ENVIRONMENT Labor & Delivery rooms, Obstetric operating rooms, Obstetric triage area, Simulation Suite, conference room

Transcription

1 UCSD DEPARTMENT OF ANESTHESIOLOGY MARY BIRCH OG/GYN ROTATION CLINICAL ANESTHESIA GOALS AND OBJECTIVES CA-3 RESIDENTS PATIENT CARE: To provide the resident with clinical experience in the anesthetic management of pregnant and non-pregnant patients that is compassionate, appropriate, and effective The Obstetric Anesthesia II patient care objective for the anesthesia resident is to further develop clinical skills and efficiency in the areas set forth in Goals and Objectives for Obstetric Anesthesia I. Labor & Delivery rooms, Obstetric operating rooms, Obstetric triage area, Simulation Suite, Skill, practice and feedback (debriefing), discussion, simulation Independently conduct an efficient, focused, and comprehensive preprocedure/pre-anesthetic evaluation, including history, physical exam, and review available studies, under both elective and emergent conditions, for pregnant patients Operating Room Lecture, Skill, Practice and feedback Recognize, without assistance, when appropriate subspecialty consults are needed, (i.e., cardiology, Perinatology, pain management) Post Recognize, without assistance, when additional studies to establish a diagnosis or evaluate severity are appropriate labor and delivery, Post, Syllabus Without assistance, develop a patient-specific management plan, with a reasonable alternate plan, for all levels of ASA classification for pregnant and non-pregnantpatients, for both elective and emergent procedures; including consideration of pre-existing medical issues and patient requests, anticipate possible intraoperative or intra labor difficulties and pursue strategies to prevent possible post anesthetic complications. Post Lecture, Skill, Practice and Defend patient management plans using EBM Post

2 Without assistance, perform safe, efficient, timely and accurate pre-anesthetic checks of all pertinent equipment and supplies (such as anesthetic machines, compressed gas cylinders, airway management supplies, monitors, suction, medications, invasive devices, and resuscitation equipment etc.) both in the OR before each case and on labor and delivery at the beginning of each shift., Skill PATIENT CARE: To provide the resident with clinical experience in the anesthetic management of pregnant and non-pregnant patients that is compassionate, appropriate, and effective Without assistance, demonstrate competent advanced airway management techniques, including "Ob difficult airway algorithm", mask ventilation, cricoid pressure, the BURP procedure, Glidescope, Long Stylet Intubation Guide, Combitube, LMA, Bullard, Trans-tracheal Jet ventilation, simulation tools, Simulation Discuss the physiologic differences in pregnant woman, fetus, and newborn, and their impact on peripartum management including placental transfer and aorto-caval compression., Case based discussion, Lecture, Syllabus Pre and Post rotation, case based Without assistance, demonstrate competence in placement of epidurals, spinals, and combined spinal/epidurals with an effective, safe and effective technique and with special emphasis on positioning and sterility, labor and delivery, Simulation tools, Skill, Simulation Degree of Difficulty - Regional Anesthesia Scale Without assistance, demonstrate competent, effective and efficient patient care during induction of anesthesia, as well as during periods of instability in the course of the anesthetic care (i.e., surgical bleeding, patient co-existing disease exacerbation, drug reaction, or other crisis), L&D, Syllabus Pre and Post rotation Without assistance, demonstrate competent, effective and efficient patient care during turn over in cases to keep the operating schedule working smoothly Preop evaluation area,, PACU, Skill, Without assistance, interpret and responds appropriately to the information from patient monitors and laboratory data (including ECG, CO 2, electronic fetal heart rate monitors, contraction monitors, Coagulation Panel, etc.), Labor and Delivery, PACU, Syllabus Pre and Post rotation Critique the choice for blood product and fluid management, Labor and Delivery, PACU feedback, Transfusion guide in Syllabus Pre and Post rotation Without assistance, transfer care of the patient after anesthesia/procedure to responsible party (PACU, L&D, or ICU nurse, etc.) in a manner that is efficient and yet ensures patients safety and comfort and continuity of care Postoperative care unit, and ICU, Skill Pre and Post rotation

3 MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the management of the surgical patient. The Obstetric Anesthesia II medical knowledge objective for the anesthesia resident is for him or her to choose one or more topics to research in depth, including a review of the relevant literature and in-depth discussion with the faculty. Examples of areas appropriate for such in-depth study might include: protocols for cesarean hysterectomy, use of ultrasound for neuraxial block placement and anesthesia techniques for parturients with pulmonary hypertension.,, Self-study, discussion with attendings and OB residents Evaluation of presentations, discussion with resident, management of cases. Critique alternative anesthetic plans using an understanding of pathophysiology particularly of preeclampsia, placenta accreta, amniotic fluid embolism, multiple births, placental abruption, and breech delivery, Case based discussion, Syllabus Critique perioperative/peripartum management plans for OB/Gyn patients based on the physiologic changes Lecture, L&D, Operating Room, Independent Study Case Based Discussion, Syllabus Critique anesthetic plans based on risk factors and perioperative considerations with all co-morbid conditions (e.g. Preeclampsia, HELLP, GERD, DM, asthma, and obesity) identified in preanesthetic examination L&D, Preanesthesia Evaluation Area, Operating Room, Independent Study Case Based Discussion, Syllabus Critique choices of drugs, including induction agents, opioids, inhalational agents, neuromuscular blocking agents, pressors, beta-blockers, vasodilators, prostoglandins, uterotonics and tocolytics Classroom, Conference,, Journal Club, Case based discussion, Simulated patient Debate fluid management options including the risk and benefits of peripartum and perioperative transfusion, L&D, Case Based Discussion, In-training exam case based Understand the pathophysiology, evaluation, and management of post partum neurological complications including post partum headache and postpartum neuropathy, L&D, PACU, postpartum units, Syllabus, Postpartum Neuropathy Evaluation Tool Case discussion,,

