DEPARTMENT OF ANESTHESIOLOGY

DEPARTMENT OF ANESTHESIOLOGY - GENERAL COMPETENCIES
FOR ALL OPERATING ROOM BASED ROTATIONS

In all Operating Room Based Rotations in the Department of Anesthesiology, residents will be evaluated in the Six General Competencies of the ACGME Outcomes Project as applied to the specialty of Anesthesiology. There will be subspecialty related competencies for each subspecialty rotation as well. These six competencies are:

Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
Medical 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
Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
Systems-Based Practice, as manifested by actions that 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
The specific application of these General Competencies to Anesthesiology will result in the following being evaluated in ALL Clinical Anesthesia Rotations.

Patient Care Skills: The anesthesiologist must demonstrate the facility to organize and expedite safe anesthetic procedures: Medical interviewing; physical examination, diagnostic studies (selection, implementation, application); synthesis of clinical information; development of management plan; technical expertise; counsel of patient and family; respect for patient’s privacy. Specifically, the anesthesiologist must demonstrate competency in the following areas:
Indicated vascular cannulations including venous, arterial, central venous and pulmonary arterial catheter insertion
Appropriate application and use of current technology for efficient and safe anesthesia care and life support of patients. Examples include direct and indirect blood pressure measurements, ventilation and respiratory gas monitoring, assessment of neuromuscular function, electrocardiographic, electroencephalographic and evoked-potential monitoring, and evaluation of laboratory results (chemistry, radiographs, etc.).
Instrument and anesthesia machine testing and calibration.
Operating room safety procedures for oxygen delivery, electrical safety, waste gas evacuation and principles of universal safety precaution.
General anesthesia
- Airway management: head position, ventilation by mask, appropriate use of oral and nasal airways
- Tracheal intubation: oral and nasal intubation by various techniques, appropriate and adequate tracheal and airway local anesthesia, fiberoptic techniques.
- Maintenance of respiration and gas exchange including management of various types of mechanical ventilation.
- Support of the circulation during the perioperative period, including the management of all types of shock.
- Support of renal function perioperatively.
- Appropriate administration of fluids and maintenance of fluid, electrolyte and acid-base balance
- Judicious use of blood products.
- Recognition and appropriate responses to significant changes in the anesthetic course
- Proper patient positioning during anesthesia.
Regional anesthesia and pain (including postoperative) management
- Spinal and epidural anesthesia and analgesia.
- IV regional anesthesia.
- Nerve blocks for diagnostic, therapeutic and surgical procedures and for postoperative pain control.
- Pain management — perioperative, acute and chronic.

MEDICAL KNOWLEDGE AND APPLICATION OF KNOWLEDGE

The Anesthesiologist must possess an appropriate fund of medical knowledge for level of training and experience and must be able to critically evaluate and use current medical information for competent patient care.
The Anesthesiologist must understands surgical procedures and anesthetic implications of surgical procedures.
The Anesthesiologist must understand the pathophysiology of patients' surgical and medical illnesses, and realize the anesthetic implications of these illnesses.
The Anesthesiologist must demonstrate basic science knowledge (physiology, pharmacology, anatomy) as related to patients and anesthetic management.
The Anesthesiologist must demonstrate specific knowledge of anesthetic techniques, drugs, and management options appropriate to the individual patient.
The Anesthesiologist must understand the pathophysiology of pain management syndromes and be able to discuss treatment options including pharmacotherapy, physical and occupational therapy, psychotherapy, and therapeutic procedures.
PROFESSIONALISM: The Anesthesiologist must demonstrate the following essential professional attributes:
High standards of ethical / moral behavior
Honesty / integrity
Reliability / Responsibility
Learns well from experience
Reacts to stressful / emotional situations in an appropriate manner
No documented current substance abuse problem
No cognitive, physical, sensory or motor impairment that precludes acquiring and processing information in an independent and timely manner or independent responsibility for any aspect of anesthesia care.
Respect for the dignity of patients and colleagues
INTERPERSONAL AND COMMUNICATION SKILLS:
The Anesthesiologist must be able to communicate and work effectively with patients, their families and members of the health care team in relevant health care delivery settings and systems. Specifically:
- Demonstrate effective communication with surgical colleagues both in and out of the OR, medical consultants and consultants from other specialties
- Demonstrate appropriate relationships and communication skills with the OR staff including circulating nurses, scrub technologists, anesthesia support personnel and all other support personnel.
- Demonstrate appropriate relationships with supervising faculty
- Demonstrate professional and appropriate relationships and communication skills with patients AND their families in the difficult and stressful perioperative period.

PRACTICE-BASED LEARNING:

The Anesthesiology resident must respond appropriately to faculty direction and criticism and demonstrate learning from faculty/resident interactions
The Anesthesiology resident must appropriately utilize general medical literature and anesthesiology literature to develop an anesthetic plan for their patients.
The Anesthesiology resident must be committed to self-education by attending Departmental educational activities including conferences, journal clubs and simulator sessions
The Anesthesiology resident must be able to use information technology to manage information, access online medical information, and support their own education.
The Anesthesiology resident must facilitates the learning of students and other healthcare professionals as well as colleagues.

SYSTEMS-BASED PRACTICE SKILLS:

The Anesthesiology resident must practice cost-effective health care that does not compromise patient care.
The Anesthesiology resident must appropriately utilize consultants and diagnostic testing information to appropriately prepare the patient for surgery.
The Anesthesiology resident must recognize the need and appropriately plan for needed postoperative recovery care including recognizing when a patient is an appropriate candidate for ambulatory surgery.
The Anesthesiology resident must possess adequate recordkeeping skills that:
- Documents anesthetic management completely and accurately
- Provides appropriate documentation of effort for reimbursement
- Demonstrates knowledge of and behavior consistent with strict Medicare compliance

Please note that many of these competencies also apply for rotations outside the operating room including critical care medicine, PACU, preop evaluation clinic, and pain management rotations. Specific competencies for each of these rotations will be available in the Goals and Objectives Document for each rotation.