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Transition
Educational Goals, Objectives, and Policies
For Residents in the Department of Anesthesia
At the Indiana University School of Medicine
Educational Goals and Objectives (Global)
The primary goal of the Residency Program of the Department of Anesthesia at Indiana
University School of Medicine is to provide a sound education that prepares residents to become
qualified practitioners of anesthesia at the superior level of performance expected of a boardcertified consulting anesthesiologist. To this end, we have an expectation that all residents who
complete their Anesthesia training in the Indiana University program will become board
certified and will provide high quality, competent patient care. We anticipate that they will strive
to improve the practice of anesthesia at the local, state and national level.
The Accreditation Council for Graduate Medical Education (ACGME) defines Competencies as:
specific knowledge, skills, behaviors and attitudes and the appropriate education experience
required of a resident to complete Graduate Medical Educational (GME) programs. It seems
logical that the natural progression of competence is a progressive movement from incompetence
to competence, ideally followed by mastery of knowledge, skills, behaviors and attitudes. Indeed
it is our desire that our residents will exceed the expectation of competence and move towards
and reach for overall mastery of the above mentioned set of objectives.
We believe that the competencies, outlined below by the ACGME, provide a template that the
Department can use to help progress our residents through the various stages of their
educational experience towards our goal of competence and ultimately mastery.
PATIENT CARE
Residents must be able to provide compassionate, appropriate, and effective patient care for the
diagnosis and treatment of health problems to promote health. Residents are expected to:
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communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and
their families
gather appropriate and accurate information about their patients
make informed decisions about diagnostic and therapeutic interventions based on patient information and
preferences, up-to-date scientific evidence, and clinical judgment
develop and carry out patient management plans
counsel and educate patients and their families
use information technology effectively to support patient care decisions and patient education
competently perform all essential diagnostic and therapeutic procedures for the practice of anesthesia
provide health care services aimed at preventing health problems and maintaining health
work with health care professionals, including those from other disciplines, to provide patient-focused care
MEDICAL KNOWLEDGE
Residents must demonstrate 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. Residents are expected to:
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demonstrate an investigatory and analytic thinking approach to clinical situations
recognize and apply the basic and clinically supportive sciences that are appropriate to anesthesiology
INTERPERSONAL AND COMMUNICATION SKILLS
Residents must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and collaboration with patients, their patients families, and professional
associates. Residents are expected to:
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create and sustain a therapeutic and ethically sound relationship with patients
use effective listening skills to elicit and provide information using effective nonverbal, explanatory, questioning,
and writing skills
work effectively with others as a member, leader of a health care team and other professional groups
PROFESSIONALISM
Residents must commit to carrying out their professional responsibilities, adhere to ethical principles,
and be sensitive to a diverse patient population. Residents are expected to:
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demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that
supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence
and on-going professional development
demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care,
confidentiality of patient information, and informed consent, and business practices
demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
SYSTEMS-BASED PRACTICE
Residents must demonstrate awareness and responsiveness to the larger context and system of health
care. Residents must have the ability to effectively call on system resources to provide care that is of
optimal value. Residents are expected to:
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understand how their patient care and other professional practices affect other health care professionals, the
health care organization, the larger society and how these elements of the system affect their own practice
know how types of medical practice and delivery systems differ from one another, including methods of
controlling health care costs and allocating resources
practice cost-effective health care and resource allocation that does not compromise quality of care
advocate for quality patient care and assist patients in dealing with system complexities
know how to partner with health care managers and health care providers to assess, coordinate, and improve
health care and know how these activities can affect system performance
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PRACTICE-BASED LEARNING AND IMPROVEMENT
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence, and improve their patient care practices. Residents are expected to:
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analyze practice experience and perform practice-based improvement activities using a systematic methodology
locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
obtain and use information about their own population of patients and the larger population from which their
patients are drawn
apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other
information on diagnostic and therapeutic effectiveness
use information technology to manage information, access on-line medical information; and support their own
education
facilitate the learning of students and other health care professionals
Institutional Regulations
The Graduate Medical Education (GME) office at Indiana University Medical Center maintains a
manual of “Personal Information for House Staff” which can be found at the below web address.
Residents should take time to familiarize themselves with this information and the policies within this
document. The GME office provides institutional oversight and all policies and procedures of the
institution will supersede any conflicts.
http://housestaff.iusm.iu.edu/forms/HSMAN_PRINTABLE%20COPY_10_2007.pdf
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1] General Educational Goals and Objectives (Clinical Anesthesia Year)
(Specific Goals and Objectives documents are distributed separately covering each Clinical
Anesthesia year and Clinical Rotation)
The goal of each of the three Clinical Anesthesia (CA) training years is to increase the residents
overall knowledge of anesthesia in order to meet the Departmental global goals and objectives.
Therefore, we expect our resident’s to progressively increase their understanding of all aspects of
anesthesia care including patient care, medical knowledge, practice based learning, interpersonal
and communication skills, professionalism or systems based practice.
CA-1 year
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Learn efficient general preparation for surgical cases
Learn preoperative evaluation, especially related to airway evaluation, anesthetic implications of disease states,
cardiac risk factors, and laboratory test evaluation, (chemistry, radiographs, etc.)
Become proficient at intubation techniques including correct head positioning, direct laryngoscopy, fiberoptic
(oral and nasal), awake intubating methods (oral and nasal), and utilization of existing tracheostomy sites
Become proficient at airway management including mask ventilation, placement of LMA and appropriate use of
oral and nasal airways
Become proficient at intravascular cannulation techniques including venous, arterial, central venous, and
pulmonary artery cannulation
Understand appropriate technology related to administering modern anesthesia including direct and indirect
blood pressure measurement, ventilation and respiratory gas monitoring, assessment of neuromuscular
blockade, electrocardiographs, electroencephalographs (and BIS), and evoked potential monitoring
Master the physics and principles of anesthesia equipment as well as anesthesia machine testing and calibration
Understand safety procedures and technology related to oxygen delivery, electrical safety, waste gas evacuation,
and universal precautions
Learn appropriate monitoring plans and proper positioning techniques
Master circulatory support and renal function support throughout the entire perioperative period
Management of shock from any cause
Management of increased intracranial pressure
Learn appropriate fluid and electrolyte management
Understand the principles of blood product usage
Learn spinal and epidural anesthesia and analgesia (including obstetrical cases) as well as the principles of acute
postoperative pain management
Master the techniques of IV regional anesthesia
Master the techniques of brachial plexus blockade
Master the techniques for managing labor and delivery of obstetric patients
Learn the physiologic, pharmacologic, and anesthetic differences between the pediatric, adult, and geriatric
patients
Become familiar with issues related to occupational stress, addiction, and the availability of counseling
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CA-2 year
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In addition, to greater mastery and a deeper understanding of the above, goals and objectives for the CA2 year
include:
Manage patients undergoing cardiopulmonary bypass, off-pump coronary artery bypass, and peripheral vascular
surgery
Manage patients undergoing one-lung ventilation
Manage all types of transplantation cases
Master cardiopulmonary resuscitation (ACLS certification during CA2 year)
Develop skills related to managing complex surgical cases involving deliberate hypotension, deep hypothermic
arrest, major vascular procedures of the aorta and cerebral circulation, and transplantation (liver, kidney,
pancreas, heart, lung)
Develop advanced chronic pain management and ICU skills
To develop an understanding of the financial, business, and practice management aspects of the modern
anesthesia environment
CA-3 year (CA3 Resident Training Goals)
CA3 residents are expected to take further initiative, leadership roles, and further independence
within the department. The CA3 year is meant to provide residents with the competencies
required to meet the expectations for a Board Certified (Consultant) Anesthesiologist.
The CA3 residents in the Department of Anesthesia are expected to refine their skills and further
enhance their understanding of the objectives outlined in the general curriculum; in addition
they are expected to expand their understanding of:
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airway management, line placement, pharmacology, spinal, epidural and regional anesthetic techniques
mentoring junior level residents and medical students
caring for patients with all forms of critical illness
providing for total care of the anesthetized patient
triaging patients in the event of mass trauma
gathering and analyzing medical literature, enhancing life-long learning
knowledge and judgment appropriate for a consultant level specialist in anesthesiology
The CA3 residents are also expected to utilize the knowledge that they have obtained in the previous
years of residency to complete their academic projects. We expect some residents to seek further
fellowship training in the various subspecialties of anesthesia.
Rotation Schedules are distributed prior to each rotation. The Department utilizes a 28 day rotation
schedule.
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Specific Educational Goals and Objectives for Subspecialty Areas of Training
The goal of the subspecialty rotations at the Indiana University School of Medicine, Department
of Anesthesiology is to train physicians to be competent and compassionate specialists in
anesthesia. To this end, the subspecialty rotations are designed to develop in the trainee the
appropriate knowledge, attitudes and skills required to care for both routine and complex
anesthetic issues. Goals and objectives for each of these rotations are provided to the residents in
a separate goals and objectives document. General goals and objectives are outlined below to
provide you with a broad overview of each of these rotations. Comprehensive goals and
objectives documents are distributed as under separate cover in order to encourage progressive
learning. Residents are expected to refer to these documents prior to the start of each rotation.
Acute Perioperative Pain Management Rotation
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Learn the physiology of the pain pathway, including nociceptors, primary peripheral afferents, dorsal horn
biology, neurotransmitters, ascending and descending pathways, neuroendocrine response to pain, synergistic
effects of spinal opioids and local anesthetics, and the use of other adjuvant (clonidine, gabapentin, ketorolac,
etc.)
