Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Assessment Guidance - The Royal College of Anaesthetists
Transcript
CCT in Anaesthetics Assessment Guidance August 2010 Version 1.4 The Royal College of Anaesthetists AG-1 Table of Contents Assessment method decode....................................................................................................................4 Guidance for Educational Supervisors and Consultants ............................................................................5 Guidance for Trainees .............................................................................................................................6 How many WPBAs? .........................................................................................................................................6 It’s the trainees responsibility ......................................................................... Error! Bookmark not defined. Basic Level ..............................................................................................................................................7 Initial Assessment of Competence..................................................................................................................7 Initial Assessment of Competence in Obstetric Anaesthesia ........................................................................9 Anaesthesia in General .................................................................................................................................10 Paediatric .......................................................................................................................................................11 Regional Anaesthesia ....................................................................................................................................12 Critical Incidents ............................................................................................................................................13 Control of Infection .......................................................................................................................................14 Intermediate Level................................................................................................................................ 15 General, urological, gynaecological and orthopaedic surgery.....................................................................15 Ambulatory and Day Surgery ........................................................................................................................16 Vascular .........................................................................................................................................................16 Trauma and Injury .........................................................................................................................................17 Regional Anaesthesia ....................................................................................................................................18 Pain Medicine ................................................................................................................................................18 Obstetrics.......................................................................................................................................................19 Paediatric .......................................................................................................................................................20 Cardiac/Thoracic............................................................................................................................................21 Neurosurgery, neuroradiology and neurocritical care.................................................................................21 Ophthalmic ....................................................................................................................................................22 Non-theatre and Sedation ............................................................................................................................23 Plastics/Burns ................................................................................................................................................24 Maxillo-facial and dental ..............................................................................................................................24 Ear, nose and throat ......................................................................................................................................25 Learning and teaching ...................................................................................................................................26 Higher Level.......................................................................................................................................... 28 Anaesthesia for neurosurgery, neuroradiology and neurocritical care ......................................................28 Cardiac/Thoracic............................................................................................................................................29 Airway Management .....................................................................................................................................30 Day-Surgery ...................................................................................................................................................31 ENT, maxillo-facial and dental surgery .........................................................................................................32 General, urological and gynaecological surgery...........................................................................................33 AG-2 Management of respiratory and cardiac arrest ...........................................................................................34 Non-theatre ...................................................................................................................................................34 Anaesthesia and Sedation outside of the Operating Theatre .....................................................................34 Obstetrics.......................................................................................................................................................35 Orthopaedic ...................................................................................................................................................36 Regional Anaesthesia ....................................................................................................................................37 Sedation .........................................................................................................................................................38 Trauma and Stabilisation ..............................................................................................................................39 Transfer Medicine .........................................................................................................................................40 Vascular .........................................................................................................................................................41 Intensive Care Medicine................................................................................................................................42 Paediatrics .....................................................................................................................................................44 Education .......................................................................................................................................................46 Pain Medicine ................................................................................................................................................46 Ophthalmic ....................................................................................................................................................47 Plastics/Burns ................................................................................................................................................48 Anaesthesia in developing countries ............................................................................................................49 Conscious sedation in dentistry ....................................................................................................................49 Remote and Rural Anaesthesia.....................................................................................................................50 Military Anaesthesia .....................................................................................................................................50 Blueprint for workplace based assessments against the basic level units of training ...............................51 Blueprint of workplace based assessments mapped against the intermediate level units of training .....52 Blueprint of workplace based assessments mapped against the higher level units of training ................53 AG-3 Assessment method decode A Anaesthesia Clinical Evaluation Exercise [A-CEX] C Case Based Discussion [CBD] D Direct Observation of Procedural Skills [DOPS] E Examination I Intensive Care Medicine Clinical Evaluation Exercise [I-CEX] L Anaesthesia List Management Assessment Tool [ALMAT] M Multi-source Feedback [MSF] S Simulation T Acute Care Assessment Tool [ACAT] AG-4 Guidance for Educational Supervisors and Consultants Trainees must undertake workplace-based assessment (WPBA) for every unit of training. The assessments do not stand alone. They are part of the evidence that the trainee will present at their ARCP. It is the responsibility of the trainee to work with their educational supervisor to plan how many and which WPBAs they should undertake. The minimum number is one each of A-CEX, DOPS, ALMAT and CBD for each unit of training where that workplace based assessment has been defined as an assessment method. In addition at the appropriate stage of training the trainee