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Stanford University Anesthesiology Residency Program
Rotation Goals, Objectives and Assessment for Residents
Core Curriculum for Ambulatory Anesthesia Rotation
Duration: 2 weeks
Rotation Director: Suma Ramzan MD
Philosophy and Description:
The Ambulatory Anesthesia Rotation at Stanford University Medical Center offers a broad experience in issues specific to the outpatient setting. The ambulatory setting involves a unique approach to the practice of anesthesia. The resident will become acquainted with and develop skills in the practice of ambulatory anesthesia. Senior (CA 2 and 3) level residents are eligible for this 2 week rotation. Residents will work in the Ambulatory Surgery Center (ASC) operating rooms. Supervision will be provided by the attending anesthesiologist who is the ASC scheduler for the day. Resident attendance at the departmental afternoon weekly lecture series and morning grand rounds is expected. It is also expected that residents spend time outside of clinical work for independent reading. Journal articles related to anesthesia for ambulatory surgery will be provided for review.
The resident clinical experience will include:
Management of a minimum of 30 patients undergoing ambulatory surgery including 10 general anesthetics emphasizing rapid emergence and 10 monitored-anesthesia-care cases ranging from anxiolysis to deep sedation.
Involvement in the management of acute postoperative pain, including familiarity with intravenous techniques, oral pain medication and other pain-control modalities.
Supervision of a junior resident during a minimum of 2 days, including discussing an anesthetic plan, and guiding and teaching the junior resident in patient care.
Understanding the dynamic management and scheduling issues unique to an ambulatory surgical center.
Modality for Resident Performance Assessment:
Residents will be evaluated in the 6 core competencies (medical knowledge, patient care, interpersonal and communication skills, professionalism, practice based learning and improvement, and systems based practice) using specific web-based evaluation forms completed by supervising faculty. Evaluation will occur at the end of the 2-week rotation. Residents must keep an accurate online log of procedures performed. An outline of core competencies with rotation objectives, instructional activities, and evaluations is outlined below in more detail.
A. Self Assessment
The resident checks off each criterion below as the material is mastered. Self reflection on your own competencies is expected.
B. Faculty Assessment
The rotation director faculty will review your self assessment, your written projects and your evaluation by the nurses.
Modified from the SAMBA Curriculum Guidelines for The Anesthesia Resident Rotation in Ambulatory Anesthesia written and approved by the Society for Ambulatory Anesthesia (SAMBA) Education Committee on November 15, 2005.
Specific Goals and Objectives For Ambulatory Anesthesia Residents
GOALS
Core CompetenciesOBJECTIVESINSTRUCTIONAL ACTIVITIESEVALUATION
ASSESSMENTMedical Knowledge:
Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others, and apply an open-minded, analytical approach to acquiring new knowledge. The resident will access and critically evaluate current medical information and scientific evidence, and apply this knowledge to clinical problem solving, clinical decision making, and critical thinking.Evaluate patients and assume progressive responsibility in a supervised setting.
Demonstrate competence in assessing patients rapidly in the ambulatory perioperative settings.
Demonstrate the skills required to recognize patients requiring immediate intervention.
When appropriate, demonstrate the skills necessary for resuscitation, intubating difficult airways and stabilization of patients.
Discuss the concept of preemptive analgesia and how to implement it in the ambulatory setting.
Discuss appropriate choices and techniques of neuraxial anesthesia to minimize time to discharge and post-anesthetic complications (e.g., spinal headache).
Discuss the utility of depth of anesthesia monitoring in the ambulatory setting.
Discuss the pharmacology of rapidly acting agents, including opioids, sedative-hypnotics, volatile anesthetics and muscle relaxants.
Describe various techniques of IV sedation.
Discuss techniques of general anesthesia to minimize post-operative problems (e.g., sedation, pain, shivering, nausea, unplanned admission).
Define criteria for PACU bypass, PACU discharge and discharge from the same-day recovery unit.
Explain the importance of turnover time and personnel management in the successful operation of an ambulatory surgery center.
