Program Specification for Master Degree Anesthesia, ICU and Pain Management

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1 Cairo University Faculty of Medicine Program type: Single Program Specification for Master Degree Anesthesia, ICU and Pain Management Department offering program: Anesthesia, intensive care and pain management Department Program code: ANES 800 Total credit points: 75 Academic year: 2009/200 Program Coordinators: Assistant Coordinators: Prof. Azza Ezzat Prof. Hanaa Abouel-Nour Prof. Amany El-Sawy External evaluators: Professors of Anesthesia, intensive care and pain management of other universities in Egypt. I. Aim of Program To provide the postgraduates with the knowledge, skills and attitudes that allows them to specialize in the field of anesthesia, ICU and pain management. The candidates should achieve satisfactory levels of basic knowledge and clinical skills in all aspects of anesthesia and ICU practice, interact with community problems and respect ethical values according to community culture. The program also aims to introduce the candidates to the basics of scientific research in the field of Anesthesia, intensive care unit and pain relief. II. Intended Learning Outcomes of the Program (ILOs) A. Knowledge and Understanding: By the end of the program the candidate should be able to: ) Recognize the detailed description of the structures of the different tissues, organs and systems of specific importance to the anesthetist as the anatomy of the airway and the spinal cord. 2) Identify the surface landmarks of the great vessels suitable for vascular access as well as areas for regional nerve block. 3) Distinguish between the normal and abnormal radiological features of the skull, chest and abdomen. 4) Understand the physiological functions and mechanism of action of body systems.

2 5) Understand the basic general pharmachodynamics and pharmachokinetics of drugs at all age groups. 6) Describe the full details about the pharmacology of all anesthetic drugs including inhalational, intravenous, muscle relaxants and local anesthetics as well as sedatives and hypnotics. 7) Identify the mechanism of action of different drugs taken by the patient and its interaction with the anesthetic drugs. 8) Understand all medical emergencies that the anesthetist may be confronted with perioperatively or in the post operative ICU. 9) Recognize the different physical laws and its application in anesthesia practice. 0) Recognize different measuring systems and monitoring devices important for delivery of safe anesthesia. ) Recognize the full details about the anesthesia machines. 2) Understand the basics of anesthetic management and recovery. 3) Know the basics of intensive care and high dependency care units and how to manage patients at risk. 4) Recognize how to score the traumatized patient and manage life threatening illness. 5) Understand the analgesic ladder, methods to asses the degree of pain sensation and define the different methods for acute and chronic pain relief. B. Intellectual Skills: By the end of the program the candidate should be able to: ) Identify the different anatomical surface markings related to anesthesia and the different areas relevant to venous or arterial access as well as chest tube insertion. 2) Interpret the normal anatomical structures on radiographs, C.T. scans and magnetic resonance images. 3) Select the proper technique of anesthesia (general, regional or local anesthesia) and identify its related complications. 4) Correlate between the clinical anesthetic interventions and the accompanying physiological responses. 5) Define the indications, contraindications, dosage and complications of drugs used for premedication, anesthesia as well as analgesics and muscle relaxants. 6) Correlate different physiological reflexes with the action responses of the different anesthetics or techniques. 7) Categorize patients according to different scoring systems (as Glasgow coma scale, ASA classification, trauma scale). 8) Describe the required preoperative investigations according to the medical status and the surgical procedure. 9) Interpret data relevant to the clinical setting e.g. respiratory function tests, laboratory investigations and radiological findings. 0) Plan and decide the premedication and anesthetic technique appropriate for the patient.

