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AMBULATORY
ANESTHESIA
NEUROANESTHESIA
OBSTETRIC ANESTHESIA
PEDIATRIC
ANESTHESIA
TRANSITION TO PRACTICE ROTATION (3 months -
Required CA-3 level Rotation)
Rotation:
Ambulatory Anesthesia - Advanced Clinical Track
Type:
CA-3 Elective
Duration: 1 month
Faculty: F. Kayser Enneking, MD
Prerequisite:
The advanced curriculum compliments the complex clinical anesthesia assignments
that the ABA categorizes as "Advanced Anesthesia Training" and would be
limited to the CA3 trainee.
In addition to the core goals and
objectives, the following activities are designed for CA3 residents to
foster and develop interest in ambulatory anesthesia:
1. Completely read one textbook
on ambulatory anesthesia.
2. Prepare and present a case or
cases related to ambulatory anesthesia in the departments case conference.
3. Participate in an ambulatory
anesthesia journal discussion.
4. Prepare a talk or a lecture
on a specific topic related to ambulatory anesthesia.
5. Select chapters and relevant
topics from Wetchler's Anesthesia for Ambulatory Surgery, and White's Outpatient
Anesthesia.
6. Observe or practice ambulatory
anesthesia in a free-standing facility as well as in a hospital-based facility.
CA-3 residents will be given more
independence in deciding anesthetic approaches to the ambulatory patients
under his or her care. In addition, they will have greater responsibilities
in the preoperative evaluation of ambulatory patients and in any decisions
as to whether the patient is an appropriate candidate for ambulatory surgery.
CA-3 residents will be given preference for the more challenging pediatric
cases and for the adult patients appropriate for regional anesthesia. The
faculty member responsible for these rotations is Dr. Enneking.
Rotation:
Neuroanesthesia - Advanced Clinical Track
Type:
Elective
Duration: 1 month
Faculty: Michael E. Mahla, MD
Prerequisites:
Successful completion of clinical base year, CA-1 and CA-2 years.
Residents doing an Advanced Clinical
Track during their CA-3 year may elect to do additional months of neuroanesthesia
beyond those completed during their CA-2 year.
Goals: In addition to those outlined
for the basic rotation in Neuroanesthesiology:
A. Expand the knowledge base with
regards to CNS physiology and pharmacology and
pathophysiology developed during
CA-1 and CA-2 years.
B. Develop clinical judgement to
provide anesthetic care for more complex neurosurgical procedures.
C. Develop technical skills necessary
to conduct more complex neurosurgical cases.
Objectives: In addition to those
outlined for the basic rotation in Neuroanesthesiology:
A. Be able to complete a thorough
preoperative evaluation for all neurosurgical patients,
recognizing impact of neurologic
disease state on perioperative management. For routine neurosurgical procedures,
accomplish preoperative preparation independently, and for complex procedures
with assistance from attending neuroanesthesiologist.
B. Plan and carry out anesthetics
for routine neurosurgical procedures with minimal assistance from the neuroanesthesia
attending physician.
C. Perform anesthetics for complex
neurosurgical procedures with assistance from the attending neuroanesthesiologist.
D. Perform all invasive monitoring
techniques and interpret information obtained reliably.
E. Understand impact of neurophysiologic
monitoring on perioperative course.
Evaluation
1. Perioperative care of each patient
will be discussed daily with attending neuroanesthesiologist.
2. At the end of the month rotation,
the neuroanesthesiology group will meet to evaluate overall performance.
The results of this evaluation will be explained to you in a letter.
3. Neuroanesthesiology attendings
will complete Departmental Resident Evaluation Forms.
4. You will complete a Departmental
Rotation Evaluation Form.
5. Dr. Mahla is the faculty member
responsible for these rotations.
Resources: As described in basic
Neuroanesthesiology Rotation
ROTATION:
Obstetric Anesthesia, Advanced Clinical Track
TYPE:
Elective
DURATION:
1, 2, or 3 months
FACULTY: Michael Froelich, MD
PREREQUISITES:
Completion of clinical base year, CA1 and CA2 years
One to three months of additional
experience in OB anesthesia is available to the CA3 resident. A resident
may take up to 3 months of the obstetric anesthesia curriculum and combine
that with other advanced rotations to make up the advanced clinical track
program.
I. Goals: In addition to those outlined
for the basic rotation in Obstetric Anesthesia, the resident will:
A. Develop a body of knowledge built
on but beyond that learned in the CA1 and CA2 rotations. In particular
we will emphasize the physiological basis of obstetric anesthesia.
B. Develop technical skills and
judgment which lead to more independent conduct of complex obstetric cases.
II. Objectives: In addition to those
outlined for the basic rotation in Obstetric Anesthesia, the resident will:
A. Independently perform a preoperative
evaluation, anesthetize, and care for postoperatively an ASA I obstetric
patient for a surgical procedure such as an exploratory laparotomy.
