Anesthesiology

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Health Science Campus
University of Toledo Medical Center

3000 Arlington Avenue
Mailstop # 1137

Phone:  419-383-3556

Fax: 419-383-3550

webmaster@utoledo.edu

Goals and Objectives

UNIVERSITY OF TOLEDO

DEPARTMENT OF ANESTHESIOLOGY

RESIDENCY GOALS

FOR THE CLINICAL ANESTHESIOLOGY YEARS

 

 

The goals of residency education in the department are based upon the six core competencies mandated by the Outcome Project of the Accreditation Council for Graduate Medical Education.  These general competencies are:

  • Patient care
  • Medical knowledge
  • Practice-based learning and improvement
  • Interpersonal and communication skills
  • Professionalism
  • Systems-based practice

Educational Goals for the CA-1 Year (0-6 months)

Medical Knowledge: 

  • Basics of the anesthesia machine and routine monitors
  • Basics of neuromuscular blockade
  • Routine use of vasoactive medications
  • Indications for the use of routinely used anesthetic drugs
  • Major cardiovascular and respiratory effects of routinely used anesthetic drugs
  • Key preoperative evaluation (patient history, physical exam, laboratory results)
  • Understand universal precautions
  • ACLS certification

Patient Care:

Cognitive objectives:

  • Manage ASA 1 patients for uncomplicated cases with minimal assistance       (induction, maintenance, emergence, and initiation of PACU stay)
  • Reliably and competently perform postoperative visits and demonstrate the proper assessment and management of common anesthetic complications
  • Estimate and administration of fluid requirements (blood, colloid, crystalloid) in routine cases
  • Identify and treat with faculty assistance basic intraoperative complications (e.g.- hypoxemia, hypotension, hypertension, arrhythmias, anuria)
  • Identify indications/contraindications and key physical landmarks for SAB, epidural placement, and regional nerve blocks.  Become familiar with the use of ultrasound guidance techniques with faculty assistance.
  • Identify indications/contraindications and key physical landmarks for the placement of invasive intravascular cannulation for monitoring purposes (arterial pressure monitoring, CVP, PA catheter, TEE) with faculty assistance

Technical skills:

  • Set up and check equipment for a routine case in a reasonable amount of time
  • Perform mask ventilation and routine tracheal intubation in straight forward airways
  • Perform peripheral and central intravenous cannulation and arterial lines with minimal assistance
  • Operate basic technical monitors and pressure transducers; check for malfunctions
  • Maintain legible, accurate and concise preoperative, intra-operative and post-operative records

Interpersonal and Communication Skills:

  • Communicate effectively with patients
  • Communicate effectively with surgeons, nurses, and other healthcare professionals to provide patient-focused care
  • Present concise, organized case presentation, including management concerns, to faculty
  • Formulate anesthetic management for ASA 1-3 patients for moderately complex surgery

Practice-based Learning and Improvement:

  • Meet ASA standards for monitoring and patient care
  • Residents must be able to evaluate and critique their patient care practice appraise and assimilate scientific evidence to make informed decisions and to improve their patient care.  Instruments include, but are not limited to, didactic lectures, textbooks, journal articles (including articles presented at monthly journal club), and faculty mentoring of clinical judgment
  • Use information technology to manage information, access on-line information, and support their own education
  • Participate in departmental quality assessment conferences

Professionalism: 

  • Residents will demonstrate commitment to undertaking and performing professional responsibilities
  • Maintain and demonstrate respect, compassion, and integrity
  • Demonstrate responsiveness to the needs of patients and society
  • Accountability to patients, society and the profession
  • Commitment to ethical principles regarding provision or withholding of clinical care
  • Confidentiality of patient information, informed consent
  • Demonstrate sensitivity and responsiveness to patient’s culture, age, sex, and disabilities

Systems-based Practice:

  • Learn and understand how types of medical practice and delivery systems differ from one another, including resource allocation and cost control
  • Apply systems-based data in resource allocation for patient assessment and management
  • Practice cost-effective healthcare and resource allocation without compromise of patient care
  • Participate in department quality assessment conferences
  • Understand how their patient care and other practices affect other health care professionals, the healthcare delivery system, and society at large, and how they in return affect their own practice

 

Educational Goals for the CA-1 Year (6-12 months).  In addition to the above, the following are expected:

Medical Knowledge:

