Goals and Objectives, Rady Children s Hospital Pediatric Anesthesia, First Month UCSD DEPARTMENT OF ANESTHESIOLOGY Rady Children s Hospital Pediatric Anesthesia, First Month PATIENT CARE: To provide the resident with clinical experience in the anesthetic management of pediatric surgical/procedural patients that is compassionate, appropriate, and effective With assistance, conduct an efficient, focused, and comprehensive preprocedure/pre-anesthetic, including history, physical examinations, and review available studies, under both elective and emergent conditions, for pediatric patients Preoperative holding area Lecture, Skill, Practice and feedback Recognize, with assistance, when appropriate subspecialty consults are needed, (i.e., cardiology, pain management) Post Anesthesia Care Unit PACU, Operating Room Recognize with assistance when additional studies to establish a diagnosis or evaluate severity are appropriate PACU, Operating Room Assign an accurate ASA classification Preoperative holding area With supervision, develop a patient-specific management plan, with a reasonable alternate plan, for pediatric patients at all levels ASA classification, for both elective and emergent procedures; the plan should include consideration of pre-existing medical issues and patient requests, anticipate possible intraoperative difficulties and pursue strategies to prevent possible post-operative complications Preoperative holding area Lecture, Skill, Practice and, Practice oral examinationsinations 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, etc.), Skill Consistently demonstrate vigilance and attention to detail during all aspects of care PACU,, Simulation, Practice oral examinationsinations Consistently check the patient s identity, procedure to be performed, consent, and side to be blocked or operated on, when applicable preoperative holding area, Simulation
PATIENT CARE: To provide the resident with clinical experience in the anesthetic management of pediatric surgical/procedural patients that is compassionate, appropriate, and effective Demonstrate competence in bag-mask ventilation, conventional laryngoscopy and endotracheal intubation, insertion and use of LMA s, and safe use of the anesthesia machine and or ventilators, Skill, Simulation Demonstrate knowledge and safe use of various infusion devices Operating Room, Skill With assistance, demonstrate competence in in placement of peripheral IV s in pediatric patients, Skill With assistance, demonstrate competence in placing central lines efficiently, safely and accurately, Skill With assistance, demonstrate competence in placing and managing of arterial lines, Skill Correctly use train-of-four nerve stimulation to guide safe and effective use of neuromuscular blocking agents and to measure effectiveness of reversal agents Operating Room, Skill With assistance, demonstrate 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), Practice oral examinations With assistance, interpret and responds appropriately to the information from patient monitors and laboratory data (including ECG, CO 2 waveform, CVP, I/O, ABG, Coag Panel, etc.), Practice oral examinations Choose rational and appropriate blood product transfusion therapy. Recognize and treat transfusion-related complications, Practice oral examinations With assistance, transfer care of the patient after anesthesia/procedure to responsible party (PACU or ICU nurse, etc.) in a manner that ensures patient safety and comfort and continuity of care PACU, ICU, Skill, Practice oral examinations With assistance, effectively manage malignant hyperthermia, including asking for immediate assistance and delegating tasks in order to ensure rapid and coordinated treatment Simulation Suite Lecture, Simulation
MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the management of the pediatric surgical/procedural patient Describe anesthetic-induced changes in physiology and anesthetic implications of common medical problems in pediatrics Describe the impact of surgical procedures on pediatric physiology Describe the pathophysiology of intraoperative events such as oliguria, hypotension, hypoxia, and cardiac rate and rhythm changes Describe the differences in pharmacologic properties of drugs within each drug class especially where different in pediatric versus adult patients Describe properties and doses of common drugs in pediatric patients, including induction agents, opioids, inhalational agents, neuromuscular blocking and reversal agents, pressors, beta blockers, vasodilators Identify risk factors and perioperative considerations in patients with common medical problems in pediatrics (e.g. Congenital Heart Disease, Trisomy 21, prematurity, Pyloric Stenosis, etc.) List indications for invasive monitoring in pediatric patients Discuss pediatric fluid and blood product management in the perioperative setting
MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the management of the surgical/procedural patient. Describe the anatomy of epidural and subarachnoid space in children Discuss etiology and treatment approaches for intraoperative events, such as hypotension, hypoxia, tachycardia and oliguria in pediatric patients Identify risk factors for postoperative nausea in children, and describe methods of prevention Discuss etiologies of postoperative hypoventilation in pediatric patients Discuss etiologies of postoperative delayed awakening in pediatric patients Describe the mechanisms of acute pain and common perioperative treatment modalities in pediatric patients