Learn the mechanism and site of action of spinal opioids
Master management of intrathecal opioids, epidural analgesia, PCA, and adjuvant therapy in the management of
acute postoperative pain
Learn the management of continuous peripheral nerve blocks for postoperative pain
Acute Perioperative Pain Management Rotation
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Understand the impact of co-existing disease orUnderstand the various pharmacologic agents utilized in the treatment of acute peri-operative pain
management—included but not limited to opioids, benzodiazapines and ketamine
Understand the use of local anesthetics in the treatment of acute perioperative pain management—included but
not limited to the uptake and distribution, biotransformation, and drug to drug interactions
Understand the utilization of peripheral nerve blocks and continuous nerve block techniques
Understand the impact of chronic pain on management of patients with acute perioperative pain
Chronic Pain
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Learn how to take a medical history from a pain patient
Perform the relevant physical examination of the pain patient
Understand and demonstrate patience, professionalism, and compassion in dealing with difficult and unfortunate
pain patients
4. Learn the art of evaluating the patient with chronic pain
5. Recognize the role of interdisciplinary approaches to chronic pain management
6. Interpret imaging studies in the capacity of a pain practitioner
7. Interpret electrodiagnostic studies, such as EMG, in the capacity of a pain practitioner
8. Recognize emergencies that may present to a pain practitioner
9. Know how to manage the emergencies
10. Recognize complex regional pain syndromes and common and less-well-known pain syndromes that present to
the pain practitioner
11. Know how to treat complex regional pain syndromes. Understand RSD, it’s causation, and potential modalities of
treatment
12. Know how to prescribe opioids and nonopioid pain medications commonly prescribed in pain therapy, as well as
side effects of the medications
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13. Know how to operate the fluoroscope machine safely and identify bony landmarks for injection
14. Know the indications, specifics of informed consent, and complications (with management) of the diagnostic and
therapeutic injections (including steroids) commonly used in pain management: epidural, spinal, sacroiliac joint,
zygapophyseal, sympathetic (lumbar and cervical), splanchnic, myofascial, bursal, and peripheral nerve
15. Learn advanced regional anesthesia techniques in controlling chronic pain
16. Know and understand the indications and methods of common neuroablative procedures used in pain therapy:
e.g., cryotherapy and radiofrequency ablation
17. Know and understand the indications and methods of insertion of spinal epidural electrical stimulating catheters
and indwelling intrathecal pumps for treatment of pain and spasticity
18. Learn how to implant spinal opioids infusion devices and manage their dosing through the home health services
19. Develop a detailed understanding of cancer pain treatment and the rational use of parenteral narcotic drugs
Obstetrical Anesthesia
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Learn to manage analgesia for labor (including epidural management)
Gain proficiency in placing spinal and epidural anesthetics
Understand and manage potential complications of labor epidurals
Learn to manage regional techniques for cesarean sections and other obstetrical procedures, as well as any
potential complications
5. Master the pharmacology of local anesthetics and spinal opioids used in obstetrical anesthesia and analgesia
6. Master general anesthesia for cesarean sections, indications and risks, as well as a working knowledge of the
difficult airway protocols
7. Learn the causes, risk factors, prevention, and treatment of post-dural puncture headache
8. Learn the basic physiology of pregnancy and fetal circulation, and their impact upon anesthetic management
9. Learn to recognize the patterns of intrauterine fetal heart rate monitoring and their significance
10. Learn the basic principles of intrauterine and neonatal resuscitation of the fetus and newborn
11. Understand and management of major obstetric complications, including pre-eclampsia, antepartum and
postpartum hemorrhage, abruption, previa, abnormal presentation, multiple gestation, uterine atony, cord
prolapse, etc
Neuroanesthesia
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Understand the determinants of intracranial pressure
Define plateau wave and define its significance, prevention, and management
State the effects of drugs commonly used in anesthesia on intracranial blood flow and intracranial pressure
State the symptoms commonly associated with increased intracranial pressure
State the intraoperative maneuvers available to control intracranial pressure and understand their indications
State the effect of temperature on cerebral oxygen demands
Describe autoregulation of cerebral blood flow
Demonstrate proficiency in the insertion of radial arterial catheters
State the major anesthetic management concerns associated with intracranial aneurysm clipping/resection
State the major anesthetic management concerns associated with resection of an intracranial mass (tumor)
Define the blood brain barrier and state its significance
Define venous air embolization and describe its diagnosis, significance (inc. risk factors), and management
State the specific considerations of providing anesthesia for magnetic resonance imaging
Define the Glasgow Coma Score
State the side- effects of common anticonvulsant medications, including interactions with drugs used in general
anesthesia
Pediatric Anesthesia
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Develop skills in procedures and techniques including arterial line placement, management of regional anesthetic
techniques for acute pain management, management of the difficult pediatric airway using laryngeal mask
airways, fiberoptic, and Light wand techniques
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Understand the history of pediatric anesthesia
Learn developmental physiology as well as physiologic and pharmacological differences from adult patients,
including but not limited to:
a. Transitional circulation
b. Airway anatomy, apnea, and periodic breathing
c. Renal physiology (fluids and electrolytes)
d. Central nervous system physiology (intraventricular hemorrhage and retinopathy of prematurity)
e. Metabolism
f. Nutrition
g. Thermoregulation
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Details of pharmacology in the pediatric patient
Developmental differences
Cardiotonic drugs
Vasoactive drugs
Alprostadil
All classes of typical anesthetic drugs
Understand the anesthetic implications of “coexisting disease”
Upper respiratory illnesses, asthma, diabetes, ex-prematurity, malignant hyperthermia and family history of
malignant hyperthermia, congenital heart diseases, malignancy, sickle cell disease and trait, increased intracranial
pressure, IRDS, BPD, cystic fibrosis, the various common and uncommon syndromes encountered in pediatric
anesthesia practice
Newborn Care
Anesthesia for pediatric neurosurgery
Management essentials
Preoperative preparation
Feeding guidelines
Premedication
Chronic medications
Induction/Maintenance Techniques
Regional techniques
Airway Techniques
Access Techniques
Position Precautions
Monitoring
Blood, Fluid and Electrolyte Management
Post-anesthesia care
Discharge criteria
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Cardiac Anesthesia
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Learn the physiology of the cardiovascular system, develop a detailed understanding of all cardiac drugs
(especially those used intraoperatively), and develop a full knowledge of all cardiovascular and peripheral
vascular disease states, and the appropriate preoperative CV/PV evaluation for patients presenting for cardiac or
vascular surgery
Learn the essentials of monitoring the patient during CV or PV surgery including typical monitoring, PA catheter
placement and interpretation, and thermodilution principles
Master the basic transesophageal echocardiographic examination of the open heart surgical patient
Learn and master the essentials of appropriate pre-bypass, bypass, and post-bypass anesthetic management
Understand the basic components of the cardiopulmonary bypass machine
Understand the differences between alpha stat and pH stat management of arterial blood gases during
hypothermia
Learn the indications and risks associated with antegrade and retrograde cardioplegia
Understand the management of valvular heart diseases with respect to preload, heart rate, and afterload
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optimization
Learn techniques related to managing anticoagulation (heparin/ACT) and antifibrinolysis (aprotinin vs
aminocaproic acid)
10. Learn the best techniques of managing off-pump coronary artery bypass cases
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Thoracic Anesthesia
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Learn the physiology of one lung ventilation
Understand how ‘increased venous admixtur’ or “shunt” occurs in both the dependent and non-dependent lung
Learn the “absolute” and “relative” indications for one-lung ventilation
Learn the best ways to manage intraoperative hypoxemia that develops during one lung ventilation
Understand principles associated with PEEP and its optimization
Learn to interpret preoperative pulmonary function tests
Learn the placement, management, and “trouble shooting” of one-lung ventilation devices including double
lumen tubes and bronchial blockers
Learn the various post-operative pain management techniques for thoracotomy patients
Understand the physiology of chronic airways disease and asthma entities and how pre-operative assessment and
intervention may impact surgical case management and post-operative care
Transplant Anesthesia
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Understand the disease entities leading to the need for transplantation
Understand intra-operative fluid and electrolyte management for those undergoing renal transplant, as well as
renal protection
Understand the metabolic events associated with pancreatic transplantation and their management
Learn all the ramifications of the dissection phase, anhepatic phase, and reanastomosis phases of liver
transplantation - including management of hematological/coagulation abnormalities, metabolic events, and
major fluid shifts
Learn the anesthetic considerations related to heart and lung transplantation
Ambulatory Anesthesia
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Learn the indications and potential benefits of performing outpatient surgical procedures
Learn the limitations related to performing outpatient surgery/anesthesia
Learn how appropriate preoperative evaluation, patient preparation, and anesthetic plans differ between
inpatients and outpatients
Learn techniques for efficient OR time management
Understand the postoperative care needs of outpatients
Understand discharge criteria for leaving the hospital
Understand follow-up techniques used for the outpatient population
ICU/Critical Care
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Know and communicate the overall plan of care with the other physicians and services, especially the primary
(admitting) surgical service
Communication with the primary, or another consultant services, must be friendly, timely, cooperative,
considerate, and professional, whether verbal or written.
Know indications for admission and discharge from the ICU
Obtain the appropriate history from the patient and other data sources for critically ill patients. This may involve
long-distance phone conversations with referring physicians, interviews with paramedics, family members, PACU
nurses, intraoperative anesthesiologists, ER physicians, surgeons, multiple charts, and copies of imaging studies.
Perform the examination of the critically ill patient: specifically the comatose, stuporous, and patient with
neurologic abnormality, and be able to communicate it verbally and on the record.
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Understand how to diagnose and treat common causes of respiratory failure: including but not limited to
pneumonia, pulmonary edema, pulmonary thromboembolus, and pneumothorax
Knowledge of indications for, insertion and calibration of, and interpretation of data from: arterial lines,
pulmonary artery catheters, central venous catheters, peripherally-inserted central (PICC) catheters,
capnographs, pressure-volume monitors on ventilators, and bispectral CNS monitors
Knowledge of intubation and initiation of invasive or noninvasive ventilatory support: indications for the use of
various methods, technical knowledge of intubation, knowledge of complications and their management, initial
orders needed for the nurse and respiratory therapist
Know how to support and wean patients using a variety of modes of mechanical ventilation: SIMV, AC, PS, IR,
HFV, PRVC, and CPAP.