must complete all the assessments that comprise the Initial Assessment of Competence and the Initial Assessment of Competence in Obstetric Anaesthesia. It is the trainee’s responsibility to ask their clinical supervisors to make the assessments - which should be filled in at the time. The trainee’s capacity to get their assessments done on time is a measure of their professionalism and the ARCP panel should take providing incomplete evidence seriously. Consultants should therefore not agree to sign off assessments retrospectively. It is OK to help the trainee if unforeseen complications make this necessary. The trainee’s performance can still be rated satisfactory if they coped appropriately for their experience. Some assessments can be undertaken in simulation. Commonly these will be DOPS. The critical incidents should be undertaken as simulations. The assessments are intended to sample a cross-section of the trainee’s capabilities and are not to be treated as a detailed competence checking exercise. Trainees should be encouraged to do assessments regularly during placements and not to store them up to the end of placement. The marking of assessments is a professional skill of the consultants. The decision they must make is whether the trainee’s performance is satisfactory or not. There is no fixed pass-mark or criterion because the consultant must make an allowance for the trainees stage of training, level of experience, the difficulty of the case and any complicating factors that might influence the progress of the work. The consultant must ask him or herself if the performance they have seen is satisfactory for this trainee given all the relevant circumstances. For instance, ALMATs can be undertaken at any time during training and a performance that is excellent at a year might be judged very erratic in ST7. Consultants should not see this as a problem because their professional skill and knowledge is recognised in asking them to make these judgements. Where performance is rated satisfactory the consultant should give feedback. This should identify good points, recognise deficiencies and where possible give guidance for further progress. There is no necessity for all training to be provided in blocks in order to facilitate these assessments. Some experiences will benefit from consistent allocation of experience whereas others may be absorbed into a more general form of work allocation. Schools of anaesthesia may wish to review their policy of placements in order to facilitate assessment of workplace performance. The annual review of progress will be required to consider progress in each of the categories. ACCS trainees will need to undertake the Initial Assessment of Competence – whatever their parent specialty. Please refer to Section 6.3 of the ACCS Core Training Programme – Curriculum and Assessment System for the training requirements for the anaesthesia component. AG-5 Guidance for Trainees How many WPBAs? The curriculum is divided into sections. Most sections have formal WPBAs identified for them. The minimum standard is to undertake one of each WPBA for each section of training (A-CEX, DOPS, ALMAT, CBD) as described in the assessment blueprint in each of the curriculum annexes or as defined by the respective Schools of Anaesthesia, whichever is the greater. Some sections such as Cardiac are usually undertaken as specific placements and clearly the assessments must be complete by the end of the block. Other clinical specialties, such as Orthopaedics, are not usually seen as block placements. The trainee must take steps to complete these assessments when suitable work presents. At some stages of training and in some Schools of Anaesthesia there are few block placements and it would be easy to fall into the trap of leaving the assessments until the end of the year. If you do this you will not have the necessary documentation for your ARCP. AG-6 Basic Level [CT1 and 2] Initial Assessment of Competence A-CEX Assessment Code Assessment IAC_A03 Preoperative assessment of a patient who is scheduled for a routine operating list [not urgent or emergency] [0-3 months] Manage anaesthesia for a patient who is not intubated and is breathing spontaneously [0-3 months] Administer anaesthesia for acute abdominal surgery [0-3 months] IAC_A04 Demonstrate Rapid Sequence Induction [0-3 months] IAC_A05 Recover a patient from anaesthesia [0-3 months] IAC_A01 IAC_A02 DOPS Assessment Code IAC_D01 IAC_D02 IAC_D03 IAC_D04 IAC_D05 IAC_D06 Assessment Demonstrate functions of the anaesthetic machine [0-3 months] Transfer a patient onto the operating table and position them for surgery [lateral, Lloyd Davis or lithotomy position] [0-3 months] Demonstrate cardio-pulmonary resuscitation on a manikin. [0-3 months] Demonstrates technique of scrubbing up and donning gown and gloves. [0-3 months] Basic Competencies for Pain Management – manages PCA including prescription and adjustment of machinery [0-3 months] Demonstrates the routine for dealing with failed intubation on a manikin. CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code IAC_C01 IAC_C02 Discuss the steps taken to ensure correct identification of the patient, the operation and the side of operation Discuss how the need to minimise postoperative nausea and vomiting influenced the conduct of the anaesthetic IAC_C03 Discuss how the airway was assessed and how difficult intubation can be predicted IAC_C04 Discuss how the choice of muscle relaxants and induction agents was made IAC_C05 Discuss how the trainee’s choice of post-operative analgesics was made IAC_C06 Discuss how the trainee’s choice of post-operative oxygen therapy was made IAC_C07 Discuss the problems emergency intra-abdominal surgery causes for the anaesthetist and how the trainee dealt with these AG-7 IAC_C08 Discuss the routine to be followed in the case of failed intubation. The Initial Assessment of Competence Certificate is available for download from the secure area of the College website. AG-8 Initial Assessment of Competence in Obstetric Anaesthesia A-CEX Assessment Code OB_BTC_A01 OB_BTC_A02 OB_BTC_A03 Assessment Basic Competencies for Obstetric Anaesthesia – conduct epidural analgesia for labour [12-24 months] Basic Competencies for Obstetric Anaesthesia – conduct regional anaesthesia for caesarean section [12-24 months] Basic Competencies for Obstetric Anaesthesia – conduct general anaesthesia for caesarean section [12-24 months][S] DOPS Assessment Code OB_BTC_D01 OB_BTC_D02 OB_BTC_D03 Assessment Basic Competencies for Obstetric Anaesthesia – top up epidural for labour analgesia [12-24 months] Basic Competencies for Obstetric Anaesthesia – top up epidural for caesarean section [12-24 months] Basic Competencies for Obstetric Anaesthesia – Perform spinal anaesthesia [12-24 months] CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context Assessment Code OB_BTC_C01 OB_BTC_C02 OB_BTC_C03 OB_BTC_C04 OB_BTC_C05 OB_BTC_C06 Assessment Discuss how changes in the anatomy and physiology due to pregnancy influenced the conduct of anaesthesia Discuss whether pregnancy influenced the choice of drugs used during anaesthesia Discuss how the conduct of general anaesthesia is affected by late pregnancy Examine the case records of a patient that the trainee has anaesthetised for operative delivery in a situation where major haemorrhage might be expected. Discuss the factors that influence the likelihood of major obstetric haemorrhage, the precautions that should be taken to deal with it and the principles of its management. Examine the case records of a patient with pregnancy associated hypertension that the trainee has treated. Discuss how this influences anaesthetic management. Examine the case records of a patient for whom the trainee provided extradural analgesia for normal labour. Discuss the methods of pain relief available for normal delivery. The Initial Assessment of Competence in Obstetric Anaesthesia Certificate is available for download from the secure area of the College website. AG-9 Anaesthesia in General A-CEX Assessment Code Assessment AGB_A01 Administer anaesthesia for laparoscopy [3-6 months] AGB_A02 Administer anaesthesia for a shared airway procedure [3-6 months if suitable cases are available] AGB_A03 Administer anaesthesia for eye surgery [12-24 months] AGB_A04 Administer anaesthesia to a diabetic patient on insulin [3-6 months] AGB_A05 Administer anaesthesia to an asthmatic or COPD patient [3-6 months] AGB_A06 Administer anaesthesia to a patient with ischaemic heart disease [6-12 months] AGB_A07 Administer anaesthesia to an elderly patient [> 80 years] [6-12 months] AGB_A08 Conduct regional anaesthesia for surgery [12-24 months] Transfer an unconscious, ventilated patient within the hospital or to another hospital [6-12 months] AGB_A09 DOPS Assessment Code AGB_D01 AGB_D02 AGB_D03 AGB_D04 Assessment Basic Anaesthetic Competences – Demonstrate use of the nerve stimulator to evaluate neuromuscular block [3-6 months] Basic Anaesthetic Competences – Assess a patient’s Glasgow Coma Scale rating and advise appropriate safe levels of monitoring and care [3-6 months] Basic Anaesthetic Competences – Perform a primary and secondary survey of an injured patient [may be done in simulator] [6-12 months] Basic Competencies for Pain Management – manages epidural analgesia by continuous infusion [6-12 months] ALMAT Assessment Code Assessment AGB_L01 Conduct an appropriate routine general surgical operating list [12-24 months] AGB_L02 Conduct an appropriate orthopaedic operating list [12-24 months] AGB_L03 Manage an emergency theatre session CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code AGB_C01 AGB_C02 Discuss how the trainee understands the patients likely feelings and apprehensions as they face surgery and how these factors influenced their management Discuss how did the trainee dealt with anticipated problems where surgeon and anaesthetist AG-10 shared the airway. AGB_C03 Discuss the trainees choice of post-operative fluids AGB_C04 Discuss the trainee’s choice and use of sedatives and tranquillisers AGB_C05 Discuss the effects and hazards of the pneumo-peritoneum induced for laparoscopic surgery AGB_C06 Discuss what additional monitoring can be used for sick patients AGB_C07 Discuss how the trainee decided