CLINICAL ANESTHESIA (PGY-1, PGY-2, PGY-3/CA-2)

CORE CURRICULUM/GENERAL COMPETENCIES FOR GME

OVERVIEW, LEARNING OBJECTIVES AND EDUCATIONAL METHODOLOGY

 

OVERVIEW:

In addition to discipline-specific proficiencies required of anesthesiology residents, the ACGME has identified a set of generic educational requirements (general competencies) that must be provided by all residency training programs.  The residency program must require its residents to develop the competencies in six areas to the level expected of a new practitioner.  These competencies include:  Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-based Practice.  Didactic and clinical experiences designed to facilitate the residents’ attainment of basic competencies in each of these core requirements are integrated throughout the PGY1-4 years of training.  Learning objectives for each core requirement are based on ACGME goals identified in “ACGME Outcome project, general competencies” modified as appropriate for the Anesthesiology Residency. Specific goals for each rotation are also competency based.

 

Residents are expected to participate fully in the educational and scholarly activities of this program and, as required, assume responsibility for teaching and supervising other residents and students. Each resident should develop a personal program of learning to foster continued professional growth with guidance from teaching staff.

 

LEARNING OBJECTIVES/EDUCATIONAL METHODOLOGY:

 

1.         PATIENT CARE

 

                OBJECTIVES:

                Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

·         Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.

·         Gather essential and accurate information about their patients

·         Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.

·         Develop and carry out patient management plans.

·         Counsel and educate patients and their families.

·         Use information technology to support patient care decisions and patient education.

·         Perform competently all medical and invasive procedures considered essential for the area of practice (including basic and advanced airway management, regional anesthesia techniques and invasive monitoring techniques).

·         Provide health care services aimed at preventing health problems or maintaining health.

·         Work with health care professionals, including those from other disciplines, to provide patient-focused care.

·         Meet specific patient care objectives as outlined for each anesthesiology rotation.

 

EDUCATIONAL METHODOLOGY:

These broad patient care competencies are addressed in every facet of the Anesthesiology Residency Curriculum, including an extensive didactic program and clinical teaching.  Faculty provide instruction, supervision and serve as role models in the clinical setting.  In addition to patient care skills acquired in the clinical setting, residents are expected to participate in case conferences, problem based learning discussions and Morbidity & Mortality (M & M) conferences, and patient simulator scenarios which allow the resident to demonstrate thought processes and information technology used to develop patient management plans and support patient care decisions.  Learning objectives for each anesthesiology rotation include specific patient care competencies relevant to that rotation.

 

 

2.         MEDICAL KNOWLEDGE

 

OBJECTIVES:

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.  Residents are expected to:

·         Demonstrate an investigatory and analytic thinking approach to clinical situations.

·         Know and apply the basic and clinically supportive sciences, which are appropriate to their discipline.

·         Successfully meet the specific medical knowledge learning objectives provided for each anesthesiology rotation.

·         Demonstrate the ability to critically assess the medical literature.

 

EDUCATIONAL METHODOLOGY:

Didactics include a program of faculty lectures, problem-based learning, small groups, case conferences, M & M conferences, Mock Oral Exams and Journal Clubs.  Formal didactics are held daily, for an average of five hours per week.  The curriculum includes lectures covering fundamental and advanced anesthesia theory and practice, physiology, pharmacology, ethical issues, quality assurance issues and a business block.  The curriculum topics are based on the American Board of Anesthesiology (ABA) American Society of Anesthesiology/ (ASA) Joint Council on In-Training Exams Content Outline, and the ACGME general competencies.

 

Evaluation of individual resident’s medical knowledge and application of knowledge to patient care is based on yearly In-Training Exam scores, Anesthesia Knowledge Tests (AKT), monthly and semiannual summative clinical knowledge evaluations, quality of participation in case conferences and PBLDs, and oral exams.

 

3.         PRACTICE-BASED LEARNING AND IMPROVEMENT

 

OBJECTIVES:

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.  Residents are expected to:

·         Analyze practice experience and perform practice-based improvement activities using a systematic methodology.

·         Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.

·         Obtain and use information about their population of patients and the larger population from which their patients are drawn.

·         Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.

·         Use information technology to manage information, access on-line medical information, and support their education.

·         Facilitate the learning of students and other health care professionals.