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. Search and access published material, including on-line electronic library textbooks and journals Conference, Independent Study, Operating room Case based discussion, Journal club, Understand Evidence Based Medicine in pediatric anesthesia and integrate it into clinical practice Conference, Independent Study, Operating room Case based discussion, Summarize and present articles at Journal club Conference, Journal club Journal club presentation, Practice self- and reflection Conference with pediatric anesthesia faculty Debriefing after case or simulation, Oral self- Assessment of debriefing, Discussion and review of oral self- Identify own strengths, deficiencies, and limits in knowledge and expertise Conference with pediatric anesthesia faculty Debriefing after case or simulation, oral self- Debriefing, Discussion and review of oral self- Discuss and research relevant pediatric anesthesia literature to support decision-making processes Preoperative Evaluation Clinic, Conference Case based discussion Design (at start of each Rady Children s Hospital rotation) a personal study and improvement plan Conference with pediatric anesthesia faculty Oral self- Discussion and review of oral self- Seek formative feedback on performance Operating room Debriefing after case or simulation, debriefing Present in quality improvement practices pertaining to patient care Conference Case based discussion Evaluation of presentation, Admit to and seek help in remedying errors Operating room, Case based discussion
INTERPERSONAL AND COMMUNICATIONS SKILLS: Be able to demonstrate communication skills that result in effective information exchange and appropriate interaction with colleagues, surgeons, patients, and ancillary personnel Maintain comprehensive, timely, and legible medical records Operating room Lecture and discussion,, skill Review of anesthesia records Convey ideas and points effectively Conference, Simulation suite, Simulation, Practice oral examinations Convey urgency but not panic in urgent/emergent situations, Simulation, Practice oral examinations Encourage questions Preoperative Evaluation Clinic, Preoperative holding area, Operating Room Establish and maintain eye contact Preoperative Evaluation Clinic, Preoperative holding area, Operating Room Be approachable Preoperative Evaluation Clinic, Preoperative holding area, Operating Room, PACU Know role in crisis PACU, Simulation Suite, Skill Listen and allows others to feel heard Preoperative clinic, Preoperative holding area, Operating Room, Post Anesthesia Care Unit
INTERPERSONAL AND COMMUNICATIONS SKILLS: Be able to demonstrate communication skills that result in effective information exchange and appropriate interaction with colleagues, surgeons, patients, and ancillary personnel First month pediatric anesthesia resident must be able to identify all and demonstrate competence in some of the characteristics and skills listed below Make others feel comfortable in conversation PACU,, Simulation Preempt/ prevent disputes PACU,, Simulation Practice team approach PACU, Simulation Suite, Simulation
PROFESSIONALISM: Be able to demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. First month pediatric anesthesia resident must be able to identify all and demonstrate competence in some of the characteristics and skills listed below Answer pages promptly PACU Demonstrate respect, compassion or responsiveness to patient's concerns or needs PACU, Skill checklist and criteria Demonstrate independence and initiative PACU Be punctual and reliable PACU Demonstrate superior work ethic PACU Demonstrate commitment to professional development Preoperative Evaluation Clinic, Conference Case based discussion, Case presentation, Journal Club presentation, Case presentation Adhere to departmental and university policy and procedures PACU Lecture and discussion, Handouts, Exhibit integrity in record keeping and medical records PACU Lecture, Skill, Anesthesia record review
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 First month pediatric anesthesia resident must be able to identify all and demonstrate competence in some of the characteristics and skills listed below Practice cost-effective health care Operating Room Lecture and discussion, Case based discussion Rely on information technology tools related to patient care Classroom, Conference, Case based discussion, Journal Club presentation, Rely on consultations with other specialties (i.e., cardiology, pain management, ethics, etc.) PACU, Classroom, Conference, Case based discussion, Considers cost-benefit analysis and cost awareness in patient care PACU, Conference, Case based discussion, Able to discuss how health delivery systems differ and how this impacts patient care in the operating room Conference, Classroom Lecture, case-based discussion Case-based discussion and Participate in systems safeguards such as "timeout" and blood product transfusion protocol Operating Room Skill Demonstration,