between inhalation and intravenous induction AGB_C08 Discuss the choice of agents and conduct of inhalation induction Discuss how massive haemorrhage was managed [volume expansion, blood transfusion, hazards including incompatibility reaction] Discuss the management of anaesthesia in the presence of common inter-current diseases e.g Asthma , COPD, Hypertension, IHD, Rheumatoid arthritis, Jaundice, Steroid therapy, Diabetes Discuss whether awareness was a potential problem. Explore the factors predisposing to awareness and the manoeuvres available to reduce the risks. Discuss any difficulties in restoring spontaneous ventilation at the end of the anaesthetic. Discuss why this patient failed to breathe and how it is possible to distinguish between opiate excess, continued anaesthetic effect and/or residual paralysis. Discuss the management of any cyanosis, hypo- and hypertension, shivering or stridor in recovery Discuss how the trainee chose a regime for post operative pain relief and how they judged its adequacy Discuss the factors influencing the occurrence of any post-operative confusion seen Discuss how the patients obesity affected their management AGB_C09 AGB_C10 AGB_C11 AGB_C12 AGB_C13 AGB_C14 AGB_C15 AGB_C16 AGB_C17 AGB_C19 Discuss how the possibility of post-operative atelactasis and pulmonary embolism influenced the anaesthetic choices. Discuss how the trainee decided that a day patient was fit for discharge home AGB_C20 Discuss any concerns the trainee had regarding their anaesthetic affecting intraocular pressure AGB_C21 AGB_C23 How did the trainee recognise and manage hypovolaemic shock What effect did the trainee expect trauma to have on gastric emptying and how did this affect their anaesthetic plan Discuss how the trainee planned anaesthesia in the presence of a recent head injury AGB_C24 Discuss the management of cervical spine injuries AGB_C25 Discuss how the trainee recognised and managed dilutional -coagulopathy AGB_C26 Discuss how factors relating to an elderly patient’s age influenced the conduct of anaesthesia. AGB_C18 AGB_C22 Paediatric A-CEX Assessment Code Assessment PAB_A02 Basic Competences in Paediatric Anaesthesia – make preoperative assessment of a fit child [12-24 months] Administer anaesthesia to a child age>5 spontaneous ventilation [12-24 months] PAB_A03 Administer anaesthesia to a child age>5 controlled ventilation [12-24 months] PAB_A01 AG-11 DOPS Assessment Code PAB_D01 PAB_D02 Assessment Basic Competences in Paediatric Anaesthesia – Conduct IV Induction in a fit child [12-24 months] Basic Competences in Paediatric Anaesthesia – Conduct inhalation induction of fit child [12-24 months] CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code PAB_C01 PAB_C02 PAB_C03 PAB_C04 Examine the case notes of a child the trainee has anaesthetised and discuss how differences in anatomy from the adult influenced the conduct of the anaesthetic. Discuss how the choice of drugs and drug doses differs from the adult. Discuss airway management and the choice of suitable anaesthetic circuits for a child. Discuss the problems of detecting and reporting child abuse in relation to the case records of a patient that the trainee has dealt with. [Child abuse need not be an issue with the patient but their history and examination should form the basis for the discussion] Regional Anaesthesia A-CEX Assessment Code Assessment RAB_A01 Conduct anaesthesia for surgery using spinal or epidural anaesthesia RAB_A02 Manage the sedative regime of a patient undergoing surgery using regional anaesthesia DOPS Assessment Code RAB_D01 Assessment Establish a peripheral nerve block CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code RAB_C01 RAB_C02 Discuss the choice of local anaesthetics & spinal opioids in the context of regional anaesthesia Discuss the innervation an spinal dermatomes of any regional anaesthetic block the trainee has used AG-12 RAB_C03 RAB_C04 Discuss the management of the complications of spinal and epidural (including caudal) analgesia [associated hypotension, shivering, nausea & anxiety] Discuss the absolute and relative contraindications to regional blockade Critical Incidents DOPS Assessment Code Assessment Basic Competences for Critical Incidents – Demonstrates the emergency management of the following critical incidents in simulation: Cardiac and / or respiratory arrest Unexpected Hypoxia with or without cyanosis Unexpected increase in peak airway pressure Progressive fall in minute volume during spontaneous respiration or IPPV Fall in end tidal CO2 Rise in end tidal CO2 Rise in inspired CO2 Unexpected hypotension Unexpected hypertension Sinus Tachycardia Arrhythmias [ST segment changes; sudden tachydysrhythmia; sudden bradycardia; Ventricular Ectopics – Ventricular tachycardia – Ventricular Fibrillation] 12. Convulsions 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. CIB_D01 Demonstrate the management of the following specific conditions in simulation: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Aspiration of vomit Laryngospasm Bronchospasm Tension Pneumothorax Gas / Fat / Pulmonary embolus Adverse drug reactions Anaphylaxis Transfusion of miss-matched blood or blood products Malignant hyperpyrexia Inadvertent intra-arterial injection of irritant fluids High spinal block Local Anaesthetic toxicity Failed intubation Difficulty with IPPV and sudden or progressive loss of minute volume It is not expected that trainees will formally demonstrate simulated management of more than a small number of these specific events but they must know the steps in managing all. AG-13 Control of Infection A-CEX Assessment Code IFB_A01 Assessment Undertake a sterile procedure with proper attention to asepsis DOPS Assessment Code IFB_D01 Assessment Demonstrate proper technique in scrubbing up to perform a neuraxial block CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code IFB_C01 IFB_C02 Discuss how the trainees anaesthetic management was influenced by the precautions taken to prevent cross-infection with healthcare associated infections Discuss how the trainees anaesthetic management was influenced by the precautions taken to control blood-borne infections AG-14 Intermediate Level [ST3 and 4] General, urological, gynaecological and orthopaedic surgery A-CEX Assessment Code Assessment GSI_A02 Conduct emergency anaesthesia for a patient with significant co-morbidities complicating anaesthesia Conduct anaesthesia for a patient for whom routine post-operative critical care is required GSI_A03 Conduct combined GA/Regional anaesthesia for an appropriate case GSI_A01 DOPS Assessment Code GSI_D01 Assessment Complete the local and on-line documentation of a critical incident ALMAT Assessment Code GSI_L01 GSI_L02 Assessment Conduct an appropriate, routine operating list including patients with significant intercurrent disease Manage an emergency theatre session of cases. CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code GSI_C01 Discuss how the patients intercurrent disease influenced the anaesthetic decision making GSI_C02 Discuss how the trainee approaches the problem of working in teams GSI_C03 Discuss how a ‘culture of safety’ influences the conduct of anaesthesia GSI_C04 Discuss how conflict with the surgical team arose or could have arisen during anaesthesia and how resolution can be achieved in the patients interest GSI_C05 Discuss the recognition of possible critical mishap during anaesthesia GSI_C06 GSI_C07 Discuss how the use of best practice minimised the risk of hospital acquired infection in this case Discuss how the anaesthetist protected the patient’s dignity and self-esteem during the course of pre-operative preparation, surgery and recovery. AG-15 Ambulatory and Day Surgery A-CEX Assessment Code DSI_A01 Assessment Undertake the assessment of patients presenting for pre-assessment prior to ambulatory or day-surgery DOPS Assessment Code DSI_D01 Assessment Make an assessment of a patient’s suitability for discharge ALMAT Assessment Code DSI_L01 Assessment Administer anaesthesia for a day surgery list – pay particular attention to the instructions given to the patient and their carers, and to the adequacy of written instructions. CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code DSI_C01 Discuss how the early discharge of the day patient influences the anaesthetic decision-making. DSI_C02 Discuss how being a day-patient influenced the pre-operative assessment and preparation of the patient. DSI_C03 Discuss what circumstances would have led to the patient being admitted overnight Vascular A-CEX Assessment Code VSI_A01 Assessment Administer anaesthesia for a peripheral revascularisation procedure DOPS Assessment Code VSI_D01 Assessment Induce anaesthesia and establish monitoring etc for major vascular surgery AG-16 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code VSI_C01 Discuss how the patients vascular disease influenced the anaesthetic decision making VSI_C02 Discuss how the risk of hypothermia influenced the anaesthetic decision making VSI_C03 Discuss the likelihood of massive bleeding and the impact of this possibility on the conduct of anaesthesia. Trauma and Injury A-CEX Assessment Code MTI_A01 Assessment Administer anaesthesia to a patient with major injuries DOPS Assessment Code MTI_D01 MTI_D02 Assessment Review neck X rays for the integrity of the cervical spine Score the Glasgow Coma Scale and decide an appropriate level of care Insert a chest drain ALMAT Assessment Code MTI_L01 Assessment Manage an anaesthetise for the ‘trauma list’ CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code MTI_C01 Discuss how fluid management was conducted MTI_C02 Discuss the how anaesthesia decisions were affected by the presence of a head injury. MTI_C03 Discuss the likelihood of massive bleeding and the impact of this possibility on the conduct of anaesthesia. AG-17 Regional Anaesthesia It is not expected that there will be a specialised rotation for this topic. The assessments will be undertaken wherever appropriate. A-CEX Assessment Code RAI_A01 Assessment Conduct a major operation with regional anaesthesia DOPS Assessment Code RAI_D01 Assessment Perform brachial plexus block RAI_D02 Perform a lower limb peripheral nerve block RAI_D03 Perform paravertebral block RAI_D04 Demonstrate the use of the ultra-sound scanner to locate nerve trunks ALMAT Assessment Code RAI_L01 Assessment Manage a list that requires some patients to have regional or combined regional/GA techniques CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code RAI_C01 Discuss how decisions regarding the use of sedatives for the awake patient were made RAI_C02 Discuss how the advantages and disadvantages of regional anaesthesia were represented to the patient RAI_C03 Discuss how the possibility of nerve injury affects the decision to use regional anaesthesia Pain Medicine A-CEX Assessment Code Assessment PMI_A01 Conduct an initial consultation with a patient attending the pain clinic (Consultant observing) PMI_A02 Conduct an acute pain round AG-18 DOPS Assessment Code PMI_D01 Assessment Perform a trigger point injection with local anaesthetic PMI_D02 Perform an epidural for acute pain PMI_D03 Perform a peripheral nerve block for acute pain PMI_D04 Perform entonox administration CBD Examine the case-notes. Discuss how the pain medicine plan was developed. Ask the trainee to explain the assessment and management decisions. