ROTATION: Obstetric (OB) Anesthesia (Shands Hospital) 
TYPE: Required or Elective; CA-3 Night Shift (Mole) Rotation  
DURATION: 1 month minimum, full time;  Night shift - 2 weeks
FACULTY:  Tammy Euliano, MD, Adam Wendling, MD, Rick Schultetus, MD, Charles Gibbs, MD    
PREREQUISITES: Completion of clinical base year and 6 months clinical anesthesia   

Please note:  There is no separate call on this rotation.  All night-time patient care will be on a night-float system.  All residents on OB anesthesia rotations will participate in the night-float system.  Residents on the night float system will be expected to participate in the daily 8am OB Anesthesia Conference prior to leaving.

CA-3 Rotation Information, click here

CORE ROTATION INFORMATION

GENERAL GOALS:

  • Learn the physiology of normal pregnancy, and how it alters the response to anesthesia  
  • Learn pertinent aspects of fetal and placental physiology, including fetal monitoring  
  • Learn what obstetricians may require from anesthesiologists, including anesthesia for other  procedures (e.g. cerclage, version, BTI)  
  • Learn how pregnancy creates special problems for the anesthesiologist  
  • Learn the nature of high-risk obstetrics on pregnancy, delivery and lactation (this would include teratogenic effects, effects on hormone secretion, lactation, bonding, involution, etc.)  
  • Be able to act as consultant to the obstetrician in the management of the pregnant patient who requires advanced cardiopulmonary care and monitoring.

SPECIFIC COMPETENCIES:  (General Competencies also apply)

PATIENT CARE SKILLS

  • Be able to perform an appropriate preanesthetic evaluation
    • Obtain pertinent information from available records
    • Review and interpret results of diagnostic tests
    • Obtain appropriate consultations with other services
  • Be able to explain the risks, answer questions and obtain informed consent for peripartum analgesia/anesthesia.
  • Place and manage a labor neuraxial analgesic, both combined spinal / epidural and epidural techniques
    • Demonstrate appropriate sterile technique
    • Place needle for block with appropriate technique
    • Place catheter through needle to an appropriate depth
    • Troubleshoot failure of catheter to pass via the needle
    • Appropriately dress and tape the epidural catheter
    • Give appropriate test dose of local anesthetic
    • Appropriately dose and manage analgesia for each stage of labor
    • Troubleshoot spotty or one-sided blocks
    • Correctly assess analgesia level
    • Demonstrate ability to recognize and manage wet tap at the time of epidural placement
  • Manage a cesarean delivery, under spinal, epidural and general anesthesia
    • Appropriately prepare the operating room prior to cesarean section
    • Demonstrate ability to administer the anesthetic effectively in the time frame needed (i.e. elective, urgent, or emergent)
    • Appropriately manage inadequate intraoperative analgesia
    • Appropriately manage intraoperative hypotension
    • Manage intraoperative nausea/vomiting
    • Initiate appropriate postoperative analgesia plan
  • Perform an appropriate postanesthetic evaluation of the peripartum patient
    • Appropriately manage the patient in the PACU, including pain, nausea and complications
    • Evaluate and treat possible complications including post-dural puncture headache

MEDICAL KNOWLEDGE:   (See also General Competencies)

  • Residents will be expected to develop and demonstrate an in-depth knowledge of:
    • the principles of obstetric anesthesia
    • the anatomical and physiological changes that occur during pregnancy and labor and delivery
    • the pharmacology of drugs used during pregnancy and labor
    • the anatomy and physiology related to neuraxial anesthetic and analgesic techniques used during labor and delivery
    • the anesthetic management of Caesarean section
    • the principles of fetal monitoring and fetal & neonatal resuscitation
    • the indications and contraindications, risks and benefits of the obstetric anesthesia procedures

INTERPERSONAL AND COMMUNICATION SKILLS, PROFESSIONALISM

  • See general competencies section
  • Residents will be expected to:
    • create and sustain a therapeutic and ethically sound relationship with parturient patients
    • consider cultural and language differences in interpersonal interactions
    • use effective listening skills
    • maintain clear and concise documentation
    • work effectively with colleagues, obstetricians, nurses and other staff as a member or leader (when appropriate) of the obstetric healthcare team
    • maintain composure in stressful situations
    • project competence and confidence