3 ) Define the appropriate method used for maintaining a patent airway (e.g. endotracheal, laryngeal mask airway, double lumen tube.etc). 2) Determine causes of intra/postoperative complications and their management. 3) Interpret readings of the standard monitors attached to the patient (Pulse oximetry, noninvasive blood pressure, heart rate and capnography) as well as additional monitors as central venous pressure monitoring. 4) Define the pathophysiology and the management of different emergencies as shock, pulmonary embolism, arrhythmias..etc. C. Professional and Practical Skills: By the end of the program the candidate should be able to: ) Recognize the medical history of the patient with special concern about common diseases (as ischemic heart disease, hypertension, DM, asthma) and how it will affect the outcome of the patient during and after surgery. 2) Perform preoperative evaluation, use the proper premedication and assess the difficulty in airway management. 3) Fulfill the preoperative sheet, choose the proper anesthetic technique and obtain the patient's consent for the anesthesia. 4) Set up anesthesia machine and its connections as well as the monitors preoperatively. 5) Establish vascular access for premedication. 6) Perform proper and safe endotracheal intubation. 7) Induce and maintain safe and appropriate levels of anesthesia during elective and emergency surgery and manage patient during the recovery period properly. 8) Apply and maintain different modes of ventilation in the operating theatre and ICU. 9) Fill the anesthesia record and check the discharge criteria. 0) Perform the technique of spinal, caudal and epidural anesthesia properly as well as peripheral nerve blocks. ) Assess and manage post operative pain in different age groups by neural blockade, patient controlled analgesia.etc. 2) Recognize and manage cardiac and respiratory arrest (basic and advanced life support). 3) Assess and manage fluid balance, blood transfusion and nutritional support. D. General and Transferable Skills: By the end of the program the candidate should be able to: ) Communicate with the patients to gain their confidence. 2) Value the ethics; respect all individuals inside and outside the operating room and pay appropriate respect to the patient. 3) Recognize the scope and limits of their role as candidates as well as the necessity to seek and apply collaboration with other workers. 4) Be responsible towards work.

4 5) Maintain a professional image concerning behavior, dress and speech. 6) Appreciate team working. 7) Achieve computer skills necessary to make use of medical data bases and use the internet for communication. 8) Show leadership skills that enable them to organize work and lead the juniors and paramedical staff. 9) Understand different scientific methodologies and have critical reading abilities. 0) Write scientific articles according to the basics of scientific research. ) Communicate with patients to take history, clinical examination and obtain consent for anesthesia. 2) Reassure the patients and explain their condition properly to alleviate their anxiety. III. Academic Standards External references for standards: Syllabus for FCARCSI (United Kingdom) IV. Program Admission Requirements According the Faculty of Medicine, Cairo University Bylaws for Post Graduate Programs (July 2009), applicants should have MBBCh or equivalent degree. According to Cairo University requirements, all applicants for postgraduate studies should fulfill preliminary courses on the following subjects; Medical statistics I English language (Toefl or equivalent degree) Computer skills (ICDL) or equivalent computer course offered by the medical education center (MEDC). Admission to the program is open during July. Training prior to registration may be accredited according to departmental and hospital evaluation. V. Program Structure and Contents Program duration: Three academic years. Program structure: Total Credit points 75 First part:.5 years - Total credit points 65 - (Table ) Compulsory courses (30 weeks) Anatomy credit point Physiology 3 credit points Pharmacology 3 credit points Physics and clinical measurements 2 credit points Internal medicine 2 credit points Basics of anesthesia 2 credit points Elective courses credit points Scientific activities 3 credit points Residency training program Part 48 credit points

5 Second part:.5 years - Total credit points 90 - (Table 2) Compulsory courses (30 weeks) Anesthesia machine and equipment credit point General anesthesia 4 credit points Specialized Anesthesia 8 credit points Surgical ICU 2 credit points Pain management credit point Scientific activities 4 credit points Residency training program Part 2 70 credit points Master Thesis: completed during second part 20 credit points. Table : First part Credit Courses Points Code Title CPs Total ILOs COMPULSORY COURSES ANES 80 Anatomy A, A 2, A 3, B, B 2, ANES 804 Physiology 3 A 4, B 4, B 6 ANES 807 Pharmacology 3 A 5, A 7, A 8, B 5, ANES 823 PCM Physics and Clinical Measurements 2 3 A 9, A 0, A, B 2, B 7, B 3, C 6 ANES 8 Internal Medicine 2 A 9, B 9, B 5, D 0, D ANES 823 BA Basics of Anesthesia 2 A 2, A 3, B 2, B 3, B 5, B 7, C 2, C 3 ELECTIVE COURSES (MEDC) choose 2 courses MEDC Critical Reading 0.5 MEDC 2 Scientific writing 0.5 MEDC 3 Evidence-Based Medicine 0.5 MEDC 4 Medical statistics II 0.5 MEDC 5 Medical ethics 0.5 MEDC 6 Communication Skills 0.5 SCIENTIFIC ACTIVITIES D 3, D 5, D 6, D 8, D 9 st Part Scientific activities 3 3 D, D 2, D 3, D 4, D 5, D 8, D 9 RESIDENCY TRAINING PROGRAM (Basic training) ANES 823 C Residency training program 48 48