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code PMI_C01 Discuss the role of the multi-disciplinary pain team in the patient’s management PMI_C02 Discuss the relative contributions of pharmacological and psychosocial management to the patient’s treatment PMI_C03 Discuss the appropriate use of opiates in the setting of this patient’s pain problem PMI_C04 Discuss the particular difficulties of treating neuropathic pain and how the problems were approached in managing this patient Obstetrics A-CEX Assessment Code OBI_A01 OBI_A02 Assessment Administer anaesthesia for caesarean section to a patient with a complicated pregnancy [hypertensive disease, placenta praevia etc] Convert epidural for labour analgesia to a regional anaesthetic for LSCS and proceed with surgery DOPS Assessment Code OBI_D01 OBI_D02 Assessment Manage an established epidural where pain relief is inadequate Undertake combined spinal-epidural ALMAT Assessment Code OBI_L01 Assessment Manage a list of two or more Caesarean Sections [12-24 months] AG-19 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code OBI_C01 Discuss how the patients disturbed blood coagulation affected anaesthetic decision making OBI_C02 Discuss the alternatives that were considered for the control of hypertension OBI_C03 OBI_C04 Discuss the factors that influenced the anaesthetic in a case of urgent caesarean section for foetal distress or antepartum haemorrhage Discuss the likelihood of failed intubation and the impact of this possibility on the conduct of anaesthesia. Paediatric A-CEX Assessment Code Assessment PAI_A03 Undertakes perioperative anaesthetic care [including both inhalational and intravenous induction techniques] for children over the age of 5 years Undertakes perioperative anaesthetic care for children less than 3 years of age under direct supervision Administer anaesthesia to a child over the age of 5 years for a shared airway procedure PAI_A04 Anaesthetise a child over the age of 5 years for an emergency abdominal procedure PAI_A01 PAI_A02 DOPS Assessment Code PAI_D01 Assessment Obtain peripheral venous access in a conscious child over 3 years PAI_D02 Conduct inhalational induction of anaesthesia in the presence of a child’s parents PAI_D03 Manage the airway including tracheal intubation in a child aged less than 3 years of age PAI_D04 Undertake caudal epidural block PAI_D05 Manage postoperative acute pain in a child over 3 years of age ALMAT Assessment Code PAI_L01 Assessment Conduct a paediatric operating list for minor/intermediate elective surgery for children over the age of 5 years. CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment AG-20 Code PAI_C01 Discuss how the presence of the parents at induction influenced the conduct of anaesthesia PAI_C02 Discuss how intercurrent diseases influenced the anaesthetic decision making PAI_C03 Discuss how differences in physiology from the adult affected anaesthetic decision making Discuss how the child’s physiology and response to injury influenced the management of pre, intra, and post op fluid management Discuss the decisions about post operative analgesia for the child PAI_C04 PAI_C05 Cardiac/Thoracic A-CEX Assessment Code CTI_A01 CTI_A02 Assessment Make a pre-operative assessment of an ASA 3 patient presenting for thoracic or cardiac surgery. Administer anaesthesia for a thoracic operation DOPS Assessment Code CTI_D01 Assessment Induce anaesthesia in the presence of significant cardiac disease. CTI_D02 Establish anaesthesia including invasive arterial and central-venous monitoring CTI_D03 Insert a double lumen endo-bronchial tube CTI_D04 Anaesthetise a patient for rigid bronchoscopy CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code CTI_C01 In the case of a patient with significant heart disease discuss how this affected the choice of anaesthetic agents, conduct of induction, conduct of emergence and post operative care. CTI_C02 In the case of a patient with high risk, discuss the prophylaxis for bacterial endocarditis. CTI_C03 CTI_C04 In the case of a patient who has had pre-operative stress testing discuss the evaluation of ischaemic heart disease and how this affects the conduct of anaesthesia In the case of a patient who has had one lung anaesthesia discuss the conduct of the anaesthetic and how this is influenced by the use of this technique Neurosurgery, neuroradiology and neurocritical care A-CEX Assessment Code Assessment AG-21 NAI_A01 Administer anaesthesia for craniotomy NAI_A02 Administer anaesthesia for surgery of the cervical spine NAI_A03 Administer anaesthesia for neuro interventional radiology NAI_A04 Administer anaesthesia for emergency craniotomy for intra-cranial haemorrhage DOPS Assessment Code NAI_D01 NAI_D02 Assessment Transfer the patient to the operating table and position them for craniotomy Induce anaesthesia for emergency craniotomy in a patient with raised intra-cranial pressure CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code NAI_C01 NAI_C02 NAI_C03 Discuss the factors that influenced the choices for the post operative care of the patient [analgesics, fluids, ITU/HDU/Ward] Explain how the need to control intra-cranial pressure has influenced the conduct of anaesthesia Discuss how the potential for massive haemorrhage influences the conduct of anaesthesia Ophthalmic A-CEX Assessment Code Assessment OPI_A01 Manage general anaesthesia for cataract surgery OPI_A02 Manage anaesthesia for vitreoretinal surgery OPI_A03 Manage anaesthesia for a child undergoing squint surgery DOPS Assessment Code OPI_D01 OPI_D02 Assessment Insert local anaesthetic drops for topical anaesthesia Perform sub-tenons or peribulbar anaesthesia ALMAT Assessment Code OPI_L01 Assessment Manage regional anaesthesia for a list of cataract surgery [sub-tenons or peribulbar – not topical] AG-22 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code OPI_C01 OPI_C02 OPI_C03 OPI_C04 Discuss the risk of the occulo-cardiac reflex and how this has influenced the anaesthetic choices Discuss the impact of the need to control intra-ocular pressure on the anaesthetic decision making Discuss the impact of extreme age upon the anaesthetic decision making including decisions about suitability for day surgery Discuss why general anaesthesia was chosen for cataract surgery Non-theatre and Sedation A-CEX Assessment Code Assessment DII_A01 Manage anaesthesia for CT scan DII_A02 Manage anaesthesia for diagnostic or interventional radiology DII_A03 Manage anaesthesia for MRI scan DOPS Assessment Code DII_D01 Assessment Transfer the patient onto the scanner for CT or MRI CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code DII_C01 Explain how the risks of radiological exposure affect the conduct of anaesthesia especially the isolated patient DII_C02 Discuss how the particular problems of MRI influence anaesthesia DII_C03 Discuss the problems of the use of contrast media DII_C04 Discuss how safe transport to and from the Radiology Department was achieved AG-23 Plastics/Burns A-CEX Assessment Code Assessment PLI_A01 Manage a free flap reconstruction PLI_A02 Manage anaesthesia for head and neck surgery PLI_A03 Manage the debridement of major burns DOPS Assessment Code PLI_D01 PLI_D02 Assessment Make an assessment of a burned patient Prescribe fluid therapy for a burned patient ALMAT Assessment Code PLI_L01 Assessment Manage a plastic surgery operating list of small cases CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code PLI_C01 Discuss the way the anaesthetics decision was affected by the requirements of the surgeon in free flap surgery PLI_C02 Discuss the anaesthetic considerations attendant upon the debridement of burns Maxillo-facial and dental A-CEX Assessment Code Assessment ENI_A01 Manage a patient for surgery in or around the airway ENI_A02 Anaesthetise a patient for laser surgery in the airway DOPS Assessment Code ENI_D01 Assessment Recover a patient from anaesthesia following dental extractions in an ambulatory clinic setting AG-24 ALMAT Assessment Code Assessment ENI_L01 Manage a dental or maxillo-facial surgery operating list ENI_L02 Manage a list of paediatric minor dental extractions in an ambulatory setting CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code ENI_C01 Discuss how the shared airway influences anaesthesia for dentistry ENI_C02 Discuss how to deal with the problem of the apprehensive child and parent in the dental setting ENI_C03 Discuss how the possibility of a difficult airway influences the conduct of anaesthesia Ear, nose and throat A-CEX Assessment Code Assessment ENI_A03 Manage an anaesthetic for tonsillectomy ENI_A04 Manage an anaesthetic for middle ear surgery DOPS Assessment Code ENI_D02 ENI_D03 ENI_D04 Assessment Manage the airway for laser surgery Manage the airway for laryngoscopy and micro-laryngeal surgery Manage induction of anaesthesia for an ENT emergency (bleeding tonsil, foreign body, stridor, abscess etc) ALMAT Assessment Code ENI_L02 Assessment Manage a list of minor and intermediate ENT cases AG-25 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code ENI_C04 ENI_C05 ENI_C06 ENI_C07 Discuss how the need to share the airway