Goals and Objectives. Assessment Methods/Tools

Transcription

1 CA-3 CARDIOVASCULAR ANESTHESIA ROTATION Minneapolis Veterans Administration Medical Center (VAMC) Rotation Site Director: Dr. Karen Ringsred Rotation Duration: 4 weeks Introduction: The patients at the Veteran s Administration (VA) Hospital are a unique group. They are usually elderly, male and commonly have a variety of serious medical conditions including significant cardiac and pulmonary disease. The VA therefore can be beneficial for the CA-3 resident in fine-tuning their skill in providing anesthesia for the geriatric population. GOALS: o To expand training of residents who are capable of providing high quality anesthesia care based on principles of teamwork and collaboration for specific population of elderly men, with multiple co-morbidities undergoing cardiovascular, thoracic, urologic and orthopedic surgery ; o To expand the training residents who use the model and life-long learning principles in providing high quality care to VA patients with special emphasis on fine-tuning preoperative assessment and preparation of geriatric patients for anesthesia, intraoperative, postoperative care and clinical management and teaching of physiologic changes related to cardiovascular procedures. Approximate Training Level Assessment Methods/Tools OBJECTIVES (by ACGME Competency) Patient Care Clinical Skills and Reasoning: o Expertly uses clinical skills of interviewing and physical examination to perform a thorough preoperative assessment of geriatric patient undergoing complex cardiac, vascular, thoracic, urologic and orthopedic surgery (mechanism to complex overt response) o Formulates a safe anesthetic management and monitoring plan for this patient population with confidence (mechanism to complex overt response) o Direct Observation o Simulation o Chart- review o Case logs Page 1 of 6

2 o Formulates a regional anesthetic plan when appropriate for the VA patient population (mechanism to complex overt response) o Expertly formulates and discusses postoperative management plan for a geriatric patient with multiple co-morbidities (mechanism to complex overt response) o Independently able to interpret hemodynamic data and waveforms, basic TEE images, ABG and other laboratory results and make appropriate adjustments in management plan (mechanism to complex overt response) Technical/Device Related Skills o Independently prepares anesthesia work area including all monitoring devices and medication administration devices for a complex case such as cardiac, major vascular, thoracic surgery in an organized, systematic fashion (complex overt response) Patient Management o Confidently performs and teaches placement of invasive monitors with minimal staff supervision: arterial, central line, pulmonary artery catheter, TEE (complex overt response) o With minimal staff involvement and intervention provides safe anesthetic management for patients undergoing procedures such as coronary artery by-pass surgery, valvular surgery, thoracic aortic surgery, carotid endarterectomy and stenting and other major vascular surgery (mechanism to complex overt response) o Skillfully monitors patient undergoing procedures with extracorporeal circulation (mechanism to complex overt response) o Skillfully manages separation from cardiopulmonary bypass with minimal help (mechanism to complex overt response) o Independently manages coagulation issues and blood component therapy (complex overt response) o Diagnoses, monitors and treats perioperative myocardial ischemia, cardiac arrhythmia, left and right ventricular failure, acute pulmonary dysfunction (mechanism to complex overt response) o Direct Observation o Simulation o Chart- review o Case logs Page 2 of 6