B. Understand the physiology of
complex obstetrical problems, such as a pregnant patient with severe preeclampsia,
with minimal intervention by the attending anesthesiologist.
C. Understand and administer neuroaxial
blocks for regional anesthesia and/or postoperative pain.
D. Demonstrate competence in use
of the fiberoptic bronchoscope in the obstetric difficult airway.
III. Evaluation to Determine Goal
Achievement:
1. The faculty will evaluate the
weekly. The attending physicians complete a Departmental
Resident Evaluation Form, which will be reviewed by the Clinical Competence
Committee. The senior attending on the service will inform the resident
of any problem. Serious problems will be discussed when they occur.
2. Understand and coordinate the
medical care of ASA III or IV patients obstetric patient. This will include
choice and use of monitors appropriate to the medical situation.
3. The resident will complete a
Departmental Rotation Evaluation Form.
4. Dr. Froelich is the faculty member
responsible for these rotations.
IV. Resources Beyond Those Noted
in the Goals and Objectives for the CA1 & CA2 Guidelines:
In collaboration with the anesthesia
attending, the CA3 resident will serve as the anesthesia consultant for
high risk obstetric patients. Responsibilities will include: evaluation
of the patient, researching the condition, writing an appropriate consultation
note and conferring with appropriate representative of obstetric and nursing
staff. The resident will also take primary initive for arrangements for
appropriate post operative/delivery care in collaboration with physicians
and nursing staff of the SICU.
ROTATION:
PEDIATRIC ANESTHESIA - Advanced Clinical Track (Includes Nemours Childrens'
Hospital)
TYPE:
ELECTIVE
DURATION: 1-3 MONTHS
FACULTY: Sno White, MD
PREREQUISITES:
Completion of Clinical Base Year, CA-1 and 2 years
Any resident in the CA3 year who
has successfully completed the pediatric curriculum of the CA-1 and 2 rotations
may elect to take additional rotations in pediatric anesthesia. The number
of rotations available varies from year to year depending on the total
number of residents and the number taking the subspecialist clinical track.
The rotations will be granted based on the resident lottery. Currently
these rotations occur at Shands and Nemours Children's Hospital in Jacksonville.
I. GOALS:
A. Develop a body of knowledge
based on but exceeding that learned in the CA-l and 2 rotations.
B. Improve ones technical skills
in administering an anesthetic and placing invasive monitors.
C. Anesthetize patients for more
complex procedures than during the beginning pediatric anesthesia rotations.
II. OBJECTIVES:
A. Be able, at the end of the rotation,
to conduct an anesthetic for a pediatric patient > 1 year with minimal
intervention from an attending.
B. Place arterial and central venous
lines in an infant with minimal intervention from an attending.
C. Understand and administer neuroaxial
blocks for regional anesthesia and/or postoperative pain.
III. Evaluation to Determine Goal
Achievement
1. You are evaluated every week by all attendings who worked with you. The attending physicians complete
a Departmental Resident Evaluation Form, which is reviewed by the Clinical
Competence Committee. Your advisor informs you of any problems identified,
and serious problems will be discussed with you immediately after they
occur. You will also be specifically evaluated by the Director of Pediatric
Anesthesia and the results of your evaluation will be discussed with you.
In addition to this formal process you should expect daily feedback from
the attending with whom you work.
2. You will complete a Departmental
Rotation Evaluation Form.
3. Dr. White is the faculty member
responsible for these rotations.
IV. Resources to Accomplish Above
Goals and Objectives (see Pediatric Anesthesia Rotation)
The person responsible for each
of these rotations is the same as the person responsible for the CORE rotation.
ROTATION:
TRANSITION TO PRACTICE
TYPE:
REQUIRED
DURATION: 3 months (1 month during academic year 2003-4 pilot project)
FACULTY: Jennie Mace, MD (coordinator) plus the following participating
faculty: Michael Good, MD,
Nikolaus Gravenstein, MD, David Bjoraker, MD, Dietrich Gravenstein, MD, David
Mackey, MD,
Michael Mahla, MD, Sno White, MD (there may be others on occasion). In
addition, Mr. Michael
Nyland, our Associate Director for Medical and Health Administration will play a
key role in
the billing and coding portion of the educational program.