with the surgeon influenced the anaesthetic decision making Discuss how possible difficulty in intubation influenced the preoperative assessment and anaesthetic decision making Discuss how the special airway tubes available for use in ENT anaesthesia and why the anaesthetist chose the device used. Discuss the way the problem of bleeding during middle ear surgery influenced the conduct of anaesthesia Learning and teaching A-CEX Assessment Code Assessment TMI_A01 Supervise a junior colleague in performing a routine operating list TMI_A02 Supervise a junior colleague in undertaking emergency anaesthesia including rapid sequence induction TMI_A03 Present a case during a departmental meeting TMI_A04 Teach a formal session during a departmental education programme DOPS Assessment Code TMI_D01 Assessment Complete a multi-source feedback assessment for a colleague TMI_D02 Undertake the completion of a A-CEX, Mini CEX, DOPS or CBD for a junior colleague TMI_D03 Prepare a powerpoint presentation CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code TMI_C01 Discuss how patient safety was protected during an episode of clinical teaching TMI_C02 Discuss how teaching was related to the context of real work TMI_C03 Discuss how the trainee made judgements about the competence of someone they were supervising TMI_C04 Discuss how to structure theatre teaching AG-26 TMI_C05 Discuss how your teaching want and whether its success could have been improved TMI_C06 Analyse the problems and benefits of teaching in a real workplace TMI_C07 Discuss the characteristics of a good teacher and discuss how well you meet the criteria AG-27 Higher Level [ST5 and 6] Anaesthesia for neurosurgery, neuroradiology and neurocritical care A-CEX Assessment Code Assessment NAH_A03 Anaesthetise a complicated ASA 1-3 adult patient for complex elective intra-cranial, spinal surgery, or neuroradiological investigations/treatment. Anaesthetise a complicated ASA 1-3 adult patients for emergency non-complex intracranial and spinal surgery with indirect supervision [i.e. craniotomy for acute sub-dural / acute decompressive lumbar laminectomy] Anaesthetise a patient for emergency neurosurgery for trauma NAH_A04 Undertakes supervision of a basic level trainee for a routine neurosurgical list NAH_A05 Conduct a ward round in neuro-critical care under direct supervision NAH_A01 NAH_A02 DOPS Assessment Code NAH_D01 Assessment Establishes anaesthesia for major neurosurgery, including appropriate invasive monitoring NAH_D02 Positions the patient on the operating table in complex positions used for neurosurgery NAH_D03 Demonstrates endotracheal intubation in a patient with an unstable spine ALMAT Assessment Code NAH_L01 Assessment Manage a neurosurgical operating list, including pre-operative assessment and immediate post-operative care. (Some cases may require the attention of a consultant anaesthetist but the trainee should continue where possible to manage the list and theatre environment.) CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code NAH_C01 Discuss the anaesthetic and surgical problems posed by surgery for acoustic neuroma. NAH_C02 Discuss how the facial nerve function can be protected NAH_C03 NAH_C04 Discuss the management of intra-cranial pressure during anaesthesia for intra-cranial haemorrhage, including the indications and management of CSF drains. Discuss the management of intra-cranial aneurysm by craniotomy and by interventional neuroradiology. Discuss the anaesthetic considerations for such procedures. AG-28 NAH_C05 Discuss the airway problems that may be encountered during anaesthesia for complex operations on the cervical spine. NAH_C06 Discuss anaesthesia for surgery in the posterior fossa. NAH_C07 NAH_C08 NAH_C09 Discuss the post-operative care, including in the ITU, of patients who have had major intracranial surgery. Discuss how the decision to stop artificial ventilation is taken and the problems that may ensue as consciousness returns. Discuss how the anaesthetist protected the patients dignity and self-esteem during the course of pre-operative preparation, surgery and recovery. Cardiac/Thoracic A-CEX Assessment Code CTH_A01 CTH_A02 CTH_A03 CTH_A04 CTH_A05 Assessment Anaesthetise a patient for coronary artery surgery under direct supervision Anaesthetise a patient for uncomplicated mitral or aortic valve replacement under direct supervision Working within the multi-disciplinary team, undertake assessment and management of a patient with acute chest trauma Anaesthetise a patient for thoracotomy and resection of lung tissue. Provide perioperative anaesthetic care to patients undergoing bronchoscopy or Video assisted Thoracoscopic Surgery (VATS) and thoracotomy for lung resection DOPS Assessment Code CTH_D01 Assessment Demonstrate the use of an appropriate cardiac output monitor – including its set up CTH_D02 Insert a chest drain CTH_D03 Demonstrate assessment of the management of chest drains in the critical care unit CTH_D04 Manages a patient for cardiopulmonary bypass, including appropriate myocardial protection, coagulation management, transfer to, and the weaning of patients from bypass with local supervision, to include: • Demonstrating understanding of the anaesthetist’s role in perfusionist administration of drugs • The problems associated with prolonged bypass and how to deal with them • Issues surrounding disconnections, air embolisation and acid base management ALMAT Assessment Code CTH_L01 Assessment Undertake a thoracic operating list including all aspects of patient, list and theatre management AG-29 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code CTH_C01 CTH_C02 CTH_C03 CTH_C04 CTH_C05 CTH_C06 CTH_C07 CTH_C08 CTH_C09 CTH_C10 Discuss the use of complex monitoring during thoracic and cardiac procedures, including measures of cardiac output Discuss the use of minimally invasive surgery for cardiac conditions and the anaesthetic approach to such treatments. Discuss the pre-operative assessment and optimisation of a patient with cardiac and thoracic disease and the use of commonly performed investigations such as cardiac catheterisation echocardiography, stress testing and radionucleotide testing and pulmonary function tests. Discuss the implications of blood and blood product transfusion on patient morbidity in cardiac surgery Discuss the risks and benefits of anaesthetic techniques for either: • Mitral valve repair and replacement • Management of post infarct VSD • Complex thoracic aortic reconstruction • Interventional cardiological procedures e.g. transvenous device placement for ASD and Aortic valve surgery Discuss the pre-operative assessment of the patient with borderline lung function requiring pneumonectomy. Discuss the management of patients with assist devices Including indications for insertion and withdrawal Discuss the role of multidisciplinary teams in the management of patients with cardiac and thoracic disease Discuss the perioperative anaesthetic management of adult patients with intrathoracic aortic pathology requiring surgery Discuss the management of post-operative bleeding in cardiac patients and describe the signs and symptoms of cardiac tamponade, its clinical management and appropriate investigation [including any appropriate near patient testing] and understands the indications for return to theatre versus continued haematological support. Airway Management A-CEX Assessment Code Assessment AMH_A01 Undertakes a list of cases for surgery in the airway and where airway difficulty is anticipated. AMH_A02 Undertakes anaesthesia for laser surgery in or near the airway AG-30 DOPS Assessment Code AMH_D01 Uses an alternative airway device AMH_D02 Performs elective fibre-optic intubation in the anaesthetised patient AMH_D03 Anaesthetises the airway for awake fibre-optic intubation AMH_D04 Performs elective fibre-optic intubation in the awake patient AMH_D05 Demonstrates the use of specialised laryngoscope for special circumstances AMH_D06 Performs fibre optic intubation in emergency situation AMH_D07 Uses jet ventilation for airway surgery Assessment ALMAT Assessment Code AMH_L01 Assessment Assesses and anaesthetizes patient requiring awake fibre-optic intubation including all discussions with the patient and preparation of equipment and operating theatre CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code AMH_C01 Discusses the use of novel airway techniques, including the use of retrograde catheters and airway exchange devices AMH_C02 Discusses the toxicity of local anaesthesia in relation to topical anaesthesia in the airway. AMH_C03 Discuss the prediction of difficulty with intubation AMH_C04 Discuss the use of fibre optic intubation in routine and emergency situations AMH_C05 Discuss the indications for, and use of crico-thyrotomy in the emergency AMH_C06 Discuss can’t intubate/can’t ventilate situations and their role in anaesthetic morbidity and mortality Day-Surgery A-CEX Assessment Code Assessment DSH_A01 Supervise a more junior trainee undertaking a day surgery list DSH_A02 Undertake a pre-assessment clinic for potential day patients ALMAT Assessment Code DSH_L01 Assessment Undertake a day-surgery list AG-31 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code DSH_C01 Discuss the criteria for deciding that a patient is suitable for day patient treatment DSH_C02 Discuss the relative merits of general and regional anaesthesia for day surgery DSH_C03 Discuss the management of a patient who attends for day surgery but whom you think is unsuitable DSH_C04 Discuss the choice of anaesthetic techniques for day surgery DSH_C05 Discuss the choice of post-operative analgesia, including local anaesthesia, for day patients ENT, maxillo-facial and dental surgery A-CEX Assessment Code Assessment ENH_A02 Undertake anaesthesia for major ENT or maxillo-facial surgery such as laryngectomy or major resection for cancer. Anaesthetises a patient for middle ear surgery ENH_A03 Supervise a more junior trainee undertaking uncomplicated ENT or maxillo-facial surgery ENH_A01 DOPS Assessment Code ENH_D01 Assessment Conduct inhalational anaesthesia in a child ALMAT Assessment Code ENH_L01 Assessment Undertakes anesthesia for a list of ENT cases including complex operations CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code