6 Table 2: Second part Courses Credit Points Code Title CPs Total ILOs COMPULSORY COURSES ANES 823 Anesthesia, ICU and Pain Management ANES 823 Ta Anesthesia Equipment ANES 823 Tb General Anesthesia 4 ANES 823 Tc Specialized Anesthesia 8 ANES 823 Td Surgical I.C.U. 2 ANES 823 Te Pain Mangement SCIENTIFIC ACTIVITIES 6 A 3, A 4, A 5, B, B 8, B 9, B 0, B, B 2, B 3, C 4, C 5, C 6, C 7, C 8, C 9, C 0, C, C 2, C 3 2nd Part Scientific activities 4 4 D 7, D 8, D 9, D 0, RESIDENCY TRAINING PROGRAM ANES 823 C2 Residency training program A 9, B, B 2, B 3, B 4, B 5, B 6, C, C 2, C 3, C 4, C 6, D, D 2, D 3, D 4, D 5, D 6, D 7 MASTER THESIS Master Thesis D 6, D 0, D Residency Training Program First Phase (Basic Training): According to the Faculty of Medicine, Cairo University Bylaws for Post Graduate Programs (July 2009), all the students should have a basic training for 8 months. They should spend at least 6 months in a general department and 6 months in emergency department(s). During this period the students will attend the basic sciences courses as well as the general compulsory course. They should also complete the elective courses. Second Phase (Special Training): All students should complete the special part of the residency training program in the Anesthesia Department. They should spend 8 months in order to acquire the needed credit points. During this period the students will attend the compulsory course(s) of the second part and will participate in the scientific activities of the department.

7 ANESTHESIA, ICU AND PAIN MANAGEMENT MASTER DEGREE PROGRAM MATRIX Courses A Knowledge and Understanding Code Name B Intellectual Skills ANES 80 Anatomy x x x x x ANES 804 Physiology x x x ANES 807 Pharmacology x x x x ANES 823 PCM Physics/Clinical Meas x x x x x x ANES 8 Internal Medicine x x x ANES 823 BA Basics of Anesthesia x x x x x x ANES 823 Ta Anesthesia Equipment x x x x x x x x x x ANES 823 Tb General Anesthesia x x x x x x x x x x ANES 823 Tc Specialized Anesthesia x x x x x x x x x x ANES 823 Td Surgical I.C.U. x x x x x x x x x x ANES 823 Te Pain Mangement x x x x x x x x x x MEDC Critical Reading MEDC 2 Scientific Writing MEDC 3 Evidence-Based Med. MEDC 4 Medical Statistics (2) MEDC 5 Medical Ethics st Part Scientific Activities 2 nd Part Scientific Activities ANES 823 C Training Program ANES 823 C2 Training Program x x x x x x x Master

8 ANESTHESIA, ICU AND PAIN MANAGEMENT MASTER DEGREE PROGRAM MATRIX Courses C Professional Skills Code Name D General and Transferable Skills ANES 80 Anatomy ANES 804 Physiology ANES 807 Pharmacology ANES 823 Physics and Clinical PCM Measurements x ANES 8 Internal Medicine x x x x ANES 823 BA Basics of Anesthesia x x ANES 823 Ta Anesthesia Equipment x x x x x x x x x x ANES 823 Tb General Anesthesia x x x x x x x x x x ANES 823 Tc Specialized Anesthesia x x x x x x x x x x ANES 823 Td Surgical I.C.U. x x x x x x x x x x ANES 823 Te Pain Mangement x x x x x x x x x x MEDC Critical Reading x x x x x MEDC 2 Scientific Writing x x x x x MEDC 3 Evidence-Based Medicine x x x x x MEDC 4 Medical Statistics (2) x x x x x MEDC 5 Medical Ethics x x x x x st Part Scientific Activities x x x x x x x 2 nd Part Scientific Activities x x x x ANES 823 C Training Program ANES 823 C2 Training Program x x x x x x x x x x x x Master x x x 0 2

