Rotation
Duration: 2 weeks
Rotation Director: Suma Ramzan MD
Philosophy and Description:
The Ambulatory Anesthesia Rotation at Stanford University Medical Center offers a broad experience in issues specific to the outpatient setting. The ambulatory setting involves a unique approach to the practice of anesthesia. The resident will become acquainted with and develop skills in the practice of ambulatory anesthesia. Senior (CA 2 and 3) level residents are eligible for this 2 week rotation. Residents will work in the Ambulatory Surgery Center (ASC) operating rooms. Supervision will be provided by the attending anesthesiologist who is the ASC scheduler for the day. 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 anesthesia for ambulatory surgery will be provided for review.
The resident clinical experience will include:
1. Management of a minimum of 30 patients undergoing ambulatory surgery including 10 general anesthetics emphasizing rapid emergence and 10 monitored-anesthesia-care cases ranging from anxiolysis to deep sedation.
2. Involvement in the management of acute postoperative pain, including familiarity with intravenous techniques, oral pain medication and other pain-control modalities.
3. Supervision of a junior resident during a minimum of 2 days, including discussing an anesthetic plan, and guiding and teaching the junior resident in patient care.
4. Understanding the dynamic management and scheduling issues unique to an ambulatory surgical center.
Modality for Resident Performance Assessment:
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. An outline of core competencies with rotation objectives, instructional activities, and evaluations is outlined below in more detail.
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.
Modified from the “SAMBA Curriculum Guidelines for The Anesthesia Resident Rotation in Ambulatory Anesthesia” written and approved by the Society for Ambulatory Anesthesia (SAMBA) Education Committee on November 15, 2005.
Specific Goals and Objectives For Ambulatory Anesthesia Residents
|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |
|Core Competencies | | | |ASSESSMENT |
|Medical Knowledge: |Evaluate patients and assume progressive responsibility in a supervised |♣ Journal Articles |♣ Faculty Rotation |Discussion with attending regarding |
| |setting. |♣ Intraop teaching by attending|Evaluations |prophylactic treatment of patients for PONV |
|Residents are expected to |Demonstrate competence in assessing patients rapidly in the ambulatory |♣ Preop and PostOp Note |) |and check in PACU for successful prevention |
|demonstrate knowledge of |perioperative settings. |♣ Weekly, Resident Lectures |♣ Review of presentation |Evaluation by attending of resident’s |
|established and evolving |Demonstrate the skills required to recognize patients requiring |♣ Grand Rounds |♣ AKT 6 |turnovers |
|biomedical, clinical and |immediate intervention. |♣ Journal Club |♣ Practice oral exams |Observation by attending of placement of LMA|
|social sciences, and the |When appropriate, demonstrate the skills necessary for resuscitation, |♣ Annual Stanford Anesthesia |♣ Annual in-training exam|successfully within 5 minutes from induction|
|application of their knowledge|intubating difficult airways and stabilization of patients. |Resident Refresher Course (ASARRC) | |and use of airway devices to successfully |
|to patient care and the |Discuss the concept of preemptive analgesia and how to implement it in |♣ CME Conference chosen by | |intubate patients. |
|education of others, and apply|the ambulatory setting. |resident | |Discussion with attending regarding patient |
|an open-minded, analytical |Discuss appropriate choices and techniques of neuraxial anesthesia to | | |care issue related specifically to |
|approach to acquiring new |minimize time to discharge and post-anesthetic complications (e.g., | | |ambulatory surgery |
|knowledge. The resident will |spinal headache). | | |Discuss pros and cons of neuraxial |
|access and critically evaluate|Discuss the utility of depth of anesthesia monitoring in the ambulatory | | |anesthesia in ASC |
|current medical information |setting. | | |Supervised use of awareness monitoring in |
|and scientific evidence, and |Discuss the pharmacology of rapidly acting agents, including opioids, | | |ASC |
|apply this knowledge to |sedative-hypnotics, volatile anesthetics and muscle relaxants. | | |Conduct IV sedation on patients without |
|clinical problem solving, |Describe various techniques of IV sedation. | | |patient feeling discomfort/pain while |
|clinical decision making, and |Discuss techniques of general anesthesia to minimize post-operative | | |maintaining spontaneous ventilation |
|critical thinking. |problems (e.g., sedation, pain, shivering, nausea, unplanned admission).| | |Reflection and discussion of things you can |
| | | | |do to improve PACU discharge and things that|