ENH_C01 ENH_C02 ENH_C03 Discuss the anaesthetic techniques and complications of major head and neck surgery Discuss the role of the multi-disciplinary team in planning major ENT and head and neck resections and reconstructions Discuss the effects on anaesthesia and convalescence of pre-operative radio and chemotherapy AG-32 ENH_C04 Discuss the preservation of the facial nerve during facial surgery ENH_C05 Discuss the problem of nutrition before and after maxillo-facial surgery ENH_C06 Discuss the paediatric conditions that lead to the need for maxillo-facial surgery General, urological and gynaecological surgery A-CEX Assessment Code Assessment GSH_A01 Undertake anaesthesia for major complex general, urological or gynaecological surgery GSH_A02 Undertakes anesthesia for a list of general, urological or gynaecological surgery GSH_A03 Anaesthetises a list of patients for general, urological or gynaecological surgery GSH_A04 Undertake anaesthesia in a patient with BMI> 40 Administer anaesthesia for a patient undergoing prolonged laparoscopic minimally invasive surgery GSH_A05 DOPS Assessment Code GSH_D01 Assessment Perform thoracic epidural anaesthesia for upper abdominal surgery GSH_D02 Undertake appropriate peripheral nerve blocks for post-operative analgesia GSH_D03 Undertake anaesthesia for a patient in whom massive haemorrhage is expected including organising venous access, infusion equipment, cell saver and appropriate blood products. GSH_D04 Undertake caudal epidural block ALMAT Assessment Code GSH_L01 Assessment Undertake an appropriate general surgical, urological or gynaecological operating list CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code GSH_C01 GSH_C02 Discuss the advantages and risks of post operative pain relief by continuous regional anaesthesia Discuss the prevalence and natural history of thrombo-embolic disease and the risks and benefits of throboprophylaxis GSH_C03 Discuss the reliability of scoring systems for predicting surgical morbidity and mortality GSH_C04 Discuss the problem of surgery for the patient with obstructive sleep apnoea GSH_C05 Discuss the possible investigations of cardio-respiratory function available for the preoperative assessment of the compromised patient requiring major surgery. AG-33 Management of respiratory and cardiac arrest This unit is one of the two higher mandatory units that all trainees must complete satisfactorily during higher training [the other is Airway management]. It is expected that this unit can be delivered in most hospitals. Learning Outcome: Develop expertise by building on the knowledge, understanding and skills gained during intermediate training Core clinical learning outcomes: The management of patients requiring cardio-respiratory resuscitation [with distant supervision] by: o Demonstrating the ability to lead a multidisciplinary resuscitation team in the initial assessment and management through to definitive care in the Intensive Care Unit if successful [including necessary transfer] o Leading the debrief sessions for both staff and relatives in a sensitive, compassionate and constructive manner Because of the nature of this learning, and the fact that episodes where skills and knowledge can be tested occur infrequently and unexpectedly, it is intended that the competences are tested only in simulation in the course of organised courses such as ALS and APLS. Non-theatre It is expected that the majority of trainees will complete this unit during higher training as many of the competencies can be achieved in the course of completing a number of other units, both general and specialist. Anaesthesia and Sedation outside of the Operating Theatre A-CEX Assessment Code DIH_A01 DIH_A02 DIH_A03 Assessment Provide anaesthesia in an environment remote from the operating theatre such as: • Radiology department • Endoscopy unit • Emergency room • ECT suite • Dental suite Evaluates the pre-operative condition and suitability of patients with significant co-morbidities for such sedation or anaesthesia remote from the operating theatre Supervise a less experienced trainee working in a non-operating theatre environment ALMAT Assessment Code Assessment DIH_L01 Manages a number of cases successively for anaesthesia or sedation at a site remote from the operating theatre. AG-34 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code DIH_C01 DIH_C02 DIH_C03 Discusses in-depth, the peri-procedure [diagnostic or therapeutic, elective or emergency] anaesthetic/sedation needs for complex ASA 1-4 patients that may take place outside the operating theatre, including remote sites [See section 6.2], including but not exclusively in the following settings: The Radiology suites, Radiotherapy and ECT Discuss the team leadership and communication skills necessary to effectively manage cases/lists in any non-theatre environment to the benefit of patients and the organisation Discuss the criteria for discharge and management of patient discharge following anaesthesia or sedation in a non-theatre environment Obstetrics A-CEX Assessment Code OBH_A01 OBH_A02 OBH_A03 OBH_A04 Assessment Undertake the management of caesarean section in a complex obstetric case such as twin delivery, moderate to severe pre-eclampsia, placenta praevia, obstetric haemorrhage, foetal distress, etc – using GA or RA as appropriate. Undertake anaesthesia for the management of vaginal delivery in complex situations. Undertake general anaesthesia for emergency caesarean section. Supervises a more junior trainee in obstetric anaesthetic duties such as instituting epidural analgesia and anaesthetising for caesarean section. DOPS Assessment Code OBH_D01 Assessment Establishes combined spinal/epidural anaesthesia OBH_D02 Induce anaesthesia in a very obese obstetric patient OBH_D03 Manages the patient with a failed or partly effective epidural block. OBH_D04 Undertake anaesthesia for a patient in whom massive haemorrhage is expected including organising venous access, infusion equipment, cell saver and appropriate blood products. ALMAT Assessment Code OBH_L01 Assessment Manages a list of routine caesarean sections AG-35 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code OBH_C01 Discuss the limitations of a non specialised maternity unit and appropriate referral to a tertiary unit OBH_C02 Discuss disturbances of blood clotting in the parturient OBH_C03 Discusses the aetiology and management of obstetric haemorrhage including the function of the multidisciplinary team in the crisis situation. OBH_C04 Discuss the monitoring of foetal status during labour. OBH_C05 Discuss current trends in maternal mortality Orthopaedic A-CEX Assessment Code Assessment ORH_A03 Undertake anaesthesia for a major orthopaedic operation in a patient with established serious intercurrent disease Undertake anaesthesia for major orthopaedic surgery (spinal, scoliosis-surgery, pelvic surgery, hip revision arthroplasty, long bone fixation in the presence of multiple injuries. Undertake anaesthesia for limb surgery (upper or lower) using peripheral nerve block ORH_A04 Undertake anaesthesia for orthopaedic surgery using neuraxial block ORH_A05 Supervise a more junior colleague undertaking routine or emergency orthopaedic surgery. ORH_A01 ORH_A02 DOPS Assessment Code ORH_D01 Assessment Establish brachial plexus block using a nerve stimulator or ultrasound to locate the nerve ORH_D02 Undertake peripheral lower limb blocks for surgery ORH_D03 Undertake anaesthesia for a patient in whom massive haemorrhage is expected including organising venous access, infusion equipment, cell saver and appropriate blood products. ORH_D04 Manages the patient with a failed or partly effective epidural block. ALMAT Assessment Code ORH_L01 Assessment Manage an orthopaedic surgical list AG-36 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code ORH_C01 Discuss the problem of bone cement causing CVS collapse ORH_C02 Discuss the prevention of thrombo-embolic complications after orthopaedic surgery ORH_C03 Discuss the physiological derangements seen in patients presenting for surgery after major trauma. ORH_C04 Discuss the problem of keeping patients warm during long orthopaedic operations ORH_C05 Discuss the problem of neuropraxia following peripheral nerve block Regional Anaesthesia There will be no special placement for regional anaesthesia. It is expected that experience in such techniques will be acquired in the course of work in appropriate surgical specialties such as orthopaedics, plastic surgery, urology etc. Evidence of significant experience in sedation must be collected in the trainee’s portfolio by the end of higher training. A-CEX Assessment Code RAH_A01 RAH_A02 RAH_A03 Assessment Undertake anaesthesia using a peripheral nerve block for surgery (brachial, femoral nerve, Deep cervical plexus blocks, Intercostal nerve blocks ,Thoracic epidural anaesthesia, Lumbar plexus blocks Sciatic blocks) Manage surgery with regional anaesthesia and sedation for a complex or lengthy procedure. Use ultrasound to guide nerve bock. Teach a junior colleague how to do a peripheral nerve block. DOPS Assessment Code RAH_D01 Assessment Establishes continuous anaesthesia or analgesia using a peripheral nerve catheter. RAH_D02 Manages the patient with a failed or partly effective epidural block. RAH_D03 Establish continuous spinal anaesthesia via catheter RAH_D04 Undertake anaesthesia for a patient in whom massive haemorrhage is expected including organising venous access, infusion equipment, cell saver and appropriate blood products. ALMAT Assessment Code RAH_L01 Assessment Undertake two or more successive list cases requiring regional anaesthesia or combined regional/general anaesthesia AG-37 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code RAH_C01 Discuss the practice, including complications, of peripheral nerve catheters. RAH_C02 Discuss the toxicity of local anaesthetics and strategies to minimise the risk of overdose RAH_C03 Discuss the problem of needle trauma to peripheral nerves RAH_C04 Discuss the problem of keeping patients warm during long orthopaedic operations RAH_C05 Discuss the problem of neuropraxia following peripheral nerve block RAH_C06 Discuss the principles of sonography in relation to the location of peripheral nerves Sedation