4 PRACTICE BASED : To be able to investigate and evaluate their own patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Debate and defend treatment approaches for perioperative or peripartum events, such as hypotension, hypoxia, tachycardia, magnesium toxicity, hypertonic and hypotonic uterus, and oligouria Lectures,, Case discussion Pre and Post rotation evaluation, case based Debate and defend choices in approaches to regional blockade of the lower body including spinal, epidural, continuous infusion epidural, and patient controlled epidural analgesia Lectures, Labor and Delivery,, Case discussion Pre and Post rotation evaluation, case based Demonstrate ability to discover information concerning clinical questions Syllabus including Ob Anesthesia Questionnaire Questionnaire evaluation and discussions Critique approaches to treatment of labor pain and perioperative pain in relation to the mechanisms of acute pain including neural narcotics and PCA Lectures,, Case discussion Pre- and Post rotation evaluation, case based The Obstetric Anesthesia II practice-based learning objective for the anesthesia resident is for him or her to continue the work begun in Obstetric Anesthesia I. Labor & Delivery, OB OR, triage area, L&D nursing station, Discussion with faculty and other residents Case-based discussion and evaluation, direct observation

5 INTERPERSONAL AND COMMUNICATIONS SKILLS: Be able to demonstrate communication skills that result in effective information exchange and appropriate interaction with colleagues, surgeons, patients, nurses, and ancillary personnel. CA-3 residents must identify, explain and demonstrate all the characteristics listed below. They will show mastery of these skills, exhibit leadership and act as role models to educate others. The interpersonal and communications skills objective for the anesthesia resident for Obstetric Anesthesia II is for him or her to choose one or more topics to practice, research and reflect upon at length, including a review of the relevant literature and in-depth discussion with the faculty and other members of the Labor & Delivery care team. Examples of areas appropriate for such in-depth review and reflection might include: review of video recordings of patient care and simulation episodes, practice dealing with behavioral and communications issues during role-playing and simulation sessions and requests for feedback from other members of the Labor & Delivery care team. Labor & Delivery, OB OR, triage area, L&D nursing station,, skill, discussion, role playing Direect observation Maintain comprehensive, timely, and legible medical records, L&D Lecture and discussion,, skill Review of anesthesia records Convey ideas and points effectively, L&D Postoperative care unit, Convey urgency but not panic in urgent/emergent situations, L&D, Postoperative care unit Know role in crisis, L&D, Postoperative care unit, Skill Practice team approach, L&D Postoperative care unit, Simulation

6 PROFESSIONALISM: Be able to demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. CA-3 residents must identify, explain and demonstrate all the characteristics listed below. They will show mastery of these skills, exhibit leadership and act as role models to educate others. The professionalism objective for the anesthesia resident for Obstetric Anesthesia II is for him or her to choose one or more topics to practice, research and reflect upon at length. P Labor & Delivery, OB OR, triage area, L&D nursing station,, skill, discussion, role playing Demonstrate respect, compassion or responsiveness to patient's concerns or needs, Skill checklist and criteria Demonstrate independence and initiative Be punctual and reliable Demonstrate superior work ethic, evaluation of questionnaire and project efforts Demonstrate commitment to professional development Case based discussion, project, questionnaire, project and questionnaire evaluation Adhere to departmental, hospital, and university policy and procedures Lecture and discussion, Handouts, Practice, Syllabus, and feedback Exhibit integrity in record keeping and medical records Lecture, Skill, Anesthesia record review

7 SYSTEMS-BASED PRACTICE: Be able to demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide health care that is of optimal value CA-3 residents must identify, explain and demonstrate all the characteristics listed below. They will show mastery of these skills, exhibit leadership and act as role models to educate others. Practice cost-effective health care Lecture and discussion, Case based discussion The systems-based practice objective for the anesthesia resident for Obstetric Anesthesia II is for him or her to choose one or more topics to practice, research and reflect upon at length, such as, for example, the role of compensation systems in motivating performance or a project involving clinical information retrieval. Classroom, computer systems, Lecture and discussion, Case based discussion Evaluation of presentation. Rely on information technology tools related to patient care, self study, Case based discussion, syllabuis Case based,