Know how each mode of ventilatory support “works” in response to patient breath initiation (know which
method is best for a given type of patient)
Know how to humanely sedate patients who require mechanical ventilation, as well as the common
complications of opioid and nonopioid sedatives
Know how to treat constipation and ileus associated with opioid sedative use
Know how to provide nutritional support to critically ill patients
Understand indications for renal replacement therapy
Know indications and techniques for the use of muscle relaxants in the ICU
Know how to minimize complications associated with stays in the ICU: e.g., orofacial, ocular, and pharyngeal
trauma, barotrauma, nosocomial infections, neuropathies, pressure ulcers, aspiration pneumonitis,
thromboemboli, gastrointestinal hemorrhage
Know indications and methods for chronic airway management via tracheostomy
As a consultant, recognize and recommend appropriate ways of evaluation and treatment of systemic illness in
critically ill patients: e.g., cardiovascular collapse, myocardial infarction, acid-base derangements, renal failure,
hepatic failure, severe immunologic reaction, stroke, thromboemboli, and common hematologic derangements
(anemia, thrombocytopenia, etc. )
Know appropriate empiric antibiotic therapy for meningitis, pneumonia, endocarditis, cellulitis, urinary tract
infections
Know complications of the use of antibiotics
Know appropriate prophylaxis for venous thrombosis, peptic ulceration pressure ulcers
Know methods of diagnosing brain death. Be able to discuss how withdrawal of care may be appropriate in
certain patients, and how such withdrawal might be undertaken
PACU/POCU
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Understand the physiologic and emotional stresses related to surgery
Understand all aspect of pain management including spinal opioids and systemic therapy
Learn the assessment and rapid intervention for all complications common in the postoperative setting including
but not limited to hypoxemia, respiratory insufficiency, hypothermia, altered mental status, pain, nausea, cardiac
arrthymias, hypotention, cardiac insufficiency, etc.)
Learn about the impact of coexisting diseases and how these impact the safe administration of anesthesia
Be able to assess and communicate preoperative, intraoperative and postoperative conditions to anesthesiology
personal, other care providers and families.
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2] Curriculum/Rotations
CA1/PGY2 and CA2/PGY3 Year
By the end of the first two years, each resident will have generally completed:
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Riley OR
University OR
V.A. OR
EskenaziOR
EskenaziOutpatient
Chronic Pain Inpatient and Outpatient
Peri-operative Care Unit/PACU
EskenaziPerioperative Pain*
Transplantation Anesthesia*
Eskenazior VA Neurosurgical Anesthesia *
Acute Peri-operative Pain*
V.A. Cardiothoracic *
Obstetrical Anesthesia *
University ICU *
EskenaziICU *
4 months
3 months
1 month
2 months
1 month
1 month
1 month
1 month
1 month
1 month
1 month
1 month
2 months
1 month
1 month
* TYPICALLY CA2 ROTATION
The additional 4/26 rotations are assigned randomly to assignments at the four main clinical sites
(University, Riley, VA, and Wishard).
CA3/PGY4 Year
Typical CA3 Year Rotation Schedule
CA3 residents are provided with a listing of electives from which to choose from the below list of
rotations based upon availability:
1 months CV
1 months Thoracic
1 month OB
1 month Neuroanesthesia
1 month Pediatrics
1 months Pain Management
1 month Critical Care Medicine at University Hospital
1 months Ambulatory/Outpatient Anesthesia
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The CA3 rotations are:
Required: (7 months)
Riley OR
EskenaziOR
General OR
Methodist Cardiovascular
Obstetrical Anesthesia
University Thoracic
University Transplant
Pediatrics
Ambulatory
General OR
CV
OB
Thoracic
Transplant
Electives (6 months available)
Each of the following electives is one month in length.
Neurosurgical Anesthesia
University Thoracic
University Transplant
Cardiothoracic
Chronic pain management
Obstetrical Anesthesia
Riley OR
General OR
Ambulatory Anesthesia
ICU
PACU/POCU
**Africa Moi University:
Residents who participate in this rotation will be expected to be in good clinical standing as
defined by acceptable performance by the Clinical Competency Committee to the American
Board of Anesthesiologist and have scored on the in-training examination at or above the 50%
of their cohort.
The educational opportunity at Moi University will continue to be a limited special elective
rotation that will complement the overall anesthesia experience. This rotation, due to the very
nature will have a high educational value and is not being utilized to fulfill service needs. As in
the past, we anticipate sending possibly one to three residents each year for this elective
rotation. The rotation length will be limited to no more than one month but may have a shorter
duration but this duration will be no less than 2 weeks.
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LABORATORY:
Residents who participate in this rotation will be expected to be in good clinical standing and have
scored on the in-training examination at or above the 60% of their cohort.
CA3 residents electing to draw experience from the various research opportunities offered by the
Department of Anesthesia can perform: clinical studies, laboratory investigation, or educational
method design and analysis (including computer-aided instruction). The resident’s career goals,
performance in the in-training exam and performance evaluations will be considered when approving
requests for the research elective. Residents who enter this track will be expected to be in good
clinical standing and they will also be expected to have scored on the in-training examination at or
above the 60% of their cohort. Residents who participate in the Clinical Scientist Track will be
required to meet formally no less than monthly with the faculty advisor and with the anesthesia
program director or their designee. Upon completion of this project residents will be expected to
provide a manuscript that is of a high enough quality to submit for potential publication or presentation
at a regional or national meeting.
Residents can participate in up to six months of research during their residency. Prior to being allowed
to enter the research elective, the planned project and prospective research proposal must be approved
by the program director and be scheduled to begin on time via collaboration with a staff or faculty
member. When appropriate, IRB approval must be obtained before the research months are to begin.
Given that Hospital Assignments and Call Schedules are typically published months in advance, in
order to provide residents with the opportunity to plan non-clinical residency related activities, it will
be expected that all requests for participation in research will be submitted in writing no later than six
months prior to the date at which the research project is expected to begin.
CA4/PGY5 Research Year
The Department of Anesthesia actively recruits residents who wish to participate in a CA4/PGY5
research year. Ideally we would like to recruit 1-3 residents per year who are interested in
participating in an additional year of research. This year of research will be monitored by the ViceChair of Research.
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3] Educational Materials
Textbooks used in the didactic curriculum are purchased by the department and distributed to all
residents.
Currently issued texts are:
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2.
Clinical Anesthesiology—Morgan, Mikail, Murray
Basics of Anesthesia—Miller and Pardo
Other review texts are available for residents to check out from the Ruth Lilly Library from
circulation; these including:
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2.
Anesthesia: A Comprehensive Review—Hall
Previous American Board of Anesthesia Tests with Answers.
These texts comprise the core of the “text-based curriculum” designed to promote the scholarly
acquisition of knowledge through mastery of authoritative and contemporary sources from the field of
Anesthesia.
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4] Formal [Didactic] Teaching
Didactic Lectures are an important part of residency education, encompassing attributes of all six
competencies, i.e., communication skills, practice based learning, and professionalism. Attendance by
residents is expected. If a resident is noted to have an excessive number of unexcused absences, this
issue will be addressed by the Clinical Competency Committee. The Clinical Competency Committee
may ask to discuss this issue in person with the resident in question. If necessary a letter addressing
the resident’s absenteeism will be provided to the resident and a copy of this letter will be placed in the
resident’s permanent file. This information may also be used to determine Certificates of Clinical
Competency as outlined in the ABA Booklet of Information.
6:30 AM- Meet by Training Year
1.
2.
3.
CA1/PGY2: Core Lectures/Simulator Lab/ In-training Review
CA2/PGY3: Selected Topics and Group Case Discussions/ Simulator Lab /In-training Review
CA3/PGY4: Special Topics with Text Review/Individual M.O. Exams/ Simulator Lab/ In-training Review
7:30 AM - All Residents and Faculty
1.
2.
3.
4.
5.
6.
Journal Club
M&M Conference
Guest (Visiting Professor) Lecturers
MARC/Research Presentations
Resident Scholar Lectures
Practice and Stress Management Topics
CA1: didactics focus on basic science, pharmacology, equipment, monitoring, and safe case
management techniques
CA2 and CA3: didactics focus on advanced topics related to clinical case management that are
selected to help the senior resident better prepare for the oral component (part 2) of the specialty board
exam in Anesthesiology. Additionally, topics related to basic sciences are incorporated into this lecture
series both to serve as a refresher of essential concepts and to help maintain focus on topics likely to be
seen on the written component (part 1) of the upcoming specialty exam in Anesthesia.
Grand Rounds: include journal reports, mortality and morbidity conference, guest lectures, resident
scholar lectures, research conferences, practice management seminars, stress management lectures
Simulator Lab: Residents attend three to four simulator sessions per year in which various
intraoperative scenarios are presented to help residents recognize and quickly react to potential lifethreatening OR events. CA3 residents are evaluated in the simulation lab on an individual basis
utilizing more advanced case scenarios.
In-Training Exam Review: all residents attend a 10 week in-training exam review during January and
February of each academic year, prior to the March exam
15
IN-TRAINING EXAMINATION
All residents are required to take the In-Training Examination in the March that follows their starting
date in the Department of Anesthesia. The registration fee for this examination during the period of
residency will be paid by the department.
It is important to recognize that a satisfactory overall clinical Competence evaluation is necessary to
pursue specialty certification by The American Board of Anesthesiology.
A sample residency contract from the School of Medicine can be found at:
(www.medicine.iu.edu/~resident/images/contract.pdf). In addition to the information contained in the
sample contract, the Department of Anesthesia requires its residents to take the yearly in-service
examination administered by the American Board of Anesthesiologists. We expect our residents to
score above the 9th percentile for their peer group. We expect our residents to perform at a level
equivalent to or higher than the national average for those with comparable durations of training. Any
score below the 10th percentile within the comparable Clinical Anesthesia year cohort defined by
American Medical School Graduates will be considered unsatisfactory in the area of knowledge by the
Clinical Competence Committee. This is a score that would be inadequate to pass the examination for
the purposes of board certification upon your graduation from residency. Therefore, we feel that this is
not an unreasonable expectation. Individuals who do not score at or above the 10th percentile within
the above cohort during the in-service examination will be placed on academic probation and may be
asked to leave the program.
