Goals and Objectives. Assessment Methods/Tools

Transcription

1 CA-3 REGIONAL ANESTHESIA ROTATION FAIRVIEW RIVERSIDE SPORTS CLINIC Medical Center - Fairview Rotation Site Director: Dr. Robert Gorman Rotation Duration: 4 weeks Introduction: This rotation provides an introduction to utilizing regional anesthetic techniques for both in-patient and ambulatory surgery. Residents will receive considerable exposure to the unique requirements of regional anesthesia. Residents are expected to perform at least 40 peripheral blocks during their residency. They are also expected to continue their care of patients into the operating room and the PACU. This ensures adequate clinical experience to develop both the motor skills necessary to perform regional blocks and the cognitive skills to manage patients throughout the perioperative period. In this rotation, residents will focus on developing the necessary motor skills to place peripheral nerve blocks and learning the principles of safe regional anesthesia. Blocks commonly taught include femoral block, sciatic block, popliteal fossa block, brachial plexus blocks (interscalene block, supraclavicular, infraclavicular, and axillary), intravenous regional anesthesia, caudal block, paravertebral block, and other selective peripheral nerve blocks. GOALS: o To train residents who are capable of providing high quality regional anesthesia care based on principles of teamwork and collaboration; o To train residents who use the bio-psychosocial model and life-long learning principles in providing high quality regional anesthesia care for intraoperative and postoperative pain in inpatient and outpatient environment. Approximate Training Level Assessment Methods/Tools OBJECTIVES (by ACGME Competency) Patient Care Clinical Skills and Reasoning: o Uses clinical skills of interviewing and physical examination to perform a thorough assessment of a patient who are candidates for regional anesthesia (perception to o Direct Observation o Chart- review Page 1 of 5

2 o Expertly formulates a safe management plan for the patient considering pros and cons of regional anesthesia (perception to o Maintains orderly patient documentation of regional anesthesia procedures (perception to Technical/Device Related Skills o Independently prepares work area for regional anesthesia procedures in an organized, systematic fashion, following the principles of patient privacy, safety, provider safety, and sterility (perception to o Case logs o Prepares for use nerve stimulator, ultrasound (perception to o Safely prepares local anesthetic agents for regional anesthesia procedures (perception to o Is familiar with continuous catheter infusion techniques (perception to o Uses techniques such as ultrasound to facilitate regional anesthesia procedures (perception to mechanism) Patient Management o Describes the appropriate for the patient regional anesthesia procedures (perception to o Demonstrates appropriate techniques and actions of primary anesthesiologist as well as assistant during placement of such blocks (perception to o Performs a variety of peripheral nerve blocks including interscalene, axillary, femoral, popliteal, ankle, Bier block and performs/observes infraclavicular, supraclavicular, lumbar plexus, sciatic, facia-iliaca blocks (perception to o Manages side effects of regional anesthesia procedures (perception to mechanism or o Manages emergent complications of regional analgesia including but not limited to management of high spinal, local anesthetic toxicity, o Direct Observation o Chart- review o Case logs Page 2 of 5

3 hemathoma, infection/abscess, etc. (perception to complex overt response) o Effectively reports and transfers care of patient to a secondary provider (perception to mechanism or Medical Knowledge o Discusses pharmacology of local anesthetic and adjunct agents o Discusses doses and toxicity of local anesthetic and adjunct agents o Introductory lecture series test o Anesthesia o Discusses pharmacology, side effects and use of agents such as knowledge test o Annual in-training clonidine, bicarbonate, epinephrine o Discusses physiologic events/changes that occur during following examination o Informal oral regional anesthetic procedure o Discusses and is able to appropriately select between various types questioning of nerve blocks o Describes and calculates equipotent doses of different opiates o Oral case presentations o Discusses side effects, contraindications and indications for different regional anesthesia techniques. Practice Based Learning and Improvement o Identify own learning deficits, develop a learning plan and carry it out (receiving to valuing) o Respond appropriately to constructive feedback (receiving to o Written essay describing an analysis of patient valuing) o Demonstrate ability to effectively search for literature (perception to management (areas of deficiencies, room for o Read, analyze and interpret the scientific literature improvement) o Immediate formative o Analyze own practice and determine ways in which you can improve your comprehensive acute pain management plan (analysis, valuing) feedback from attending o Direct observation Page 3 of 5

4 Interpersonal and Communication Skills o Journal club presentations and case presentations o Use of effective listening, questioning, and explanatory skills in gathering information from patients and in providing information to patients, families, the public, and other health care providers (receiving to valuing) o Skill in working as a member of a patient care team including other physicians, nurses, other health care professionals, social workers, and volunteers (receiving to valuing) o Maintain comprehensive, timely, and legible medical records (receiving to valuing) Professionalism o Direct observation with patient o Direct observation in simulation o 360 global rating o Learner classroom presentation o Awareness and management of his/her own values and attitudes, which might interfere with appropriate patient care specific to management of patients with acute pain (receiving to valuing) o Responsiveness to and management of issues that relate to sociocultural aspects of family life, and social adjustment related to ethnicity, religion, culture, gender or sexual preference (receiving to valuing) o Consistent compassion, honesty, integrity and respect for others in all professional activities (receiving to valuing) System Based Practice o direct observation o 360 o Work in inter-professional teams to increase patient safety and quality of care (perception to o Coordinate patient care (perception to o direct observation o 360 o M&M conference o Discuss system-based problems as they pertain to patient care at M&M conferences (knowledge to analysis) presentation with system analysis Page 4 of 5

5 Scholarly/Research Activities Reading Requirements The resident should read the following chapters while taking the rotation: Text: Chapters: The resident will be expected to complete a minimum of reading preparation. This will include: Textbooks: Peripheral Nerve Blocks, Hadzic. Plexus Anesthesia, Winnie. Journals (Online): Regional Anesthesia and Pain Management. Techniques in Regional Anesthesia and Pain Medicine. Clinical Anesthesiology. Computer Media: Peripheral nerve blocks on DVD: lower limbs (Lippincott). Peripheral nerve blocks on DVD: upper limbs (Lippincott). Assessments The resident will receive a summative written evaluation form at the end of the rotation from the Site Director, as well as verbal feedback informally throughout the rotation. The case-logs of the resident will also be evaluated periodically by the clinical competency committee for the number and type of procedures and anesthetic techniques entered to ensure they are obtaining adequate experience. Notes Page 5 of 5