| |Define criteria for PACU bypass, PACU discharge and discharge from the | | |result in patient admission after same day |
| |same-day recovery unit. | | |surgery. |
| |Explain the importance of turnover time and personnel management in the | | |Completion of checklist |
| |successful operation of an ambulatory surgery center. | | | |
| |Describe techniques and procedures to minimize "down time" of the | | | |
| |operating room and of the surgical staff. | | | |
| |Discuss the difference between "home-readiness" and "street fitness." | | | |
| |Differentiate between freestanding, hospital-affiliated and | | | |
| |hospital-based surgery centers. | | | |
| |Discuss protocols for handling unplanned admission, acute emergencies | | | |
| |and emergency hospital transfer. | | | |
| |Discuss the role of the anesthesiologist in office-based anesthesia | | | |
| |practice. | | | |
| |Describe state, local and federal guidelines for regulation of | | | |
| |office-based surgery and anesthesia. | | | |
| |Discuss the role of the medical director of an ambulatory surgery | | | |
| |center. | | | |
|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION |ASSESSMENT |
|Core Competencies | | | | |
|Patient Care: |Gather accurate, essential information from all sources, including |♣ Journal articles |♣ Faculty Rotation |Discussion with attending regarding medical |
| |medical interviews, physical examinations, medical records and |♣ Intraop teaching by attending|Evaluations |problems discovered in the preop evaluation |
|The resident will provide |diagnostic/therapeutic procedures. | |♣ ASC Nursing Staff |that affect your anesthesia management when |
|patient care that is |Identify the main aspects of the history and physical examination |♣ Grand Rounds |Evaluation |conducting a same day surgery |
|compassionate, appropriate and|relevant to patients undergoing surgery in the ambulatory setting and |♣ ASARRC | |Discussion with attending to list the the |
|effective for the promotion of|determine appropriate laboratory tests. |♣ CME conference chosen by | |pros and cons of regional v.s. general |
|health, prevention of illness,|Select patients for ambulatory anesthesia and assess the severity of |resident | |anesthesia for ambulatory surgery |
|and the treatment of |common diseases including, but not limited to hypertension, renal | | |Observation by attending of preop, intraop |
|disease. . |disease, neurological disorders, cardiovascular disease, diabetes, | | |and postop care of patients. |
| |pulmonary disease and obesity. | | | |
| |Make recommendations about preventive, diagnostic and therapeutic | | | |
| |options and interventions that are based on judgment, scientific | | | |
| |evidence, and patient preference. | | | |
| |Discuss with patients the risks and benefits of regional and general | | | |
| |anesthesia and monitored anesthesia care, especially as they pertain to | | | |
| |their condition and surgery. | | | |
| |Develop, negotiate and implement effective patient management plans and | | | |
| |integration of patient care. | | | |
| |Discuss, negotiate and implement preoperative preparation, including | | | |
| |using psychological preparation, anxiolytics, opioids, antacids and | | | |
| |antiemetics. | | | |
| |Discuss, negotiate and implement preemptive and multimodal analgesia and| | | |
| |antiemetic techniques. | | | |
|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |
|Core Competencies | | | |ASSSESSMENT |
|Effective Interpersonal and |Demonstrate interpersonal and communication skills that enable them to |♣ Modeling by Faculty |♣ Faculty Rotation |Evaluation by attending |
|Communication skills: |establish and maintain professional relationships with patients, |♣ In-Service Talk |Evaluations |Evaluate presentation. |
| |families, and members of their and other health care teams. |♣ Grand Rounds |♣ ASC Nursing Staff |Review nurses 360 evaluation on residents |
|To demonstrate interpersonal |Provide effective and professional consultation to other physicians and |♣ Anesthesia Crisis Resource |Evaluation |Observation by attending of a timeout |
|and communication skills that |health care professionals and sustain therapeutic and ethically sound |Management (ACRM) | |performed by resident and nurses. |
|result in effective |professional relationships with patients, their families, and | | |Observation by attending of resident’s |
|information exchange and |colleagues. | | |participation with patient positioning and |
|teaming with patients, their |Use effective listening, questioning, narrative and nonverbal skills to | | |communication with surgeons regarding any |
|families, and other health |communicate with patients and families. | | |issues. |
|professionals |Interact with consultants and referring physicians in a respectful, | | |Review cases with attending |
| |appropriate manner. | | |Completion of checklist |
| |Maintain comprehensive, timely, and legible medical records. | | | |