PRACTICE-BASED LEARNING AND IMPROVEMENT

  • See general competencies section
  • Residents will be expected to:
    • recognize and correct gaps in their knowledge and expertise in obstetric anesthesia
    • use the various modalities available for practice-based learning including morning conference, self-directed reading, the OB article library, and the OB Anesthesia Wiki
    • obtain and use information technology to manage information, access on-line medical information
    • locate, appraise and assimilate evidence from scientific studies related to the practice of obstetric anesthesia
    • apply knowledge of study designs and statistical methods to the appraisal of clinical studies

SYSTEMS-BASED PRACTICE

  • See general competencies section
  • Residents will be expected to:
    • Use a team approach with the obstetricians and the labor and delivery nurses to provide prompt, efficient and safe medical care for the obstetrical patient
    • Keep accurate and complete records of anesthetic care,  including appropriate coding for subsequent billing, even in the stressful, rapidly moving labor and delivery environment.
Evaluation to Determine Goal Achievement  
  • The OB faculty will directly observe and evaluate at least five of each of the competencies listed under patient care skills (direct observation)
  • A written examination covering the cognitive elements of medical knowledge and patient care sklls
  • Patient Questionnaires about resident interactions
  • 360 evaluation by nursing staff, colleagues, supervisors, and others with significant contact
  • Simulation exercises (both patient care skills and medical knowledge)
  • Resident Portfolio (case logs and other accomplishments)

 Teaching Resources to Accomplish Objectives  

  • Patients: 2800 deliveries / year, 30% cesarean section; generally high risk population  
  • Teaching materials: All current OB anesthesia textbooks; 15 formal lectures in core lecture series; daily conferences on morning rounds; residents to prepare one 20-minute talk on topic of their choosing; review of current OB anesthesia-related literature 
  • OB anesthesia faculty:  
    • Tammy Euliano, M.D.   (Chief)
    • Adam Wendling, MD
    • Mary Herman, MD
    • Charles Gibbs, MD
    • Raymond Schultetus, M.D.

          Dr. Euliano is the faculty member responsible for this rotation. 

CA-3 LEVEL GOALS AND COMPETENCIES

CA-3 level rotations in OB anesthesia may occur at Shands at UF (Dr. Euliano).  In addition to those competencies developed during the core rotation, you will also:

Patient Care Skills

  • Develop technical skills and judgment which lead to independent conduct of complex obstetric cases.
  • Be able to instruct (under the direct supervision of an obstetric anesthesia attending) a junior resident in the basics of an ASA I or II obstetric case. This is particularly relevant to those aiming toward an academic career or a job that entails teaching other care givers. The resident will never substitute for the attending.
  • Independently manage labor analgesia for multiple patients on a busy obstetrical anesthesia service
  • Administer neuroaxial blocks for regional anesthesia and/or postoperative pain both in normal patients and in patients with complex problems such as heart disease or preeclampsia with minimal direct attending physician supervision.
  • Independently perform (with minimal attending supervision) a preoperative evaluation, anesthetize, and care for postoperatively an ASA I obstetric patient for a surgical procedure such as an exploratory laparotomy or (especially) a cesarean section.  
  • Demonstrate competence in use of the fiberoptic bronchoscope in the obstetric difficult airway.  
  • Manage complex obstetrical problems, such as a pregnant patient with congenital heart disease or the patient with severe preeclampsia, with appropriate assistance from the attending anesthesiologist.  

MEDICAL KNOWLEDGE:   (See also General Competencies)

In addition to those outlined for the basic rotation in Obstetric Anesthesia, the resident will:  

  • Develop a body of knowledge built on but beyond that learned in the CA1 and CA2 rotations. An in-depth knowledge of the physiological basis of obstetric anesthesia and the maternal and fetal pharmacology of anesthetic drugs will be acquired and demonstrated.   
  • Develop a knowledge base to assist in management of complex obstetrical problems, such as a pregnant patient with congenital heart disease or the patient with severe preeclampsia

SYSTEMS-BASED PRACTICE
  • See general competencies section
  • Participate in the administrative aspects of an obstetric anesthesia service - by giving in-service presentations for nurses, and by consulting with obstetricians and neonatologist.

The faculty responsible for these rotations are:  Shands at UF:  Dr. Euliano 

           Revised 6/2008

  RETURN TO INDEX FOR GOALS AND OBJECTIVES