16
5] Supervisory Lines of Responsibility/Resident Progressive Patient Care Responsibilities
Residents responsibility for patient care will be rotation specific. Goals and Objectives for each of
these rotations specifically outline expectations in the area of patient care. These Goals and Objectives
are available on the Department of Anesthesia intranet site. As previously mentioned the goal of each
of the three Clinical Anesthesia (CA) training years is to increase the residents overall knowledge of
anesthesia in order to meet the Departmental global goals and objectives which include an expectation
that all residents who complete their Anesthesia training in the Indiana University program will
become board certified and will provide high quality competent patient care. Therefore, we expect our
resident’s to progressively increase their understanding of all aspects of anesthesia care including
patient care, medical knowledge, practice based learning, interpersonal and communication skills,
professionalism or systems based practice.
In the clinical setting, individual instruction is given to each resident on a case by case basis with the
aim of sharing knowledge regarding safe anesthesia practices, expansion of the resident’s repertoire of
technical skills, and the conveyance of scholarly academic information related to the components of
the operation and anesthetic techniques.
Resident supervision is provided at all anesthetizing areas before, during, and after surgery. Prior to
surgery, the resident and teaching staff perform an evaluation of pertinent medical history, physical
findings, laboratory studies, previous anesthetic records, and prior perioperative complications of the
patient or direct blood relatives.
Progressive responsibility is provided to residents as they advance through each successive year of
clinical anesthesia training. The goals and objectives documents for each rotation have been separated
into basic and advanced subdivisions in order to help the resident progress in their overall knowledge.
Clinical case assignments are also determined based upon the resident’s level of training.
Members of the teaching faculty is in attendance at induction, and emergence, and are regularly present
during the maintenance phase of the surgical case to discuss and direct ongoing patient management
and to teach residents [and medical students] about the key academic points of the case. Staff members
are available for management of recovery room and day surgery problems and “sign-out” patients from
both facilities.
Members of the teaching staff are available on a full-time basis by pager, cell phone, or landline. Call
and back-up staff, who are either physically present in the operating room or available for consultation
on a 24/7/365 basis. Faculties are present at all locations during the administration of all operative
anesthetics and general anesthetics to ensure that appropriate lines of supervision are maintained.
ICU/CC – From 6:30 AM till 4:00 PM, on site ICU teaching faculty are physically present. Cases or
management issues arising after standard hours are supervised by the ICU faculty (available on a
fulltime basis by pager, cell phone, or landline). In the case of emergency “in-house” anesthesia, call
residents, or anesthesia teaching faculty are available to provide assistance.
Acute Pain Care- the chronic pain faculty supervises the care and management of all acute pain
(spinal opioid) patients on all wards and in the ICU. The chronic pain faculty (available on a fulltime
basis by pager, cell phone, or landline), on call and back-up staff, who are either physically present in
17
the operating room are available for consultation on a 24/7 basis by pager, cell phone, or landline,
supervise management issues arising after standard hours.
Chronic Pain- A member of the Pain faculty supervises and manages all chronic pain patients and
related needs through the residents presence in the Pain Clinic at all times during each work day. Pain
faculty, available on a full-time basis, supervises all management issues referred to rotating residents
or fellows after standard hours.
Obstetrics- A member of the teaching faculty is present in the OB units at all times during the day.
After hours, the faculty on call for the operating rooms is present for all surgical cases and for the
placement of epidural analgesia whenever the resident is in the early-mid stages of training. All
epidural analgesia should be “staffed” with faculty at any time of the day or night in order to establish
a safe analgesic plan. Anesthesia faculty is available 24/7 to supervise all anesthetic.
Transitions of Care/Handoffs Policy- A handoff is defined as the communication of information to
support the transfer of care and responsibility for a patient/group of patients from one provider to
another. Transitions of care are necessary in the hospital setting for various reasons. The
transition/hand-off process is an interactive communication process of passing specific, essential
patient information from one caregiver to another. Transition of care occurs regularly under the
following conditions:
1.
2.
3.
4.
Change in level of patient care, including inpatient admission from an outpatient procedure or diagnostic area,
transfer to or from a critical care unit or peri-operative care areas.
Temporary transfer of care to other healthcare professionals within procedure or diagnostic/anesthetizing areas
Discharge, including discharge to home or another facility such as skilled nursing care
Change in provider or service change, including change of shift for nurses, resident sign-out, and rotation changes
for residents.
The transition/hand-off process must involve face-to-face interaction with both verbal and
written/computerized communication, with opportunity for the receiver of the information to ask
questions or clarify specific issues. The transition process should include, at a minimum, the following
information in a standardized format that is universal across all services:
1.
2.
3.
4.
5.
Identification of patient, including name, medical record number, and date of birth
Identification of admitting/primary physician
Diagnosis and current status/condition of patient
Recent events, including changes in condition or treatment, current medication status, recent lab tests, allergies,
anticipated procedures and actions to be taken.
Changes in patient condition that may occur requiring interventions or contingency plans
Each residency program must develop components ancillary to the institutional transition of care
policy that integrate specifics from their specialty field. Programs are required to develop scheduling
and transition/hand-off procedures to ensure that:
1.
2.
3.
Residents do not exceed the 80-hour per week duty limit averaged over 4 weeks.
Faculty are scheduled and available for appropriate supervision levels according to the requirements for the
scheduled residents.
All parties involved in a particular program and/or transition process have access to one another’s schedules and
18
4.
5.
6.
7.
contact information. All call schedules should be available on department-specific password-protected websites
and also with the hospital operators.
Patients are not inconvenienced or endangered in any way by frequent transitions in their care.
All parties directly involved in the patient’s care before, during, and after the transition have opportunity for
communication, consultation, and clarification of information.
Safeguards exist for coverage when unexpected changes in patient care may occur due to circumstances such as
resident illness, fatigue, or emergency.
Programs should provide an opportunity for residents to both give and receive feedback from each other or
faculty physicians about their handoff skills.
Each program must include the transition of care process in its curriculum. Residents must
demonstrate competency in performance of this task. Programs must develop and utilize a method of
monitoring the transition of care process and update as necessary.
Some simple protocols that have been developed that are easily integrated into the practice of
anesthesia include:
SAIF-IR
Summary
Active issues
If-then contingency planning
Follow-up activities
Interactive questioning
Read backs
SOAP
Subjective
Objective
Assessment
Plan
Expectations
Explanation
Each of the above two transition of care strategies can be appropriate used as a template to provide
information associated with transition of care. Obviously, the detail needed to in each instance will
vary depending upon the specific needs of the patient.
19
6] Technical Objectives
The technical objectives are to instruct the resident to administer general anesthesia via various
pharmacological methods and to develop the repertoire necessary to manage a wide array of clinical
situations. Placement of subarachnoid and epidural conduction blockade is a key focus of training for
surgery, the management of acute and chronic pain, and for obstetrics. Skills in administering regional
anesthesia, via a variety of approaches, are stressed. Residents at all levels are expected to become
proficient in venous cannulation, arterial cannulation, and central line placement (Central Venous
Pressure Lines and Swan-Ganz Catheters) and their interpretation. Particularly emphasized are all
aspects of airway management, including but not limited to: awake and asleep intubation, fiberoptic
intubation, laryngeal mask airway placement, use of intubating LMAs, and use of the lightwand. Also
stressed are skills and techniques to manage and evaluate intraoperative complications, especially
those that are cardiovascular in nature.
7] ACGME/RRC Compliance
Many of you may not have experience with the term ACGME/RRC. The ACGME stands for the
Accreditation Council on Graduate Medical Education. The RRC represents the Residency Review
Committee. Even though these terms may seem relatively unfamiliar, these organizations have the
ability to place programs on probation and can even withdraw training accreditation. The Department
of Anesthesia very seriously evaluates all communications from these organizations. Your future as
anesthesiologists depends upon the Department maintaining its accreditation. Hence, when issues are
brought to your attentions that deal with matters concerning “compliance”, the “ACGME”, or the
“RRC”, these are to be taken with the utmost seriousness and there is an expectation that these issues
will be immediately addressed. Due to the serious nature of any infraction regarding these issues and
the potential negative impact that these violations may have on the entirety of the residency, the
Department reserves the right to immediately suspend or terminate individuals that do not comply with
these issues in a timely manner.
Electronic Case Log System- All residents are required to utilize the ACGME website for entry of
case logs. This should be done on a regular basis no less than twice during every four weeks rotation
block.
In addition to the Case Log System that is maintained by the ACGME, the Department of Anesthesia
would encourage residents to familiarize themselves with other portions of the ACGME website. This
site contains supplemental useful and important information regarding issue involving residency
training.
Academic Projects- The ACGME/RRC had mandated that all anesthesia residents “must complete”
an academic project or assignment. Additionally, the RRC requires that a faculty member monitors
progress of each of these projects.
Participation in an academic project must be formally documented by the completion of the CA 3
(PGY4) year via a “report” to the program director. The reports should be in the basic format of
“Background, Methods, Results, and Conclusions or Discussion.” Documentation of educational
20
initiatives will be accomplished with a report outlining the goals, a copy of the educational material,
and appropriate references.
Projects that are acceptable include but are not limited to:
1.
2.
3.
4.
5.
6.
7.
MARC presentations
Grand Rounds presentations: reporting on an academic subject or project in which the resident has invested
significant time and effort (Journal Club and M&M conferences do not fulfill this requirement).
Publication of original research or case report
Preparation of a training manual or engaging in a special training assignment
Completion of a project that promotes the educational mission of the residency program such as educational
material development or significant participation in an ISA workshop or poster session (All require the same
degree of formal documentation as noted above)
Resident Scholar Lecture: Residents with a particular interest or expertise in an academic topic, or for the
presentation of original research, are invited to present a detailed lecture at Grand Rounds for project credit. Four
time slots per academic year will be made available for this purpose.
Other proposed projects/academic presentations as approved by the residency program director
Internet-Based Data Entry Programs - The following “Web-based” programs are utilized by the
department for supplying data regarding resident education and status in compliance with the
rules and regulations of its web-based sponsor (in parenthesis):
1.
2.
3.
4.
5.
6.