Describe techniques and procedures to minimize "down time" of the operating room and of the surgical staff.
Discuss the difference between "home-readiness" and "street fitness."
Differentiate between freestanding, hospital-affiliated and hospital-based surgery centers.
Discuss protocols for handling unplanned admission, acute emergencies and emergency hospital transfer.
Discuss the role of the anesthesiologist in office-based anesthesia practice.
Describe state, local and federal guidelines for regulation of office-based surgery and anesthesia.
Discuss the role of the medical director of an ambulatory surgery center. J o u r n a l A r t i c l e s
I n t r a o p t e a c h i n g b y a t t e n d i n g
P r e o p a n d P o s t O p N o t e
W e e k l y , R e s i d e n t L e c t u r e s
G r a n d R o u n d s
J o u r n a l C l u b
A n n u a l S t a n f o r d A n e s t h e s i a R e s i d e n t R e f r e s h e r C o u r s e ( A S A R R C )
C M E C o n f e r e n c e c h o s e n b y r e s i d e n t
F a c u l t y R o t a t i o n E v a l u a t i o n s h t t p s : / / s t a n f o r d . m e d h u b . c o m )
R e v i e w o f p r e s e n t a t i o n
A K T 6
P r a c t i c e o r a l e x a m s
A n n u a l i n - t r a i n i n g e x a m
D i s c u s s i o n w i t h a t t e n d i n g r e g a r d i n g p r o p h y l a c t i c t r e a t m ent of patients for PONV and check in PACU for successful prevention
Evaluation by attending of residents turnovers
Observation by attending of placement of LMA successfully within 5 minutes from induction and use of airway devices to successfully intubate patients.
Discussion with attending regarding patient care issue related specifically to ambulatory surgery
Discuss pros and cons of neuraxial anesthesia in ASC
Supervised use of awareness monitoring in ASC
Conduct IV sedation on patients without patient feeling discomfort/pain while maintaining spontaneous ventilation
Reflection and discussion of things you can do to improve PACU discharge and things that result in patient admission after same day surgery.
Completion of checklist
GOALS
Core CompetenciesOBJECTIVESINSTRUCTIONAL ACTIVITIESEVALUATIONASSESSMENTPatient Care:
The resident will provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, and the treatment of disease.. Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures.
Identify the main aspects of the history and physical examination relevant to patients undergoing surgery in the ambulatory setting and determine appropriate laboratory tests.
Select patients for ambulatory anesthesia and assess the severity of common diseases including, but not limited to hypertension, renal disease, neurological disorders, cardiovascular disease, diabetes, pulmonary disease and obesity.
Make recommendations about preventive, diagnostic and therapeutic options and interventions that are based on judgment, scientific evidence, and patient preference.
Discuss with patients the risks and benefits of regional and general anesthesia and monitored anesthesia care, especially as they pertain to their condition and surgery.
Develop, negotiate and implement effective patient management plans and integration of patient care.
Disc u s s , n e g o t i a t e a n d i m p l e m e n t p r e o p e r a t i v e p r e p a r a t i o n , i n c l u d i n g u s i n g p s y c h o l o g i c a l p r e p a r a t i o n , a n x i o l y t i c s , o p i o i d s , a n t a c i d s a n d a n t i e m e t i c s .
D i s c u s s , n e g o t i a t e a n d i m p l e m e n t p r e e m p t i v e a n d m u l t i m o d a l a n a l g e s i a a n d a n t i e m e t i c t e c h n i q u e s . J o u r n a l a r t i c l e s
I n t r a o p t e a c h i n g b y a t t e n d i n g
G r a n d R o u n d s
A S A R R C
C M E c o n f e r e n c e c h o s e n b y r e s i d e n t F a c u l t y R o t a t i o n E v a l u a t i o n s
A S C N u r s i n g S t a f f E v a l u a t i o n
D i s c u s s i o n w i t h a t t e n d i n g r e g a r d i n g m e d i c a l p r oblems discovered in the preop evaluation that affect your anesthesia management when conducting a same day surgery
Discussion with attending to list the the pros and cons of regional v.s. general anesthesia for ambulatory surgery
Observation by attending of preop, intraop and postop care of patients.