| |Give appropriate discharge and follow up instructions to patients and | | | |
| |their families. | | | |
| |Perform evaluations of the attending staff and rotation. | | | |
|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |
|Core Competencies | | | |ASSESSMENT |
|Practice based learning and |Use scientific evidence and methods to investigate, evaluate, and |♣ Intraop teaching by attending|♣ Faculty Rotation |Evaluation by attending and discussion |
|improvement: |improve patient care practices and demonstrate this by referring to the |♣ Journal articles |Evaluations |during cases |
| |appropriate literature. |♣ Grand Rounds |♣ Review of Presentation |Reflect on things you learned that you need |
|To demonstrate practice-based |Identify areas for improvement and implement strategies to enhance | | |to improve on |
|learning and improvement that |knowledge, skills, attitudes and processes of care. | | |Completion of checklist |
|involves investigation and |Analyze and evaluate practice experiences and implement strategies to | | | |
|evaluation of their own |continually improve the quality of patient practice. | | | |
|patient care, appraisal and |Develop and maintain a willingness to learn from errors and use errors | | | |
|assimilation of scientific |to improve the system or processes of care. | | | |
|evidence, and improvement in |Use information technology or other available methodologies to access | | | |
|patient care |and manage information, support patient care decisions and enhance both | | | |
| |patient and physician education. To this end, the resident will | | | |
| |demonstrate the ability to use the available inter- and intranet | | | |
| |resources (e.g., Medline and hospital-based IT services) | | | |
|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |
|Core Competencies | | | |ASSESSMENT |
|Systems-based Practice: |Demonstrate both an understanding of the contexts and systems in which |♣ Modeling by Faculty |♣ Faculty Rotation |Discussion regarding aspects of the overall |
| |health care is provided, and the ability to apply this knowledge to |♣ Collaboration with nurses and|Evaluations |system of care that can be improved upon |
|To demonstrate an |improve and optimize health care. |nursing management | |with emphasis on efficiency and safety in |
|awareness of and |Access and utilize the resources, providers and systems necessary to |♣ Grand Rounds | |the ASC |
|responsiveness to the |provide optimal care. | | |Discussion about common reasons for |
|larger context and system |Identify the limitations and opportunities inherent in various practice | | |unexpected hospitalization of ambulatory |
|of health care and the |types and delivery systems, and develop strategies to optimize care for | | |surgical patients. |
|ability to effectively |the individual patient. | | |Define the concepts of fast-tracking” and |
|call on system resources |Apply evidence-based, cost-conscious strategies to prevention, diagnosis| | |“home readiness” |
|to provide care that is of|and disease management. | | |Complete checklist |
|optimal value |Collaborate with other members of the health care team to assist | | | |
| |patients in dealing effectively with complex systems and to improve | | | |
| |systematic processes of care | | | |
|GOALS |OBJECTIVES |INSTRUCTIONAL ACTIVITIES |EVALUATION | |
|Core Competencies | | | |ASSESSMENT |
|Professionalism: |Demonstrate behaviors that reflect a commitment to continuous |♣ Modeling by faculty |♣ Faculty Rotation |♣ Write medical notes in EPIC on all |
| |professional development, ethical practice, an understanding and |♣ Self-Directed Reading |Evaluations |patients under your direct care |
|To demonstrate a commitment to|sensitivity to diversity and a responsible attitude toward their |♣ Presentation |♣ Attendance at Lectures |preoperatively. |
|professional responsibilities,|patients, their profession and society. |♣ Grand Rounds |♣ Updating Case Logs |♣ Discuss with an attending one |
|adherence to ethical |Demonstrate respect, compassion, integrity, and altruism in | |♣ Complete documentation |difficult ethical dilemma encountered in ASC|
|principles, and sensitivity to|relationships with patients, families, and colleagues. | |♣ ASC Nursing Staff |♣ Attendance at lecture |
|diversity. |Demonstrate sensitivity and responsiveness to the gender, age, culture, | |Evaluation |♣ Completion of checklist |
| |religion, sexual preference, socioeconomic status, beliefs, behaviors | | |♣ Obtain feedback from nurses and |
| |and disabilities of patients and professional colleagues. | | |their 360 evaluation |
| |Adhere to principles of confidentiality, scientific/academic integrity, | | | |
| |and informed consent. | | | |
| |Recognize and identify deficiencies in performance and give constructive| | | |
| |feedback. They will demonstrate this in their evaluations of medical | | | |
| |students and faculty. | | | |
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