9 Master Thesis All master-degree students should prepare a thesis in Anesthesia, ICU or Pain Management. The department and the ethical committees must approve the protocol of the research. The thesis includes a review part with or without a practical part. The thesis is supervised by one or more senior staff members and may include other specialties according to the nature of the research. The thesis should be evaluated and approved by a committee of three professors including one of the supervisors and an external professor. Scientific Activities: The students should actively participate in the scientific activities of department such as: Journal club once every two weeks. Seminars (including recent topics and controversial issues) once weekly. Students are expected to participate in the discussions. Scientific meetings arranged by the department Attendance of thesis discussions Morbidity and mortality monthly meetings Each activity is monitored and given credit points registered in a special section in the residency-training logbook. The student should collect the required points before allowed to sit for the final exam. VI. Regulations for Progression and Program Completion After collecting the required credit points for the respective courses, the first phase of the residency training, and the scientific activities, the student will be eligible to sit for the first part examination. In case the student fails to pass the examination, he may proceed in the clinical training and can resubmit for the next examination. After passing the first part, the student submits a protocol for Master Thesis at the beginning of the second part. Before submitting to the final examination he/she should finish the thesis and get approval, complete phase 2 of special training program, and collect the required credit points. The candidate will receive his degree after passing this final examination. Master degree should be obtained within a maximum of 6 years after registration date. VII. Assessment A: Assessment Tools Supervision and Monitoring of Training Program According to the Faculty of Medicine, Cairo University Bylaws for Residency Training Programs, professors carry continuous assessment during the program. A residency-training program logbook will be kept for each student to document all his/her clinical, laboratory and/or operative/procedural activities as well as his/her participation in different scientific activities. The head of the department should allow the students to undergo the final examination when they complete their training program and collect the credit points needed.

10 Formal Assessment According the Faculty of Medicine, Cairo University Bylaws for Post Graduate Programs (July 2009). Students should be assessed at the end of first part and of the second part.. First Part Final Exam: Anatomy: one-hour written exam + oral exam. Physiology: Two-hour written exam + oral exam Pharmacology: Two-hour written exam +oral exam Physics and Measurements: Two-hour written exam + oral exam Internal Medicine: Three-hour written exam +oral exam + clinical exam. Basics of Anesthesia: One-hour written exam (including short essay and multiple choice questions) + oral exam + clinical exam 2. Second Part Final Exam Part 2: Anesthesia : Three written examinations including short essay questions, and MCQ (including problem solving)+ oral examination + clinical examination B: Assessment Schedule:. First Part Final Exam: The written exam will be held in April/October (four days): Day one: Anatomy and Physiology (3 hours) Day two: Pharmacology (2 hours) Day three: Physics and Measurements (2 hours) Day four: Internal Medicine (3hours) Day five: Basics of Anesthesia (hour) This will be followed by the clinical and oral exams in separate days 2. Second Part Final Exam: The written exam will be held in May/ November (four days): Day one: Written exam (3hours) Day two: MCQ (3hours) Day three: Case report (hour) This will be followed by the clinical and oral exams in separate days C: Weighing Of Assessment (Marks allocated to courses): (50 marks for each credit point)

11 Courses Marks Code Title Written Oral Clinical Total FIRST PART ANES 80 Anatomy ANES 804 Physiology ANES 807 Pharmacology ANES 823 PCM Physics/Clinical Measurements ANES 8 Internal Medicine ANES 823 BA Basics of Anesthesia Total First Part 650 SECOND PART ANES 823 Ta Anesthesia Equipment ANES 823 Tb General Anesthesia 50 ANES 823 Tc Specialized Anesthesia ANES 823 Td Surgical I.C.U. 50 ANES 823 Te Pain Mangement 75 Remarks It is mandatory to pass the three papers of the Anesthesia exam separately. Passing mark in a written exam is 60% VIII. Evaluation of Program Intended Learning Outcomes Date of approval by department: Program coordinator: Assistant Coordinator: Prof. Azza Ezzat Assist. Prof. Hanaa Abouel Nour Prof. Amany El-Sawy Total Second Part 800 Evaluator Tool Sample. Senior Students Questionnaire at the end of All the PG students the program 2. Alumni The faculty is currently Not yet determined developing an Alumni office for postgraduates 3. Stakeholders A meeting will be arranged during annual conference of the department Available representatives from: - Army hospitals - National medical insurance - Medical syndicate 4. External Evaluators Review program and courses Attending the final exam 5. College Quality Assurance Annual program reviewer committee - Ministry of health Once before implementation Bi-annual report

12 Program Coordinator Prof. Azza Ezzat Prof. Hanaa Abouel Nour Prof. Amany El-Sawy Head of Department Prof Khalid ElBorolosy

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