This is an important unit of training, as it covers core skills required by all anaesthetists [including those with a major commitment to ICM]. It is expected that the competencies/minimum learning outcomes will be gained during the course of higher training through ST year 5 and 6, rather than as a dedicated block There will be no special placement for sedation. It is expected that experience in such techniques will be acquired in the course of work in appropriate surgical specialties such as orthopaedics, plastic surgery, urology etc. Evidence of significant experience in sedation must be collected in the trainee’s portfolio by the end of higher training. A-CEX Assessment Code Assessment CSH_A01 Provide single agent sedation for an appropriate procedure CSH_A02 Provide sedation using multiple agents for an appropriate procedure ALMAT Assessment Code CSH_L01 Assessment Manage sedation for a succession of patients CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code CSH_C01 Discuss the selection of patients for sedation CSH_C02 Discuss the advantages and disadvantages of multi-agent sedation regimes CSH_C03 Discuss safe monitoring for sedation techniques. AG-38 CSH_C04 Discuss protection of the airway during sedation. CSH_C05 Discuss the management of agitation occurring in the sedated patient. CSH_C06 Supervise a junior colleague in managing sedation. Trauma and Stabilisation A-CEX Assessment Code MTH_A01 MTH_A02 MTH_A03 MTH_A04 Assessment Plays an effective senior role to lead a multi-disciplinary trauma team, co-ordinating and delivering the early hospital care of all types of complex multiply injured patients including the primary survey, resuscitation and secondary survey and appropriate HDU/ICU admission Undertakes perioperative anaesthetic care to all multiply injured patients including HDU/ICM admission if required for continued care Conducts interview with relatives of multi-trauma victim Supervises a less experienced trainee undertaking trauma care DOPS Assessment Code MTH_D01 MTH_D02 Assessment Demonstrates the ability to identify common abnormalities on the CT scans in patients with head injury, including but not limited to: • Extradural haematoma • Subdural haematoma • Intracerebral haematoma • Skull fractures • Diffuse axonal injury • Subarachnoid blood • Abnormalities of the ventricular system • The integrity of the cervical spine Interpret the chest x-ray appearances in a patient with major chest trauma CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code MTH_C01 Discuss the importance of teamwork in managing the patient with multiple injuries MTH_C02 Discuss the problems posed by emergency anaesthesia for the arrest of haemorrhage MTH_C03 Discuss the circumstances where induction of anaesthesia in the emergency department is justified and the problems this creates MTH_C04 Discuss the diagnosis and treatment of concealed haemorrhage in the injured patient MTH_C05 Discuss emergency analgesia for the seriously injured patient MTH_C06 Discuss the indications for immediate intubation and ventilation in the patient with multiple AG-39 trauma MTH_C07 MTH_C08 MTH_C09 Discusses the role of pre-hospital care of multiply injured patients including triage and modes of transport to hospital Explains the importance of good communication networks with the out of hospital emergency services Outlines the importance of major incident planning within hospitals and the roles and responsibilities of members of the anaesthetic team. Transfer Medicine This is an optional unit for trainees who undertake specialised attachments in pre-hospital care and helicopter retrieval. A-CEX Assessment Code TFH_A01 TFH_A02 TFH_A03 Assessment Undertakes the lead clinical care role in transporting a patient to another hospital Organises the inter-hospital transfer of a patient to another hospital, demonstrating the necessary organisational and communication skills required to effect the transfer in a timely and efficient manner Communicates with patients and relatives/carers when organising transfers, clearly explaining the reason for the transfer. TFH_A04 Teaches the basic competencies of intra-hospital transfer to trainees TFH_A05 Supervise more junior trainees undertaking intra-hospital transfers DOPS Assessment Code TFH_D01 Assessment Demonstrates the correct use of communication by radio TFH_D02 Demonstrates a willingness to participate in audit, critical incident reporting and research TFH_D03 Demonstrates the ability to package a patient for transfer by helicopter CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code TFH_C01 Discusses the special requirements of inter-hospital transfer by helicopter TFH_C02 Demonstrates a basic understanding of HEMS legislation TFH_C03 Describes the effects of flight on: • Patient’s physiology • Monitors / equipment • Medical staff AG-40 TFH_C04 Discusses the key aspects of safety relating to helicopter transfer: • Loading / unloading a patient • Securing a patient during transfer • Personal safety TFH_C05 Discusses the drills required during common emergencies on helicopters TFH_C06 Discusses the principles of communication with flight crew and correct radio procedures TFH_C07 Discusses the principles of handover following helicopter transfer TFH_C08 TFH_C09 Discusses the importance of team working and outlines the roles and responsibilities of the medical, ambulance and aircrew Discusses the key qualities of leadership required in those undertaking transfers, including the safe management of complex or prolonged transfers by land or air TFH_C10 Discusses the key issues in basic radio communication TFH_C11 Discusses the importance of audit of the transfer process, reporting of critical incidents during air transfer and research TFH_C12 Understands the basics of crew resource management TFH_C13 Discusses the issues regarding supervision of arranging patient transfers TFH_C14 Demonstrates the ability to plan teaching of trainees the basic levels of competencies for intra-hospital transfer TFH_C15 Demonstrates basic crew resource management skills Vascular This unit can be undertaken as either an intermediate or higher level unit. In the latter case there are more assessments suggested. A-CEX Assessment Code Assessment VSH_A01 Administer anaesthesia for a peripheral revascularisation procedure VSH_A02 Administer anaesthesia for an open aortic revascularisation procedure VSH_A03 Administer anaesthesia for repair of a leaking or ruptured aortic aneurysm Administer sedation or anaesthesia for radiological intervention for peripheral vascular disease Manage a patient for lower limb amputation VSH_A04 VSH_A05 DOPS Assessment Code VSH_D01 VSH_D02 Assessment Induce anaesthesia and establish monitoring etc for major vascular surgery Set up and use a cell saver AG-41 ALMAT Assessment Code VSH_L01 Assessment Anaesthetise a list of patients for vascular procedures CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code VSH_C01 Discuss how the patients vascular disease influenced the anaesthetic decision making VSH_C02 Discuss how the risk of hypothermia influenced the anaesthetic decision making VSH_C03 Discuss the likelihood of massive bleeding and the impact of this possibility on the conduct of anaesthesia. VSH_C04 Discuss the major complications of surgery for peripheral vascular disease Intensive Care Medicine I-CEX Assessment Code ICH_I01 ICH_I02 ICH_I03 ICH_I04 Assessment Responds to a call to assess a potential acute admission in the emergency department, ward etc. Performs general assessment and develops an appropriate plan for the patients immediate care – including the decision regarding the need to admit to ITU or HDU. Responds to a call to assess a potential acute admission of a SICK CHILD in the emergency department, ward etc. Performs general assessment and develops an appropriate plan for the patients immediate care – including the decision regarding the need to admit to ITU or HDU. Undertakes assessment and initial management of a patient with: • Multiple injuries • Burns • Complications of pregnancy • DKA • Sepsis • Haemorrhagic shock • Self poisoning Plans and institutes inotrope treatment in a hypotensive patient. Including choice of agents and doses. Explains the rationale for their decisions. ICH_I05 Establishes and manages renal replacement therapy ICH_I06 Receives from theatre team and establishes post-operative care of patient following: • Complex abdominal surgery • Upper GI or thoracic surgery • Craniotomy • Major plastic reconstruction surgery • Emergency surgery for perforated bowel AG-42 • ICH_I07 Surgery for multiple injuries Establishes care plan for withdrawal of active treatment and start of palliative care DOPS Assessment Code Assessment ICH_D01 Performs fibre optic bronchoscopy and BAL in the intubated patient under supervision ICH_D02 Performs transthoracic cardiac pacing ICH_D03 Inserts chest drain ICH_D04 Performs abdominal paracentesis ICH_D05 Undertakes tests to diagnose brain-stem death Introduces: • Internal jugular line • Subclavian line • Arterial line • Catheter for renal replacement treatment In respect of airway care : • Performs induction and intubation • Changes tracheostomy tube • Performs bronchial toilet and BAL through fibre-optic scope in intubated patient • Performs bronchoscopy for percutaneous tracheostomy • Performs percutaneous tracheostomy ICH_D06 ICH_D07 ICH_D08 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU ICH_D09 Supervises a junior colleague in the performance of a practical procedure ICH_D10 Undertakes measurement of cardiac output using any available technology and provides an interpretation of the results ICH_D11 Writes (or enters into the computer) the patient’s continuation report and plan ACAT Assessment Code Assessment ICH_T02 Undertakes intensive care ward round and makes the major management decisions including where appropriate: • Discharge from ITU • Changing major parameters of respiratory support – e.g. weaning from ventilation • Beginning discussions about withdrawal of care • Making appointments to meet relatives Manages a ‘shift’ as the senior doctor present in the unit ICH_T03 Appropriately guides, supervises and teaches a junior colleague during a ‘shift’ ICH_T01 AG-43 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code