ADS [ACGME]—web Accreditation Data System—yearly report with updates
ECLS[ACGME/RRC] --sent early July
RTID [ABA] --new residents enrolled in early July
CCC-RTR [ABA-ASA joint council] --sent every six months
National GME Census [AAMC and AMA]-- yearly
ERAS and NRMP [AAMC]
a. -Applications from MS4 students viewed starting September 1st
b. -Applicants selected from ERAS pool and sent invitations to interview
c. -Match ranking sent in February of the following year via NRMP
ACLS Certification- All residents in their CA2 year are scheduled for training in ACLS in order to
achieve certification by the CA3 year. The scheduling of the ACLS requirement will be facilitated by
the associate chief resident.
Assessment and Documentation Methodologies have been developed and implemented by the
department to confirm the achievement of these competencies. These have typically been formally
submitted to the Dean’s Office and exist as an addendum to this document.
The specific assessment tools include:
1.
2.
3.
4.
5.
6.
7.
-Clinical Competency Report [addresses all six components]
-Global Performance Assessment- every 6 months
-Anesthesia Simulator Lab Evaluation
-Resident Teaching Evaluation- OR and ACLS Course
-Anonymous resident (peer) evaluations (every 6 months)
-Medical Student/Resident evaluations (after medical students rotate on anesthesia)
-CA2 grand rounds presentations, which assesses communication and professionalism (all CA2 residents are
assigned to provide one grand rounds presentation on the subject of their choice)
21
DUTY HOURS AND RELATED ISSUES
Duty Hour Requirements
Strict enforcement of the below duty hours is a requirement of the ACGME. If at any time a
resident believe that they might violate any of these duty hours, the program director, chair of
the department of anesthesia or the section director who has oversight of the specific hospital
needs to be contacted prior to any violations to ensure that no violations of the duty hours occur.
Effective July 2008, the ACGME issued common accreditation standards for resident duty hours which
includes:
1.
2.
3.
4.
5.
6.
7.
-Limiting resident hours to 80/wk averaged over 4 weeks
-Mandating 1 out of 7 days free of patient care duties averaged over 4 weeks
-Limiting call to no more than once every third night averaged over 4 weeks
-Limiting call hours to a maximum of 24-hour shifts
-Residents should obtain a minimum 10-hour rest period between work periods
-Requiring the institution and department to monitor duty hours, moonlighting activities (as part of the 80hr/wk),
and residents emotional well-being
-Requiring that priority be given to education (over clinical service), full-time faculty supervision, and limited
resident time devoted to routine patient care support services (IV, phlebotomy)
The Department of Anesthesia has implemented policies to insure that the Anesthesia residency
program is in full compliance with all ACGME “Duty Hour” and related regulations and
requirements.
Residents must fill out monthly audit cards (below) to demonstrate that their working conditions
are in compliance with the ACGME rules and regulations and to help identify any areas of noncompliance.
All cards with any responses indicating a problem are investigated and corrective action is taken
and documented.
Sample of monthly resident survey on duty hours compliance form shown below.
22
23
EMPLOYMENT OUTSIDE OF RESIDENCY
Moonlighting Guidelines
The IU School of Medicine and the Committee on Graduate Medical Education have established a
“moonlighting policy”. The essential components of this are as follows:
“The IUSOM believes that moonlighting by house officers is inconsistent with the educational
objectives of the house officer’s training and is therefore a practice to be discouraged.”
The Program Director must be informed about any moonlighting activities by the resident, which must
be submitted in writing and in advance, using the enclosed IUSOM form submitted by each resident
outlining all moonlighting activity.
This form must be completed annually and updated whenever there is a change in the moonlighting
activity and the Program Director must acknowledge this activity by signing this form and placing it in
the resident’s folder. Unapproved moonlighting or moonlighting that coincides with training program
assignments or that interferes with training may result in disciplinary action up to and including
termination.
Residents are not required to engage in moonlighting, but if so engaged, must be licensed for
unsupervised medical practice in the State of Indiana, and must obtain liability coverage outside the
jurisdiction of the University and training program.
The Department of Anesthesia currently only supports visa holders who possess J-1 visas (educational
based). Residents on J-1 visas may not engage in moonlighting in the United States.
Residents sign a document acknowledging that they have received and read these policy components.
The below moonlighting policy is added in order to highlight the above constraints on the topic of
moonlighting.
Departmental Policy on Moonlighting
Additionally, the Department’s policy states:
“Employment outside of residency responsibilities (“moonlighting”) is strongly discouraged. It is
permissible for residents to accept outside employment that precedes a normal clinical day in the
department only if all employment responsibilities end by 12:00 midnight the preceding evening.
Documentation that this policy is not being followed will be referred to the Clinical Competence
Committee for a decision as to the resident’s future status in the department.”
The above policies are not meant to supersede University Policies which can be found in the “Personal
Information for House Staff” manual.
Residents who moonlight must assure that they have coverage for malpractice and hold an
appropriate Indiana Medical License.
24
8] Resident Evaluation Methods and “Feedback”
1.
2.
3.
4.
5.
6.
7.
8.
9.
Residents are evaluated monthly on each rotation, with a report on each resident [assessing all ACGME
competencies] being sent to the Clinical Competency Committee.
The Clinical Competency Committee evaluates residents every three months and the RTR/CCC report is
electronically filed with the ABA at the appropriate intervals.
The CCC evaluations are completed by the faculty, which seeks to address the Six Competencies of the ACGME.
All years have two exams, one every 6 months, based on the material of the didactic course for the given training
year. Results are reported to the RPD and the resident.
Regular Anesthesia Simulator Laboratory evaluations are performed based on a toolbox assessment approach,
with unsatisfactory reports being sent to the program director for further review.
Presentations are evaluated for communication effectiveness and professionalism and help to evaluate for
ACGME competency requirement.
Residents are given full access to their academic files during normal business hours.
Residents can discuss their academic progress with the RPD upon request.
CCC issues a 6 month report (pink card) to each resident. [Sample card shown below:] Residents are required to
discuss their progress with a member of the faculty (normally this will be the faculty mentor described below)
and obtain their signature. Residents must also sign and return this card to the appropriate secretarial staff.
Front side
Name_______________________________________
Date_________________
The ACGME asks that all programs have some mechanism by which periodic
feedback is provided to its residents regarding their performance. Below is a
simple global assessment of your performance to date. One should not
view these classifications as anything other than the Department's way of
helping you focus on areas of potential improvement. [Additionally,
residents are free to check their academic file at any time.]





Outstanding (both above average knowledge base and clinical skills)
Above Average (either above average knowledge base or clinical skills)
Average (adequate knowledge base and clinical skills)
Below Average (either below average knowledge base or clinical skills)
Unsatisfactory (both below average knowledge base and clinical skills)
Suggested method(s) of improvement:






none necessary
read/study more
focus on improving technical skills
improve work habits in the OR- with respect to time management
improve work habits in the OR- with respect to communication skills
improve work habits in the OR- with respect to directing your practical priorities
Reverse side
I ________________________________________________________, have personally
(Print Faculty Member Name)
discussed this resident’s progress in the program covering the last six months of
training on _________________.
(Date)
____________________________
Resident
____________________________
Faculty
25
9] Anonymous Evaluation by Residents of the Faculty and of the Program
1.
2.
3.
4.
5.
6.
Monthly Faculty Evaluations
Yearly Program Evaluations
As necessary, the RPD interviews senior residents to discuss faculty strengths and weaknesses
Yearly CA3 Exit Evaluation
CA1/2/3 evaluations of the Didactic Courses every 6 months
Faculty evaluation of residency program on a yearly basis
10] Educational Quality Assurance Methods
1.
2.
3.
4.
5.
6.
Yearly ITE / Specialty Boards for all residents completing at least one year of clinical training (ABA & ASA report
results to Department for review)
Yearly resident evaluation of the program.
ITE results, course evaluations, resident input, and exit polling data are all used to improve the courses/program
either through content, organization, sequence presentation, or lecturer; and are factored into the subsequent
year’s curriculum.
Evaluations of resident performance on internal exams are reviewed by course directors to establish areas of
deficient didactic training.
Comments made on items listed in #9 (above) are reviewed by the RPD and Chairman, and acted upon by the
appropriate administrative entity whenever a negative pattern is noted or any reasonable actionable complaint is
discovered.
Input from the residents is obtained regarding way of improving the anesthesia program prior to each Anesthesia
Graduate Medical Education Meeting. These meetings are held at least twice yearly. If deficiencies are found a
written plan of action is generated. This plan is reviewed at the subsequent meeting in order to ensure forward
progress in the area of educational improvement. The residents are asked to submit their suggestions to the
Chief Residents or directly to the Program Director. All responses are confidential unless permission is provided
by the author of the suggestion to share their identity.
26
11] Initiatives to Address Substance Abuse, Stress, Fatigue and Sleep Deprivation
POLICY on SUBSTANCE ABUSE
Substance abuse amongst anesthesiologist has been well described in the literature. The
Department of Anesthesia considers any violation of this policy very seriously. Many instances
of substance abuse are preceded by issues associated with stress. Educational programs as well
as faculty advisory groups have been put into place to emphasize the importance of this issue.
Self-administration of controlled substances for non-medical purposes will result in immediate
suspension from the Department of Anesthesia.
If requested and appropriate, the department will attempt to assist the resident in making arrange for
treatment. It is expected that the resident will take responsibility for any costs incurred for treatment
that are not covered by their health insurance carrier.
It is expected that the individual will comply with all rules, regulations, and monitoring parameters set
forth by the State Licensure Board related to substance abuse.
Following appropriate therapy and counseling, and upon receipt of recommendations of professional
substance abuse specialists and counselors, the application of the involved individual may be
considered by the Chair, Residency Program Director, Clinical Competency Committee and the
Residency Selection Committee for available residency positions.
Information concerning misuse of controlled substances will be shared with faculty members who are
asked to provide personal recommendations.
Resident education regarding substance abuse includes:
1.
2.
3.
4.
5.
6.
7.
All residents are provided a copy of the substance abuse policy
The issue of substance abuse is discussed during resident orientation
A volunteer “Faculty Advisor Group” has been established to help to serve as both confidants and guidance
counselors. Many residents, during their training, experience personal problems that are common to many in
that age group. However, unlike those with other jobs, the ongoing demands of intense career preparation when
juggled with personal problems, can lead to disabling stress as well as behavior that is destructive to the
educational process and to individual relationships.