 

EDUCATIONAL METHODOLOGY:

M & M/Quality Assurance conferences provide a formal structure for analysis of patient care outcome data and identification of trends or system issues that may be changed to improve patient care.  Residents are “debriefed” after patient simulator sessions and faculty facilitate identification of critical incidents and scientifically based patient care algorithms to prevent incidents or improve patient outcomes when managing specific critical incidents.

 

Didactic program includes basic introduction to statistics.  Residents may elect to attend the General Clinical Research Center (GCRC) courses for more in-depth instruction.  A six-month “clinical scientist track” is available as an elective for PGY-4’s interested in in-depth exposure to academic research and scientific investigation.  Residents critically review current literature with faculty guidance at a monthly Journal Club.  Residents are encouraged to review relevant studies and journal articles for each anesthesiology subspecialty and are expected to be able to access on-line medical information.

 

Residents are assigned to teach clinical skills to medical students, junior anesthesiology residents, rotating residents from other specialties and EMT students under faculty supervision.  PGY-4 residents each prepare and present a formal lecture on a topic approved by a faculty mentor to residents and faculty, incorporating current scientific evidence and literature.

 

4.         INTERPERSONAL AND COMMUNICATION SKILLS

 

OBJECTIVES:

                Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patient’s families, and professional associates.  Residents are expected to:

·         Create and sustain a therapeutic and ethically sound relationship with patients.

·         Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills.

·         Work effectively with others as a member or leader of a health care team or other professional group.

 

EDUCATIONAL METHODOLOGY:

Faculty serve as role models in the clinical setting.  Faculty observe and critique residents’ interview skills during preoperative patient assessments in the Day Surgery Pre-op Clinic. SICU faculty observe and critique residents’ communication skills as member of interdisciplinary care team and interactions with patients and families in stressful situations.  Faculty review resident’s pre-op notes, anesthesia records, and progress notes (post-anesthetic, SICU notes, PACU notes, intubation notes) for completeness and accuracy.

 

 

5.         PROFESSIONALISM

 

OBJECTIVES:

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.  Residents are expected to:

·         Demonstrate respect, compassion, and integrity, responsiveness to the needs of patients and society that supersedes self-interest, accountability to patients, society, and the profession, and a commitment to excellence and on-going professional development.

·         Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.

·         Demonstrate sensitivity and responsiveness to patient’s culture, age, gender, and disabilities.

 

EDUCATIONAL METHODOLOGY:

An ethics lecture/case conference, approved for CME credit in ethics and risk management, is scheduled approximately once every year as part of formal didactic schedule.  Residents are encouraged to discuss ethical issues with faculty as they present during clinical patient care.  All residents are required to attend a yearly conference on substance abuse/impaired physicians.  Significant others are also invited to attend. Medical Ethics is incorporated into the didactic program, including ethics based lectures, case conferences and PBLDs.

 

Faculty serve as role models of professional behavior.

 

Residents maintain a portfolio of scholarly activities to help track their professional growth and development.  This is used as a tool to encourage self-directed learning and goal setting.

 

6.         SYSTEMS-BASED PRACTICE

 

OBJECTIVES:

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.  Residents are expected to:

·         Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.

·         Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.

·         Practice cost-effective health care and resource allocation that does not compromise quality of care.

·         Advocate for quality patient care and assist patients in dealing with system complexities.

·         Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.

 

EDUCATIONAL METHODOLOGY:

Medical practice issues are addressed in a formal “Business Block”.  The “Business Block” includes a series of formal lectures and small group discussions (approximately 23 contact hours) that are repeated every two years.  The ASA handbook “Starting Out: A Practice Management Guide for Anesthesiology Residents” serves as a textbook for the Business Block.  Residents are required by the UT system to complete 5 hours of risk education every year, including a four-hour Risk Management Workshop at UTMB. Residents must also complete an online risk management course offered through Education in Legal Medicine (ELM) Exchange, Inc at least once during their residency.  Medical Practice Issues are encountered daily in the clinical setting and residents learn by observation of and discussion with faculty and reference-based learning. In addition, online resources are available from the ASA website (Resident Practice Management Education) that includes the handbook as well as several lectures that can be viewed by the resident.

 

Residents are encouraged to practice cost-effective, high quality health care through role modeling by faculty and didactic sessions.  Didactics include awareness of anesthetic drug/equipment cost vs. benefit and responsible selection of preoperative workup (lab tests, EKG, stress tests, etc).

 

Many residents select senior projects that relate to effective Systems Based Practice and Quality Improvement. The Department QI Committee includes a resident member and other residents are recruited to be involved in departmental QI projects.

 

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