Rotation: Regional Anesthesia X X X X X X FE, CL 2 4 MCQ FE, CL 2 4 X MCQ FE, CL FE, CL. Week 2-4. Week 1-2

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1 Week 1-2 Week 2-4 Interpersonal & Comm. Skills Practice-based Learning & Imp Systems-based practice Assessment FE=Faculty Eval MCQ=Quiz MO=Mock Oral CL=CHecklist Rotation: Regional Anesthesia COMPETENCIES GOAL: Acquire the knowledge and experience to be able to provide perioperative pain and anesthetic management The resident physician will be able to perform basic, intermidiate and advanced regional anesthetic techniques for perioperative pain and anesthetic management OBJECTIVE 1: Provide compassionate, appropiate and effective perioperative pain mananagement 1.1. Formulate appropiate anesthetic / analgesic plans for upper and lower extremity procedures 1.2. Explain the options and risks at an appropriate level of detail for patients of varying backgrounds OBJECTIVE 2: Demonstrate knowledge of regional anesthesia and perioperative pain management as well as the application of this knowledge to patient care including indications, contraindications and potential complications 2.1. Dominion of principles of nerve stimulators, insulated needles and its clinical applications 2.2 Dominion of clinically relevant anatomy for regional anesthesia 2.3. Knowledge of local anesthetics, adjuvants and their pharmacology and toxicity 2 4 MCQ OBJECTIVE 3: Demonstrate the ability to investigate and evaluate patient care and assimilation of scientific evidence to continuosly

2 Week 1-2 Week 2-4 Interpersonal & Comm. Skills Practice-based Learning & Imp Systems-based practice Assessment FE=Faculty Eval MCQ=Quiz MO=Mock Oral CL=CHecklist Rotation: Regional Anesthesia COMPETENCIES improve patient care based on constant self-evaluation and lifelong learning 3.1. Spontaneously criticizing his/her own performance 3.2. Independently serching relevant literature as applied to improve selfperformance as well as applying feedback to practice OBJECTIVE 4: Demonstrate interpersonal and communication skills that result in effective information exchange and collaboration with patients, their families and healthcare professionals 4.1. Provide effective patient education/information to obtain informed consent as applied to regional anesthesia 4.2. Communicate effectively with surgical team to state pros and cons of regional anesthesia GOAL 5: Demonstrate a commitment to carrying out professional responsibilities and adherence to ethical principles Fulfill clinical duties in a timely and appropiate manner as well as act with integrity with patients, nurses, fellows and healthcare providers GOAL 6: Demonstrate awareness of and responsiveness to the larger context and the Veteran Health System of

3 Week 1-2 Week 2-4 Interpersonal & Comm. Skills Practice-based Learning & Imp Systems-based practice Assessment FE=Faculty Eval MCQ=Quiz MO=Mock Oral CL=CHecklist Rotation: Regional Anesthesia COMPETENCIES health care and the ability to effectively call on other resources in the system to provide optimal health care Work effectively as a VA physician and indentify areas for quality improvement as applied to VHS. GOAL 7: Demonstrate knowledge of regional anesthesia complications including LAST and its appropiate management Effectively run LAST drill with appropiate clinical judgement based on the clinical scenario at hand 2 4, MO

4 ANESTHESIOLOGY SERVICE NF / SG VHS DEPARTMENT OF ANESTHESIOLOGY UNIVERSITY OF FLORIDA ACUTE PAIN MANAGEMENT AND REGIONAL ANESTHESIA ROTATION MALCOLM RANDALL VA MEDICAL CENTER GUIDELINES FOR EVALUATION OF COMPETENCY (FE: Faculty Eval, MCQ:Quiz, CL:Checklist) GOAL To acquire the knowledge and experience to be able to perform basic, intermediate and advance regional anesthetic techniques for perioperative pain and anesthetic management. GENERAL AND SPECIFIC OBJECTIVES Per ACGME core competency, as follows: () Provide compassionate, appropriate, and effective perioperative pain management. Documented by: 1. Formulating plans for appropriate upper and lower extremity blocks when clinically indicated 1.1. Proficiency in single shot and continuous brachial plexus and its terminal nerve blocks 1.2. Proficiency in single shot and continuous lumbar plexus and its terminal nerve blocks 1.3. Proficiency in single shot and continuous sacral plexus and its terminal nerve blocks 2. Proficiency in placement of thoracic and lumbar epidural catheters 3. Proficiency in single shot and continuous subarachnoid blocks 4. Proficiency in superior laryngeal and recurrent laryngeal nerve blocks 5. Proficiency in ultrasound guided techniques to achieve nerve and plexus blocks () Demonstrate knowledge of regional anesthesia and perioperative pain management as well as the application of this knowledge to patient care including indications, contraindications and potential complications 1. Knowledge of nerve stimulators and insulated needles, basic principles, clinical applications and troubleshooting 2. Proficiency with local anesthetics with clinical applications and toxicity 3. Dominion of clinically relevant anatomy of the brachial plexus 4. Dominion of clinically relevant anatomy of the lumbar plexus 5. Dominion of clinically relevant anatomy of the sacral plexus 6. Dominion of clinically relevant anatomy of the airway, eye and their blocks 7. Dominion of clinically relevant anatomy of the spine and surrounding structures

5 8. Dominion of Bier block concept, indications and complications 9. Dominion of basic principles of sonography 10. Discussing principles and indications for various local anesthetic adjutants such as clonidine, bicarbonate, NSAIDs, narcotics, ketamine and epinephrine 11. Recognize the clinical signs and symptoms of local anesthetic overdose and toxicity and how to intervene in such instances Practice-Based Learning and Improvement () Demonstrate the ability to investigate and evaluate patient care and assimilation of scientific evidence to continuosly improve patient care based on constant selfevaluation and life-long learning. Documented by: 1. Performing step-by-step approach to the performance of peripheral and neuroaxial blocks, yet adapting when indicated as per patients clinical conditions 2. Understanding appropriate techniques and actions for both the primary anesthesiologist performing a peripheral nerve block as well as the assistant during the placement of such blocks 3. Spontaneously searching relevant literature on issues in regional anesthesiology 4. Spontaneously criticizing his/her own performance and procedural skill 5. Seeking and applying feedback to improve performance Interpersonal and Communication Skills () Demonstrate interpersonal and communication skills that result in effective information exchange and collaboration with patients, their families, and health care professionals. Documented by: 1. Providing effective patient education regarding indications, risks and side effects of procedures. 2. Obtaining appropriate informed consent from patients addressing elements relevant to regional anesthesia 3. Communicating pros-and-cons of regional anesthesia effectively with other members of the health care team () Demonstrate a commitment to carrying out professional responsibilities, and adherence to ethical principles. Documented by: 1. Acting responsibly and with integrity with patients, nurses, fellow residents and health care providers. 2. Fulfilling clinical duties in a timely and appropriate manner. 3. Adhering to ethical principles including respect for patient privacy. 4. Demonstrating active interest in learning and participating in the care of patients receiving regional anesthesia and their perioperative pain management as relevant for their recovery and transition to rehabilitation Systems-Based Practice () Demonstrate awareness of and responsiveness to the larger context and the Veteran Health System of health care and the ability to effectively call on other resources in the system to provide optimal health care.

6 1. Working effectively as a member of the patient care team. 2. Understanding basic principles of safety in administering regional anesthesia. 3. Indentifying areas for quality improvement in the administration of regional anesthesiology.