  • Diagnose and assess significant cardiovascular events (e.g.- caval compression by surgeons, hypovolemia, pulmonary embolization, ischemia, myocardial depression et al.)
  • Describe basic aspects of neuroanesthesia (effect of anesthetic drugs, management of increased ICP, etc), cardiovascular anesthesia (effect of aortic cross-clamping, pharmacologic management, etc), and orthopedic anesthesia (patient positioning, peripheral nerve blocks for post-op pain management, etc)
  • Describe basics of obstetric anesthesia (physiology of pregnancy, patient positioning, techniques for elective C-section, etc)
  • Interpret and apply data from pulmonary artery catheterization, discuss indications for and complications of use
  • Pass USMLE Step 3 by the end of the CA-1 year
  • Pass ABA/ASA In-training Exam with a minimum percentile = 30

Patient Care:

Cognitive objectives:

  • Manage difficult airways with close supervision for elective surgery
  • Perform emergency airway management utilizing a rapid sequence induction in the OR, ICU, and emergency department with supervision
  • Manage ASA 3 patients for uncomplicated surgery with staff assistance
  • Initiate management of trauma (airway management, intravascular access, monitoring) and other emergency cases with staff assistance
  • Manage massive blood transfusion and identify and manage complications
  • Manage PACU cases with supervision, including admission assessment, diagnosis and management of airway, ventilatory, and hemodynamic problems, and discharge assessment.

Technical skills:

  • Assemble and balance transducers without assistance
  • Perform central and arterial cannulation with supervision and occasional assistance
  • Perform spinal and epidural anesthesia and peripheral nerve blocks with supervision or occasional assistance in most patients
  • Perform intubation in patients with difficult airways utilizing a fiberoptic bronchoscope, McGrath laryngoscope and other specialized instruments

Interpersonal and Communication Skills:

  • Cogently discuss management of ASA 3 patients with anesthesiology faculty and with surgeons
  • Defend choice of monitoring techniques
  • Defend selection of anesthetic technique and drugs, and discuss options
  • Work with and teach medical students

 

Educational Goals for the CA-2 Year.  In addition to the above, the following are expected:

Medical Knowledge:

  • Identify pathophysiology and anesthetic concerns associated with basic and complex pediatric cases
  • Discriminate between specific obstetric syndromes and their anesthetic implications and management
  • Define the requirements for routine open heart surgical procedures and the implications of cardiopulmonary bypass
  • Demonstrate indications for and benefits of individual vasoactive and anesthetic drugs
  • ACLS recertification, if required
  • Pass ASA/ABA In-training Exam with minimum percentile = 30

Patient Care:

Cognitive Objectives:

  • Manage medical diseases in surgical patients (pulmonary, cardiovascular, endocrine, renal)
  • Manage routine pediatric, vascular, thoracic, and neurosurgical cases with minimal faculty assistance

Technical skills:

  • Perform spinal, lumbar epidural and thoracic anesthesia in patients with extremes of body habitus
  • Insert peripheral IV’s in pediatric patients greater than 2 years of age
  • Perform peripheral nerve blocks with minimal faculty assistance
  • Insert central venous and pulmonary artery catheters with supervision and occasional assistance
  • Manage acute post-operative pain

Interpersonal and Communication Skills:

  • Cogently discuss management plan with faculty, surgeon and consultants of patients
  • Review the literature and provide leadership in discussions with junior residents and at journal club
  • Analyze critical events and describe management reasonably well on practice oral board exam
  • Organize and present lectures to faculty and residents at teaching conferences
  • Actively teach medical students

 

Educational Goals for the CA-3 Year.  In addition to the above, the following are expected:

Medical Knowledge: 

  • Demonstrate principles of all major subspecialties in depth
  • Recognize and discuss important articles in recent medical literature
  • Complete an academic project per ACGME requirements and with faculty consultation

Patient Care:

Cognitive Objectives:

  • Manage independently, with faculty availability and administrative presence, ASA 4 patients for complex elective and emergency surgery
  • Manage patients with acute and chronic pain
  • Perform complex PACU care with faculty availability
  • Manage complex medical problems in the OR and ICU with faculty availability

Technical skills:

  • Perform uncomplicated transesophageal echocardiography monitoring with minimal supervision
  • Perform all previously mentioned procedures with clinical independence and administrative supervision only

Interpersonal and Communication Skills:

  • Meet ABA criteria for a consultant in anesthesiology
    • Organize information and express yourself clearly
    • Demonstrate sound judgment in decision-making and application
    • Synthesize and apply basic scientific principles to clinical problems
    • Demonstrate adaptability to rapidly changing clinical situations
  • Supervise and mentor medical students
  • Actively teach fellow residents
  • Supervise junior residents who are on call, along with faculty

 

 

 

           

Last Updated: 3/22/15