GOALS
Core CompetenciesOBJECTIVESINSTRUCTIONAL ACTIVITIESEVALUATION
ASSSESSMENTEffective Interpersonal and Communication skills:
To demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals
Demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and members of their and other health care teams.
Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.
Use effective listening, questioning, narrative and nonverbal skills to communicate with patients and families.
Interact with consultants and referring physicians in a respectful, appropriate manner.
Maintain comprehensive, timely, and legible medical records.
Give appropriate discharge and follow up instructions to patients and their families.
Perform evaluations of the attending staff and rotation. M o d e l i n g b y F a c u l t y
I n - S e r v i c e T a l k
G r a n d R o u n d s
A n e s t h e s i a C r i s i s R e s o u r c e M a n a g e m e n t ( A C R M )
F a c u l t y R o t a t i o n E v a l u a t i o n s
A S C N u r s i n g S t a f f E v a l u a t i o n
E v a l u a t i o n b y a t t e n d i n g
E v a l u a t e p r e s e n t a t i on.
Review nurses 360 evaluation on residents
Observation by attending of a timeout performed by resident and nurses.
Observation by attending of residents participation with patient positioning and communication with surgeons regarding any issues.
Review cases with attending
Completion of checklist
GOALS
Core CompetenciesOBJECTIVESINSTRUCTIONAL ACTIVITIESEVALUATION
ASSESSMENTPractice based learning and improvement:
To demonstrate practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvement in patient careUse scientific evidence and methods to investigate, evaluate, and improve patient care practices and demonstrate this by referring to the appropriate literature.
Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care.
Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice.
Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care.
Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. To this end, the resident will demonstrate the ability to use the available inter- and intranet resources (e.g., Medline and hospital-based IT services)
I n t r a o p t e a c h i n g b y a t t e n d i n g
J o u r n a l a r t i c l e s
G r a n d R o u n d s
F a c u l t y R o t a t i o n E v a l u a t i o n s
R e v i e w o f P r e s e n t a t i o n
E v a l u a t i o n b y a t t e n d i n g a n d d i s c u s s i o n d u r i n g c a s e s
R e f l e c t o n t h i n g s y o u l e a r n e d t h a t y o u n e e d to improve on
Completion of checklist
GOALS
Core CompetenciesOBJECTIVESINSTRUCTIONAL ACTIVITIESEVALUATION
ASSESSMENTSystems-based Practice:
To 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 valueDemonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.
Access and utilize the resources, providers and systems necessary to provide optimal care.
Identify the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient.
Apply evidence-based, cost-conscious strategies to prevention, diagnosis and disease management.
Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve s y s t e m a t i c p r o c e s s e s o f c a r e
M o d e l i n g b y F a c u l t y
C o l l a b o r a t i o n w i t h n u r s e s a n d n u r s i n g m a n a g e m e n t
G r a n d R o u n d s
F a c u l t y R o t a t i o n E v a l u a t i o n s
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Discussion about common reasons for unexpected hospitalization of ambulatory surgical patients.
Define the concepts of fast-tracking and home readiness
Complete checklist
GOALS
Core CompetenciesOBJECTIVESINSTRUCTIONAL ACTIVITIESEVALUATION
ASSESSMENT
Professionalism:
To demonstrate a commitment to professional responsibilities, adherence to ethical principles, and sensitivity to diversity. Demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession and society.
Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues.
Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues.
Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.
Recognize and identify deficiencies in performance and give constructive feedback. They will demonstrate this in their evaluations of medical students and faculty.
M o d e l i n g b y f a c u l t y
S e l f - D i r e c t e d R e a d i n g
P r e s e n t a t i o n
G r a n d R o u n d s
F a c u l t y R o t a t i o n E v a l u a t i o n s
A t t e n d a n c e a t L e c t u r e s
U p d a t i n g C a s e L o g s
C o m p l e t e d o c u m e n t a t i o n
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