The residents are made aware that the School of Medicine maintains professional counseling which is provided to
resident who request these services at no cost
Additionally, the Department conducts a formal lecture on “Impairment” along with University Counselors
presenting methods of accessing their services. In cases where residents are experiencing family related stresses,
the RPD personally intervenes in a manner best able to facilitate resolution of the problem without disruption of
the training process.
Yearly grand rounds lectures are scheduled to discuss issues associated with substance abuse and sleep/fatigue
issues
Both the CA1 and CA2 residents receive yearly lectures utilizing the video “Wearing Masks”
27
POLICY on RESIDENCY GRIVANCE
We are committed to assuring that a positive work environment is maintained in order to foster
resident education and patient care. At times issues may arise in which differences of option occur. It
is important to understand that residents should provide input so that these differences can be discussed
in order to provide clarification or so corrective measures can be considered for overall program
improvement. Residents at no time should experience harassment, intimidation or retaliation. In most
instances, the Chief Resident or Program Director should be alerted to these concerns however, other
mechanisms are also in place to address these issues and they include:
o
o
o
o
Department Chair
Teacher Learner Advocacy Committee
Dean of Graduate Medical Education
Dean of Educational Affairs
274-0275
[email protected]
274-8383
278-6153
The handbook entitled Personal Information for House Staff provides the following overview of the
Teacher Learner Advocacy Committee.
TLAC Composition and Process
The Executive Associate Dean for Academic Affairs (EADAA) appoints the chairperson of the TLAC.
The TLAC membership will include elected students, residents and faculty along with students,
residents and faculty, appointed by the EADAA. Every attempt will be made to have a broad-based
and diverse membership. At times, it will be necessary to convene a subgroup of the
TLAC to investigate specific complaints. Once convened, a subgroup’s membership should remain
consistent through the resolution of the individual case. The TLAC will hold two regularly scheduled
meetings per year. One will be at the beginning of the academic year (August) to review the charge to
the TLAC with the EADAA and the other at the end of the academic year to review the policy and
recommend appropriate changes to the policy and procedures. Other meetings will be held on an “asneeded” basis.
An individual wishing to discuss a possible complaint can seek ‘consultation’ with any member of the
TLAC. Following that consultation, if the complainant seeks to initiate a formal process, a written
description of the complaint, signed by the complainant, must be submitted to a member of the TLAC
who will forward the document to the TLAC chair. The TLAC will conduct a preliminary review of
the complaint, giving the reporting complainant, and any other persons, as the TLAC shall determine,
an opportunity to recount information on the matter. If the TLAC moves forward with the complaint to
a formal hearing, the TLAC chair or his/her designee is responsible for notifying the involved parties
in writing of the complaint and the time and place of the TLAC hearing. At this time confidentiality of
the complainant cannot be guaranteed by the TLAC.
When the TLAC convenes a hearing, the EADAA will also be notified.
A Recorder will be selected by the TLAC during each hearing. The Recorder will record adequate
minutes of every meeting. The TLAC Recorder will not record deliberations of the TLAC on findings
and recommendations or TLAC deliberations regarding excusing TLAC members from sitting on the
case. This record shall serve as the official documentation of the hearing. The Recorder will maintain
minutes until resolution of the complaint at which time they will be sent to and stored in the office of
the EADAA.
28
The complainant and the respondent have an opportunity to submit written documents addressed to the
TLAC. The complainant shall present any information first, followed by a presentation by the
individual against whom a complaint is made. The respondent has the right to access the hearing
minutes that include statements made by the complainant or any witness, or be present during hearings
as determined by the TLAC. Similarly, the complainant has the right to access the hearing minutes that
include statements made by the respondent or any witness or be present during hearings as determined
by the TLAC members. As an internal dispute resolution process, no party will be permitted to be
represented by legal counsel during the TLAC hearings.
Witnesses will be present only when they are called to give information. After speaking, they will be
asked to leave and will not speak to each other prior to or during the proceedings. Both the respondent
and the complainant can be harmed by breaches of confidentiality and all who are involved in the
process of responding to allegations must be cautioned to maintain confidentiality.
The TLAC’s record and summary of deliberations will be sent to the EADAA. The EADAA will then
decide what action to take with recommendations from the TLAC members as well as other IUSM
leadership. The EADAA, or his/her designee, will advise the respondent and complainant concerning
the final disposition of the matter.
Note: This procedure is not intended to supplant or replace other remedies a complainant or respondent
may have, but simply to provide a voluntary forum for the resolution of disputes. Formal charges of
discrimination should be filed with the Office of Affirmative Action.
POLICY on RESIDENT FATIGUE and SLEEP DEPRIVATION
Symptoms of fatigue, sleep deprivation, and stress occur periodically with all individuals. When
fatigue, sleep deprivation, and stress inappropriately impacts one’s ability to provide safe care to
patients and inhibit the ability to act in a safe fashion, the Department of Anesthesia requires
arrangements be made in order to alleviate any untoward events.
The Department maintains a monthly tracking of “duty hours” as outlined by the ACGME. All
rotations have been designed to not violate these duty hour requirements. Nonetheless, the above
issues associated with fatigue, sleep deprivation and stress can still occur.
When these issues become apparent to the extent that performance in the area of patient care and
personal safety are placed into question, the section director at the institution the resident is rotating
and the program director should be immediately notified so appropriate actions can be instituted.
Residents should be immediately removed from patient care responsibilities and some or all of the
below measures should be considered:
1.
2.
3.
4.
Remove resident from direct patient care; this may require utilization of the emergency call resident.
Provide an appropriate opportunity for rest within the call room or other appropriate area of the hospital.
Arrange for taxi service for the resident in order to assure safe transport home.
Other management as deemed appropriate.
29
In cases where residents are impacted by fatigue, sleep deprivation and stress due to long-term issues,
the resident may need to be removed from patient care for a longer period. If this occurs, the
Department Chair, Chief Resident, Department of Graduate Medical Education, Chair of the Clinical
Competency Committee, University Counseling and Program Director may be notified and an
appropriate action plan will be developed.
With any issue relating to this matter, a root cause analysis will be performed to determine if any
corrective actions with resident scheduling will diminish the possibility of further such incidents.
RESIDENTS EDUCATION REGARDING FATIGUE AND SLEEP DEPRIVATION
1.
2.
3.
4.
All residents are provided a copy of the fatigue and sleep deprivation policy.
A volunteer “Faculty Advisor Group” has been established to help to serve as both confidants and guidance
counselors. Many residents, during their training, experience personal problems that are common to many in
that age group. However, unlike those with other jobs, the ongoing demands of intense career preparation when
juggled with personal problems, can lead to disabling stress as well as behavior that is destructive to the
educational process and to individual relationships.
The residents are made aware that the School of Medicine maintains professional counseling which is provided to
resident who request these services at no cost
Yearly grand rounds lectures are scheduled to discuss issues associated with substance abuse and sleep/fatigue
issues
12] Family/ Medical Leave of Absences (FMLA)
As per University House Staff policy, the FMLA is based on the following qualifying reasons:
1.
2.
3.
4.
for birth of a son or daughter or care for a newborn child
for placement with the resident of a son or daughter for adoption or foster care
to care for resident’s spouse, son, daughter, or parent with a serious health condition
because of a serious health condition that makes the resident unable to perform the functions of his/her jo
13] Vacation, Leave, and ABA “Make-up” Time
The policies related to vacation, paid and unpaid leave and ABA make-up time are as follows:
IU SCHOOL OF MEDICINE
HOUSE STAFF PAID TIME OFF POLICY
Paid time off for residents and fellows will be encouraged for the purpose of increasing the personal
well-being of the house staff member. The intent of the Paid Time Off Policy is to give each resident
and fellow in PGY levels 1 and 2 three seven-day weeks free from their training responsibilities and
each resident and fellow in PGY levels 3 and above four seven-day weeks free from their training
responsibilities.
All PGY1s and 2s will receive 21 days of paid time off. This consists of 15 weekdays and 6 weekend
days.
All PGY3s and above will receive 28 days of paid time off. This consists of 20 weekdays and 8
weekend days.
30
Paid time off must be taken during an academic year and cannot be accumulated from one year to the
next.
No payment will be made for unused paid time off at the completion of training.
Programs may place limits on the times of the year when paid time off can be taken.
Paid time off must be taken as part of the School of Medicine leave and counted against the six weeks
paid leave; this applies to the FMLA leave as well (See IUSM Leave of Absence Policy).
Paid time off for personal days will be at the discretion of the program director.
Vacation:
All vacations must be taken in full week blocks. CA1 residents receive 3 weeks of vacation. CA2 and
CA3 residents receive 4 weeks of vacation.
Vacation requests must be placed with the chief resident or his/her designee.
The number of residents who may be on vacation at one time is limited.
PGY1 and PGY2 (CA1) get three calendar weeks of vacation (15 weekdays).
PGY3 (CA2) and PGY4 (CA3) get four calendar weeks of vacation (20 weekdays).
You may not carry-over vacation weeks from one academic year to the next (use it or lose it).
FMLA:
Up to 12 weeks of FMLA may be taken [6 paid and 6 unpaid]
The 6 weeks of paid leave includes vacation weeks.
Unused vacation during any academic year will be counted towards the 6 weeks of paid leave
So a CA1 gets just 3 extra paid weeks, and a CA2 and CA3 get just 2 extra paid weeks.
Therefore, used vacation “eats into” the paid leave time
ABA:
The ABA requires residents to make-up time away exceeding 20 typical OR weekdays/year. If
residents take more time away from the program than is allowed by the ABA the resident will be
required to extend their residency education by the number of days absent from the program.
Since the ABA requires 36 months of training to sit for the Board Exam, the ABA allows for a
maximum of 20 typical weekdays away from training per year (after which the time must be added to
the end of training) which we regard as 4 weeks. Unused vacation weeks can be applied to reduce time
owed at the end of the residency if the program director and resident agree that this is in the trainee’s
best interest.
ABSENCE FROM TRAINING
When a resident is unable to perform clinical responsibilities because of illness or family emergency, it
is the resident’s responsibility to notify the appropriate faculty at the current hospital assignment. It is
unacceptable to make contact through another resident, nurse, secretary, or an answering machine.