3 o Safely and efficiently transports and transfers care to a secondary provider (perception to complex overt response) Medical Knowledge o Confidently discusses cardiac physiology, coronary anatomy and physiology, preoperative cardiac evaluation, cardiovascular pharmacology, anesthetic pharmacology during cardiac surgery, anesthesia for myocardial revascularization with assessment of coronary artery disease, preoperative risk, associated disease assessment goals and choices of anesthetic management, premedication, hemodynamic monitoring, induction, maintenance, type of conduits and techniques, myocardial protection, complications, anesthesia for valvular surgery, extracorporeal anesthesia (application, analysis) o Expertly discusses postoperative management of cardiac patients fast-track surgery, glycemic control, complications of cardiac surgery, reoperation for bleeding, pain management (application, analysis) o Expertly discusses anesthesia for vascular surgical procedures aortic dissection, thoracic aneurysm, coarctation of aorta (application, analysis) o Confidently describes CNS protection, spinal cord protection, deep hypothermic circulatory arrest (application, analysis) o Discusses anesthesia for major vascular surgery, pathophysiology for major vascular disease, preoperative evaluation, risk assessment and risk reduction, anesthesia for carotid endarterectomy (general versus regional anesthesia, intraoperative blood pressure management, monitoring of cerebral perfusion, postoperative complications), abdominal aortic reconstruction, endovascular abdominal aortic aneurysm repair (application) o Expertly discusses management of a patient undergoing thoracic procedures, physiologic changes that occur during one-lung ventilation and thoracoscopic surgery (application, analysis) o Introductory lecture series test o Anesthesia knowledge test o Annual in-training examination o Informal oral questioning o Simulation o Oral case presentations Page 3 of 6

4 o Confidently describes regional anesthesia and analgesia approach for a VA patient undergoing different types of procedures including thoracic, vascular, orthopedic and urologic surgeries (application, analysis) Practice Based Learning and Improvement o Discusses and reviews differences between the management at VA medical facilities and other health care organizations they have encountered discusses pros and cons (valuing) o Independently recognizes importance of identifying own learning deficits, developing a learning plan and carry it out, seeks feedback, is confident in literature search techniques and able to analyze obtained literature with confidence (valuing to internalizing) o Analyzes own practice and determines ways in which they can improve the practice (analysis, valuing) Interpersonal and Communication Skills o Written essay describing an analysis of patient management (areas of deficiencies, room for improvement) o Immediate formative feedback from attending o Direct observation o Journal club presentations and case presentations o Develops and improves communication skills with geriatric o Direct observation population and their families (valuing) with patient o Use and promotion of effective listening, questioning, and o Direct observation in explanatory skills in gathering information from patients and in providing information to patients, families, the public, and other health care providers (valuing, organizing, internalizing) o Uses expert skills to effectively and efficiently communicates pertinent patient information to a secondary care provider (valuing, organizing, internalizing) simulation o 360 global rating o Learner classroom presentation Page 4 of 6

5 o Promotes, encourages and emphasizes skills in working as a member of a patient care team including other physicians, nurses, perfusionist, other health care professionals, social workers, and volunteers (valuing to internalizing) o Maintain comprehensive, timely, and legible medical records (valuing to internalizing) Professionalism o Promotes and teaches awareness and management of his/her own values and attitudes, which might interfere with appropriate patient care specific to management of cardiac and vascular patient (receiving to valuing) o Promotes responsiveness to and management of issues that relate to socio-cultural aspects of family life, and social adjustment related to ethnicity, religion, culture, gender or sexual preference (receiving to valuing) o Demonstrates consistent and intentional compassion, honesty, integrity and respect for others in all professional activities (receiving to valuing) System Based Practice o direct observation o 360 o Describes and understands the unique VA system where veterans receive medical care (mechanisms) o Promotes, encourages others to develop well versed interprofessional o direct observation o 360 o M&M conference teams to increase patient safety and quality of care (perception to complex overt response) presentation with system analysis o Independently coordinates patient care in the settings of cardiac surgery (perception to complex overt response) o Discuss system-based problems as they pertain to patient care at M&M conferences (knowledge to analysis) Page 5 of 6

6 Scholarly/Research Activities Reading Requirements The resident should read the following chapters while taking the rotation: Text: Chapters: Assessments The resident will receive a summative written evaluation form at the end of the rotation from the Site Director, as well as verbal feedback informally throughout the rotation. The case-logs of the resident will also be evaluated periodically by the clinical competency committee for the number and type of procedures and anesthetic techniques entered to ensure they are obtaining adequate experience. Notes Page 6 of 6