PREREQUISITES:
Completion of Clinical Base Year, CA-1 and CA-2 years and approval of Dr. Mace
I. GOALS:
The Transition to Practice rotation is a 3-month rotation in the CA-3 year
that will closely simulate a private practice environment. Four
operating rooms in the Shands OR suite will be designated each day to be
assigned to residents working in this rotation. Five residents will be
assigned to this rotation for a three month period. They will form a
Private Anesthesiology Group that will be tasked with the following:
- Clinical coverage of the four
transition to practice operating rooms
- Improve clinical, work flow and time
management skills to become a maximally efficient and competent
anesthesiology clinician
- Management of their own work
schedules, including late coverage of these operating rooms each day
- Learning to appropriately bill and
code for all anesthesiology services provided in these operating rooms
- Learn to manage case flow in these
four rooms to get the most productivity in the least time
- Learn to interface with other health
care personnel to produce the most competent, caring, and efficient
operating room unit possible
The five residents assigned to this
rotation will form their own private practice group and develop a group
administration (i.e. president and financial officer). They will
manage their own daily work schedule and clinical assignments to the
four operating rooms designated for this rotation. ONE resident
from the group at a time may be on vacation or assigned to the night
float team. No additional vacation / leave / or night float
time will be permitted from this rotation. In general, it will be
expected that at least 4 residents will be available for this rotation
each day. On days when one resident from the group is
not available, a CRNA or AA will be assigned to one of the rooms.
One resident from the group will be assigned each day as the floor
runner. This resident will manage all case flow in the four rooms
assigned to this rotation. This resident will also be responsible
for preoperative preparation and postoperative care for all patients in
these four rooms. In addition, if there is a CRNA / AA assigned to
the group on a particular day, the floor runner will be responsible for
working with that practitioner to develop and implement anesthetic plans
with only observational input from the faculty member covering the room.
Finally, this resident, along with the faculty, will be responsible for
giving breaks as needed to each practitioner.
II. OBJECTIVES:
- Quality Practice:
The resident will independently develop and implement safe and
appropriate anesthetic plans for each case assigned in his / her
room. The resident will implement the plans for induction,
maintenance and emergence with only observational involvement from
attending anesthesiologists. Anesthesiology attendings will only
intervene in the management of these cases when medically necessary
– residents will remain responsible for communication about ongoing
medical / surgical issues with attending anesthesiologists as
always. These cases will not be used for teaching new techniques.
Anesthesiology residents in this rotation will be CA-3 residents
only who are thought to be ready to transition to practice. First
and second year residents are not eligible for this rotation.
- Efficiency:
- The first patient should
be on the operating room table by 0730 with all paperwork
complete. The anesthesiology resident must make certain that
appropriate preoperative evaluation and counseling have
occurred. The nursing staff must assure that all other
paperwork is completed in time to meet this goal.
- For routine ASA I and II
patients, the resident will be able to induce anesthesia and
turn over the case for surgical activity in 10 minutes or less
from the time the patient is placed on the operating room
table. More complex cases may take somewhat longer, but the
goal should be 10 minutes.
- The patient should
emerge promptly from anesthesia, and transport to the recovery
area should occur in less than 10 minutes from the application
of the dressing.
- Turnover time from
leaving the OR to the next patient on the table ready for
induction should be no more than 20 minutes.
- In the case where the
resident is not efficient or appropriately moving along, the
anesthesiology attending will intervene and speed things up.
The goal will be to have such interactions disappear by the end
of the rotation.
- Coding / billing:
The resident on this rotation should learn to properly code and bill
for all procedures performed in the transition to practice room.
Each resident will meet with Mr. Nyland for an orientation to
billing and coding. In addition, they will be provided with
specific reading material they will be expected to learn during the
rotation. The floor runner each day will be responsible for
assuring proper billing / coding in each room and will meet with
billing / coding personnel to assure optimal coding that is fully
Medicare compliant.
III. EVALUATION TO DETERMINE GOAL
ACHIEVEMENT
- You are evaluated every week by all attendings who worked with you. The attending physicians complete
a Departmental Resident Evaluation Form, which is reviewed by the Clinical
Competence Committee. Your advisor informs you of any problems identified,
and serious problems will be discussed with you immediately after they
occur. You will also be specifically evaluated by the Dr. Mace and the results of your evaluation will be discussed with you.
- Each GROUP of residents assigned
to this rotation will also be evaluated in the following areas:
- Ability to work together to
accomplish daily work tasks in a competent and efficient fashion
- Ability to work with other
health care personnel
- Ability to appropriately code
and bill for all services provided
- Evaluative input in these
areas will be provided by OR nurses, scrub technicians,
anesthesiology technicians, preop area / recovery personnel,
billing / coding personnel, and Mr. Michael Nyland
- Each GROUP will be evaluated for
productivity (to be defined), and the most productive group during
the academic year will be publicly acknowledged and rewarded at
graduation.
IV. Resources available to accomplish the
above Goals and Objectives (see General Shands Operating Room Rotation)
- In addition, the following reading
material on billing / coding is available for residents on this
rotation:
- (PENDING - TBA)
-
Semo JJ, Esq. Starting out: A Practice Management Guide for
Anesthesiology Residents. The American Society of
Anesthesiologists, 2001.
-
Systems
Based Practice Section of the Classic Articles Library
-
Health
Care Systems Section of the Classic Articles Library
RETURN
TO INDEX FOR GOALS AND OBJECTIVES
Revised 6/25/02