The American Board of Anesthesiology permits a maximum of 20 working days (4 clinical work
weeks) a year away from training during Clinical Anesthesia Years 1-3. This is inclusive of vacation,
sick leave, family leave, military obligations or any other reason that prevents the resident from being
able to provide scheduled clinical duties. To be eligible to enter the examination system of the
31
American Board of Anesthesiology, it will be necessary to extend the resident’s residency training by
the number of days that exceed this allowable 20 days during each year of the Clinical Anesthesia
years.
In addition to the above, a resident who is absent from their duties is responsible for notifying
the Administrative Assistant responsible for residency affairs via e-mail within 7 days of any
and all absences from training that are not due to vacation or previously scheduled and
approved meetings.
SPECIFIC POLICIES GOVERNING OTHER RESIDENT ACTIVITIES:
Attendance at Scientific Meeting
CA1 and CA2 residents attend meetings at their own expense and the time is counted as vacation.
CA 3 residents may attend the American Society of Anesthesiologists meeting (October), the New
York Postgraduate Assembly meeting (December) or International Anesthesia Research Society
meeting (March) and other major scientific meetings with the program directors approval at their own
expense. The time away (maximum 5 days) will not be counted as vacation. Other meetings are
considered as vacation time.
All reasonable expenses will be paid to attend a meeting when the resident is on the scientific program
(i.e. a presenter). The Program Director must prospectively approve this meeting.
All residents are encouraged to attend the annual meeting of the Indiana Society of Anesthesiologists.
All residents are invited to attend dinner meetings of the Indianapolis Society of Anesthesiologists.
There is no fee to attend these meetings.
CA3 attendance at meetings that do not count as vacation will be limited to the number of residents
who may be away without jeopardizing clinical coverage.
Any deviation from this policy must be first approved by the Chief, Associate Chief Resident and
Program Director. Additionally, the individual in charge of scheduling issues at the clinical site that is
going to be directly impacted by any deviations from this policy must also be contacted and approve of
the absence. All special requests must be in writing. Additionally, written confirmation of the
acceptance of these special absences must also be obtained from all individuals in writing.
Practice Management Seminar and Lectures
Each year, a practice management seminar is held for the benefit of the CA 3 residents. This features
speakers from the medical and business community with the objective of providing a forum for topics
and questions regarding practical aspects of serving in the profession. Additionally, guest lectures
offered in the CA 2 year are provided as part of the core curriculum to expose residents to various
components of private and academic practice
32
Day After Night Call
It is the policy of this department that residents who take in-house first call for the operating rooms are
not permitted to administer anesthesia the following day. This policy does not excuse the post-call
resident from attending scheduled teaching conferences should they occur on the day following inhouse first call.
Postoperative Note
Each resident must fill out, record the time and date, and sign the Postoperative Notes section of the
anesthesiologist’s form that is in the patient’s chart. The optimal time to write the postoperative note
will be the following day when making preoperative rounds on new patients. In the case of
outpatients, the Postoperative Notes section should provide information regarding the patient’s status
at the time of release.
Journal Subscriptions
It is recommended that every resident join the American Society of Anesthesiologists (ASA) and
consider joining the International Anesthesia Research Society (IARS). Additionally, access to
Medline (OVID) and other academic search tools can be accessed online through the Ruth Lilly
Medical Library.
Membership in these societies includes a subscription to ANESTHESIOLOGY (ASA). Membership
in the ASA also includes membership in the Indiana Society of Anesthesiologists.
The department will pay the initial fee (1-year for ASA). After the first year, the renewal for the
journal Anesthesiology and resident membership in the ASA is the resident’s responsibility. Residents
should use their home mailing address to receive this journal and any other mailings from the ASA.
Scrub Suit Policy
Scrub suits are not to be worn from the hospital to your home or from your home to the hospital.
Intentional violation of this policy is the basis for recommending immediate suspension to the Dean of
Indiana University School of Medicine.
Email
The University provides each resident with an e-mail account for his/her use. These e-mail accounts
must be checked on a routine basis (no less than once a week). Due to technical issues beyond the
control of the Department of Anesthesia, e-mail originating from an Indiana University account being
sent to an Indiana University account cannot be forwarded to an outside account such as Hotmail or
Yahoo. Therefore, it is critical that you maintain your Indiana University e-mail account in working
order. Any negative impact that occurs due to the above issue regarding the transfer of e-mail
information from Indiana University e-mail accounts or other departmental sources will be considered
the responsibility of the resident.
33
American Board of Anesthesiology
All residents are expected to understand and follow the rules and regulations contained within the
ABA Booklet of Information. It is essential that you follow the rules contained within this booklet in
order to be eligible to sit for the board certifying examination. An electronic copy of this handbook is
available at “www.theaba.org”.
Faculty Mentors:
A Faculty Mentorship program is utilized in order to help insure a greater degree of consistency in the
areas of resident evaluation (for example six month evaluations, i.e. pink cards) and to provide the
resident with more formal faculty mentorship. This may include discussing questions regarding job
opportunities, opinions about best study habits, oral board preparation, what texts to read or a myriad
of other questions. In addition, the faculty mentor will be responsible for helping the resident to
understand the importance of administrative duties and the importance of maintaining accurate case
logs, evaluations and other questions associated with the organizational practice of medicine that we
all deal with on a daily basis.
It is not the intent that faculty should know all the answers. The faculty is encouraged to refer the
resident to another member of the faculty, the Chair, members of the Clinical Competency Committee,
or the Residency Program Director if further consultation is felt to be necessary.
We would like to make this a positive experience for the resident. If either a resident or faculty
member requests a reassignment, this request will be granted and a new faculty mentor will be chosen.
It may be that a resident and a particular faculty member enjoy some common leisure activity (fishing,
bowling, collecting stamps, etc.) that may help to better build a relationship through these
commonalities and we would encourage residents and faculty to consider these as important guideposts
in order to optimize the success of this program.
Administrative Responsibility:
Compliance with administrative duties is becoming an ever increasing part of healthcare. Resident
Physicians are required to comply with a number of tasks in order to maintain good standing in the
department and fulfill mandated requirements of National and State organizations. Some of these
requirements have been outlined in the above text and will be again listed in order to help you meet
these benchmarks. They include:
1.
2.
Maintaining an active Medical License
Maintaining and review (no less than weekly) an iupui.edu e-mail address in order to assure that communication
from the Graduate Medical Education Department and the Department of Anesthesia are accessible
3. Appropriately completing patient perioperative charting
4. Making sure that preoperative evaluations are complete and accurate
5. Making sure that intra-operative records are maintained and accurate
6. Making post-operative notation on all patients
7. Completing and returning monthly “yellow” duty hours cards in a prompt fashion
8. Completing and returning six month “pink” resident assessment cards within one month of distribution with
faculty and resident signature
9. Completing and Returning faculty evaluations within two weeks of distribution
10. Updating resident case logs no less than monthly (ideally this task should be done on a daily basis in order to
maximize accuracy)
34
11.
12.
13.
14.
Completing and returning evaluation on didactic lectures within two weeks of distribution
Completing and returning yearly general ACGME evaluations
Completing electronic ACGME surveys
When a resident is unable to perform clinical responsibilities due to illness or family emergency, it is the
resident’s responsibility to notify the appropriate faculty at their current hospital assignment. It is unacceptable
to make contact through another resident, nurse, secretary, or an answering machine.
The Clinical Competency Committee will be provided this information in order to assess the residents
progress in the areas of patient care, professionalism, communication and systems based practice.
Noncompliance with the above responsibilities may require that an unacceptable evaluation be
submitted to the American Board of Anesthesiology.
Operating Room Computer Usage Policy
Consistent with the American Society of Anesthesiologists motto of “vigilance,” the following policy
will be in effect.
Computers in the operating room should not divert the attention of the anesthesia resident or staff
anesthesiologist from patient care responsibilities. Specifically, the computer by the anesthesia work
station should be used only for medically-related activities while a patient is present in the room.
POLICY FOR RESIDENT APPOINTMENT, ELIGIBILITY, SELECTION, AND
PROMOTION
Policies regarding resident appointment can be found at
http://housestaff.iusm.iu.edu/forms/HSMAN_PRINTABLE%20COPY_10_2007.pdf
Key points that are outlined in the above link include:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Signed Letter of Appointment and Patent Agreement, Medical or Dental School Diploma
ECFMG Certificate
Licensure/ Health Screening
I-9 Form
Compliance and HIPAA
Location of Residence
VISA (as appropriate for non-U.S. citizens)
J-1 sponsored by ECFMG
J-2 accompanied with Employment Authorization Form I-688B
F-1 for one year of residency
The Department of Anesthesia currently has 4 categorical and approximately 22 advanced positions
that it offers through the National Resident Matching Program. Applicants are individually considered
and invited for interviews. Graduates of United States allopathic and osteopathic medical schools are
considered. Foreign Medical Graduates are considered if they hold a current ECFMG certificate.
Foreign citizens who meet the previous qualifications are considered if they hold a J1 visa or other
appropriate visa as listed above.
35
The Residency Selection Committee meets during the application season to evaluate and consider
resident applicants. Grades, board scores, letters of recommendation, personal statement and previous
life experiences are taken into account during the selection process.
Promotion of residents is based upon evaluations that are obtained at the conclusion of each four week
rotation. The Clinical Competency Committee utilizes a competency based evaluation system that
considers the six core competencies as outlined above and by the ACGME. Formal reporting of
resident evaluation is provided to the American Board of Anesthesiology every six months.
ACGME ANNUAL ANONYMOUS ELECTRONIC SURVEY
The ACGME administers an anonymous electronic survey to each resident. Compliance with
performing this survey is very important to assure ongoing accreditation of the Anesthesia Program.
This survey should be carefully read and all questions should be honestly answered.
http://www.acgme.org/acWebsite/resident_survey/resident_survey_general_questions_20062007.pdf
BASIC EXAMINATION POLICY:
Unfortunately, not all residents may be able to meet the expectations of becoming board certified. In
2014 the ABA instituted a new examination system that consists of both written and oral/practical
exams. The written exam system has been divided into two phase’s BASIC and ADVANCED exams.
Residents will be expected to take the BASIC examination after completion of their first year of
residency. The ABA has provided specific expectations regarding individuals that are unable to pass
the BASIC examination. The ABA states:
“A resident who fails the BASIC Examination for the first time may take the Examination again at
the next opportunity. A resident who fails the BASIC Examination a second time will
automatically receive an unsatisfactory for the Clinical Competence Committee (CCC) reporting
period during which the examination was taken. After a third failed attempt at the BASIC
Examination, a resident will be required to complete 6 months of additional training. After a fourth
failed attempt a resident will be required to complete an additional 12 months of residency training.
Continuation of residency training is at the discretion of the individual training program.”
Even though the ABA provides residents the opportunity to take the exam an infinite amount of times,
the Department of Anesthesia at Indiana University will only support three attempts. A resident who is
unable to pass the BASIC exam within three attempts will be asked to leave the Anesthesia Residency
Program at Indiana University. If a resident is unable to pass the exam on the second attempt, a 6
month letter of appointment will be provided as opposed to the typical one year appointment. This
appointment status will be extended upon passage of the BASIC exam on the third attempt in order to
allow the resident to complete their anesthesia training; contingent upon satisfactory performance
reviews by the Clinical Competency Committee within the five competency areas as outlined by the
ACGME.
36
Addendum 1:
Expectations and Honor Code
The primary goal of the Residency Program of the Department of Anesthesia at Indiana
University School of Medicine is to provide a sound education that prepares residents to
become qualified practitioners of anesthesia at the superior level of performance expected of a
board-certified consulting anesthesiologist. To this end, we have an expectation that all
residents who complete their Anesthesia training in the Indiana University program will
become board certified and will provide high quality, competent patient care. We anticipate
that they will strive to improve the practice of anesthesia at the local, state and national level.
The Accreditation Council for Graduate Medical Education (ACGME) defines Competencies
as: specific knowledge, skills, behaviors and attitudes and the appropriate education experience
required of a resident to complete Graduate Medical Educational (GME) programs. It seems
logical that the natural progression of competence is a progressive movement from
incompetence to competence, ideally followed by mastery of knowledge, skills, behaviors and
attitudes. Indeed it is our desire that our residents will exceed the expectation of competence
and move towards and reach for overall mastery of the above-mentioned set of objectives.
We believe that the competencies, outlined below by the ACGME, provide a template that the
Department can use to help progress our residents through the various stages of their
educational experience towards our goal of competence and ultimately mastery.
Simplistically, the above can be synthesized into three broad expectations. These expectations
are outlined as follows:
1. We expect our residents to become superior Clinical Anesthesiologists.
2. We expect our residents to become Board Certified within the specialty of Anesthesia.
3. We expect our residents to maintain the highest level of Character.
In order to help provide guidance in the area of character, we have developed an honor code
that we expect individuals to follow. This code is not meant to replace the Indiana University
School of Medicine Honor Code but should be considered a supplement to this document.
Violation of the below will result in reprimand and possible termination from the Anesthesia
Residency Program. These expectations are not meant to be fully comprehensive but include:
1. Residents will not lie, cheat or steal
2. Residents will maintain an attitude of caring and compassion
3. Residents will comply with administrative needs associated with residency related
matters
4. Residents will follow the Core-Competencies as outlined by the ACGME
5. Residents will not use drugs in an illicit manner either personally or as a party to the
illegal/inappropriate distribution these substances
37
6. Residents understand that “VIGILANCE” is the motto of anesthesia and that they will
be expected to maintain the highest degree of professionalism in this area
Your signature with date below attests that you understand and will follow the above. If
you have any questions regarding this matter, please do not hesitate to contact the
Program Director for further clarification.
________________________________________
______________
Signature
Date
________________________________________
Print name legible
38
Addendum 2
Transitions of Care/Handoff Policy
Department of Anesthesia
1. Transitions of Care: A handoff is defined as the communication of information to support the transfer
of care and responsibility for a patient/group of patients from one provider to another. Transitions of car
e are necessary in the hospital setting for various reasons. The transition/hand-off process is an interac
tive communication process of
passing specific, essential patient information from one caregiver to a
nother. Transition of care occurs regularly under the following conditions:
1. Change in level of patient care, including inpatient admission from an outpatient procedure or
diagnostic area, transfer to or from a critical care unit or peri-operative care areas.
2. Temporary transfer of care to other healthcare professionals within procedure or
diagnostic/anesthetizing areas
3. Discharge, including discharge to home or another facility such as skilled nursing care
4. Change in provider or service change, including change of shift for nurses, resident sign-out,
and rotation changes for residents.
The transition/hand-off process must involve face-to-face interaction with both verbal and
written/computerized communication, with opportunity for the receiver of the information to ask
questions or clarify specific issues. The transition process should include, at a minimum, the following
information in a standardized format that is universal across all services:
1.
2.
3.
4.
Identification of patient, including name, medical record number, and date of birth
Identification of appropriate proceduralist/surgeon
Diagnosis and current status/condition of patient
Recent events, including changes in condition or treatment, current medication status, recent lab
tests, allergies, anticipated procedures and actions to be taken
5. Changes in patient condition that may occur requiring interventions or contingency plans
In order to enhance patient hand-off/transition of care:
1.
2.
3.
4.
5.
6.
7.
Residents do not exceed the 80-hour per week duty limit averaged over 4 weeks.
Faculty is scheduled and available for appropriate supervision levels according to the requireme
nts for the scheduled residents.
All parties involved in the program and/or transition process have access to
resident sched
ules and contact information. All call schedules are available on department-specific password
-protected websites and also with the hospital operators.
Patients are not inconvenienced or endangered in any way by frequent
transitions in th
eir care.
All parties directly involved in the patient’s care before, during, and after the transition have op
portunity for communication, consultation, and clarification of information.
Emergency and back-up coverage exist when unexpected changes in patient care occur due to ci
rcumstances such as resident illness, fatigue, or emergency.
Programs should provide an opportunity for residents to both give and receive feedback from
each other or faculty physicians about their handoff skills.
39
Residents are evaluated at minimum three times per year within our simulation laboratory and transition
of care exercises are specifically integrated within simulated scenarios. These simulated scenarios are
both video and audio recorded and when appropriate are replayed so that further discussion and
education in this area can occur.
Some simple protocols that have been developed that are easily integrated into the practice of anesthesia
include:
SAIF-IR
Summary
Active issues
If-then contingency planning
Follow-up activities
Interactive questioning
Read backs
SOAP
Subjective
Objective
Assessment
Plan
Expectations
Explanation
Each of the above two transition of care strategies can be appropriate used as a template to provide
information associated with transition of care. Obviously, the detail needed in each instance will vary
depending upon the specific needs of the patient.
Your signature with date below attests that you understand and will follow the above. If you have
any questions regarding this matter, please do not hesitate to contact the Program Director for
further clarification.
________________________________________
______________
Signature
Date
________________________________________
Print name legible
40
Addendum 3
BASIC EXAMINATION POLICY:
Unfortunately, not all residents may be able to meet the expectations of becoming board certified. In
2014 the ABA instituted a new examination system that consists of both written and oral/practical
exams. The written exam system has been divided into two phase’s BASIC and ADVANCED exams.
Residents will be expected to take the BASIC examination after completion of their first year of
residency. The ABA has provided specific expectations regarding individuals that are unable to pass
the BASIC examination. The ABA states:
“A resident who fails the BASIC Examination for the first time may take the Examination again at
the next opportunity. A resident who fails the BASIC Examination a second time will
automatically receive an unsatisfactory for the Clinical Competence Committee (CCC) reporting
period during which the examination was taken. After a third failed attempt at the BASIC
Examination, a resident will be required to complete 6 months of additional training. After a fourth
failed attempt a resident will be required to complete an additional 12 months of residency training.
Continuation of residency training is at the discretion of the individual training program.”
Even though the ABA provides residents the opportunity to take the exam an infinite number of times,
the Department of Anesthesia at Indiana University will only support three attempts to pass the
BASIC examination. A resident who is unable to pass the BASIC examination within three attempts
will be asked to leave the Anesthesia Residency Program at Indiana University. If a resident is unable
to pass the examination on the second attempt, a 6 month letter of appointment will be provided as
opposed to the typical one year appointment. This appointment status will be extended upon passage
of the BASIC examination on the third attempt in order to allow the resident to complete their
anesthesia training; contingent upon satisfactory performance reviews by the Clinical Competency
Committee within the five other competency areas as outlined by the ACGME.
Your signature with date below attests that you understand and will follow the above. If you
have any questions regarding this matter, please do not hesitate to contact the Program Director
for further clarification.
________________________________________
______________
Signature
Date
________________________________________
Print name legible
41
Addendum 4
DUTY HOURS AND RELATED ISSUES
The Department of Anesthesia has implemented policies to insure that the Anesthesia residency
program is in full compliance with all ACGME “Duty Hour” and related regulations and
requirements.
Residents must fill out monthly audit cards to demonstrate that their working conditions are in
compliance with the ACGME rules and regulations and to help identify any areas of noncompliance.
All cards with any responses indicating a problem are investigated and corrective action is taken
and documented.
ABSENCE FROM TRAINING
WHEN A RESIDENT IS UNABLE TO PERFORM CLINICAL RESPONSIBILITIES
BECAUSE OF ILLNESS OR FAMILY EMERGENCY, IT IS THE RESIDENT’S
RESPONSIBILITY TO NOTIFY THE APPROPRIATE FACULTY AT THE CURRENT
HOSPITAL ASSIGNMENT.
IT IS UNACCEPTABLE TO MAKE CONTACT THROUGH ANOTHER RESIDENT, NURSE,
SECRETARY, OR AN ANSWERING MACHINE.
In addition to the above, a resident who is absent from their duties is responsible for notifying
the Administrative Assistant responsible for residency affairs via e-mail within 7 days of any
and all absences from training that are not due to vacation or previously scheduled and
approved meetings.
________________________________________
______________
Signature
Date
________________________________________
Print name legible
42