ICH_C01 Discuss the use of vasoconstrictors such as noradrenaline in the sick patient ICH_C02 Discuss the indications, technique and complications of pericardiocentesis ICH_C03 Discuss transvenous pacing ICH_C04 ICH_C05 Discuss national legislation and guidelines relating to child protection and their relevance to critical care Discuss the management of catastrophic upper-gastrointestinal bleeding including oesophageal varices. ICH_C06 Discuss the significance of raised blood lactate levels in the sick patient ICH_C07 Discuss the management of heart failure in the intensive care unit ICH_C08 Discuss the choice of antibiotics for: Pneumonia Meningitis Acute sepsis from leaking bowel Septic shock secondary to UTI ICH_C09 Discuss the problem of nosocomial and hospital acquired infection in the ITU ICH_C10 Explain the principles of organ support in a patient who is to donate their organs Paediatrics A-CEX Assessment Code PAH_A01 PAH_A02 PAH_A03 PAH_A04 PAH_A05 PAH_A06 PAH_A07 PAH_A08 Assessment Undertakes perioperative anaesthetic care [including both inhalational and intravenous induction techniques] for children over the age of 3 years. Undertakes perioperative anaesthetic care for children less than 1 years of age under direct supervision Undertakes the anaesthetic management of the young child [less than 3 years of age] with the possibility of a full stomach Undertakes anaesthesia for children over the age of 3 years for diagnostic radiological procedures Undertakes the management of an anaesthetic emergency in a child e.g.: acute airway obstruction, croup and acute epiglottitis, inhaled foreign body, loss of airway, laryngospasm, malignant hyperthermia, anaphylaxis Undertakes intra or inter hospital transport of a critically ill child or infant Demonstrates ability to take responsibility and appropriate action when non-accidental injury is suspected Provide appropriate sedation for a non-painful or LA intervention in a child over the age of 3 years AG-44 DOPS Assessment Code PAH_D01 Assessment Obtain peripheral venous access in a child where access is difficult PAH_D02 Obtain peripheral venous access in an infant or neonate PAH_D03 Establish central venous access in a child over the age of 3 years PAH_D04 Establish invasive arterial monitoring in a child over the age of 3 years PAH_D05 Manage the airway of an infant or neonate including tracheal intubation PAH_D06 Manage postoperative acute pain in an infant or neonate PAH_D07 Undertake the management of fluids, electrolytes, glucose and temperature perioperatively PAH_D08 Calculate the fluid and electrolyte requirements of an infant after emergency laparotomy PAH_D09 PAH_D10 Calculate appropriate ventilator settings and fresh gas flows for an infant or neonate undergoing surgery Undertake discussions with patients, parents and/or carers in connection with a child’s anaesthesia and surgery ALMAT Assessment Code PAH_L01 PAH_L02 Assessment Provide anaesthesia for an elective list of paediatric patients presenting for operations of moderate complexity Provide anaesthesia for a list of paediatric patients presenting for emergency operations CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code PAH_C01 PAH_C02 PAH_C03 Undertakes a critical discussion about the problems and risks inherent in anaesthesia for former premature babies and children with significant co-morbidity Undertakes a critical discussion about the commoner problems of paediatric intensive care, including ventilatory and circulatory support, upper airway problems and trauma. Provides a clear explanation of the current local and national guidelines for provision of paediatric services PAH_C04 Discuss pain relief in infants and neonates PAH_C05 Discuss temperature regulation in infants and neonates AG-45 Education The assessments in education are compulsory at the higher level. They are not assessed using the mark-sheets for clinical WPBA Assessment Code TMH_01 TMH_02 Assessment Make a presentation (paper, audit etc) to a departmental meeting. There should be use of presentation software, a hand-out and a feed-back form for the audience Teach a small group tutorial of more junior trainee anaesthetists. There should be use of presentation software, a hand-out and a feed-back form for the audience TMH_03 Directly supervise and teach a junior trainee anaesthetist undertaking a routine operating list. TMH_04 Directly supervise and teach a junior anaesthetist undertaking an emergency anaesthetic TMH_05 Teach a practical procedure Optional units Pain Medicine A-CEX Assessment Code PMH_A01 PMH_A02 PMH_A03 Assessment Demonstrates the ability to respond to a complex acute pain problem in an in-patient Demonstrates a full assessment (to include biological, social and psychological domains) and forms a multi-professional management plan for a complex chronic pain patient Demonstrates a full assessment (to include biological, social and psychological domains) and forms a multi-professional palliative medicine management plan for pain and other symptoms for a cancer pain patient DOPS Assessment Code PMH_D01 Assessment Undertakes lumbar epidural steroid injection PMH_D02 Undertakes lumbar facets/medial branch blocks PMH_D03 Undertakes regional and nerve blocks for acute and chronic pain management ALMAT Assessment Code PMH_L01 Assessment Undertakes and leads an acute pain ward round AG-46 CBD Examine the case-notes. Discuss how the pain medicine plan was developed. Ask the trainee to explain their assessment and management decisions. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code PMH_C01 PMH_C02 PMH_C03 PMH_C04 PMH_C05 Discuss the principles of neural blockade including autonomic blocks, in acute and chronic pain Discuss the advanced assessment and management principles of chronic and acute-on-chronic pain in a multi-professional context Discuss the advanced assessment and management principles of cancer pain in a multiprofessional context Discuss the principles and describes the applications of physiotherapy and other physical therapies used for treating pain Discuss the psychological mechanisms in pain and techniques for their management including cognitive behavioural approaches PMH_C06 Discuss the place of surgery in the management of pain PMH_C07 Discuss the importance of disability and incapacity, and factors influencing their assessment PMH_C08 Discuss the importance of psychological, social and ethical issues around good pain medicine PMH_C09 Discuss the role of social services, rehabilitation and other support services Ophthalmic A-CEX Assessment Code Assessment OPH_A01 Undertakes perioperative anaesthetic care of an adult patient requiring routine or emergency ophthalmic surgery OPH_A02 Undertakes anaesthetic care for a child aged at least 5 for ophthalmic surgery [Ref Paeds] OPH_A03 Undertake sedation for an ophthalmic procedure OPH_A04 Supervise a more junior colleague undertaking ophthalmic anaesthesia DOPS Assessment Code OPH_D01 OPH_D02 Assessment Perform peribulbar block. Perform sub-Tenon’s block. ALMAT Assessment Code OPH_L01 Assessment Manage an eye surgery list AG-47 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code OPH_C01 Discuss the perioperative anaesthetic care for surgery for tumours of the eye and orbit OPH_C02 OPH_C04 Discuss anaesthesia for advanced reconstructive oculoplastic surgical techniques Discuss techniques for post-operative pain relief in patients undergoing major reconstructive oculoplastic surgery Discuss the complications of sharp-needle eye blocks OPH_C05 Discuss the management of inadvertent ocular needle puncture OPH_C06 Discuss the difficulties presented by ambulatory cataract surgery in the elderly with serious co-morbidities. OPH_C07 Describe the anatomy relevant to eye blocks OPH_C03 Plastics/Burns A-CEX Assessment Code Assessment PLH_A01 Provide safe perioperative anaesthetic care for a plastic surgical free-flap operation – such as breast reconstruction PLH_A02 Undertake anaesthesia for the debridement and grafting of major burns PLH_A03 Undertake anaesthesia for a plastic surgical procedure of the face DOPS Assessment Code Assessment PLH_D01 Provides a management plan for the post-operative care of a patient who has undergone plastic surgery including the methods of assessment of adequacy of blood flow in reconstructive flaps PLH_D02 Calculate and prescribe the fluid replacement regime for a burned patient PLH_D03 Manage analgesia for a patient with burns ALMAT Assessment Code PLH_L01 Assessment Demonstrate correct management of a patient with a severe inhalational injury AG-48 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code PLH_C01 PLH_C02 PLH_C03 PLH_C04 Describes appropriate anaesthetic techniques for major plastic surgical cases including freeflap surgery Explains the principles of anaesthesia for primary and secondary cleft lip and palate repair [if not completed in paediatric training] Describes the recognition & appropriate management of the plastic surgical patient with a potentially difficult or compromised airway including Describes local protocols for the transfer of burns patients to specialist regional centres Anaesthesia in developing countries Assessment in this area will be organised by the educational supervisors in the UK and in the overseas placement. Conscious sedation in dentistry A-CEX Assessment Code CSH_A03 CSH_A04 Assessment Undertakes sedation of an adult for dental surgery in a clinic setting remote from the operating theatres including assessment and supervision of recovery Undertakes sedation of an child aged more than 5 years for dental surgery in a clinic setting remote from the operating theatres including assessment and supervision of recovery DOPS Assessment Code CSH_D01 Assessment Demonstrates inhalational sedation with nitrous oxide in a child aged over 5 CSH_D02 Undertakes inhalational sedation with nitrous oxide in an adult CSH_D03 Undertakes sedation using multiple agents and multiple routes of administration CSH_D04 Undertakes sedation using intra-venous TCI technique ALMAT Assessment Code CSH_L02 Assessment Undertakes a list of patients requiring sedation for dental procedures AG-49 CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to preop preparation, choice of induction, maintenance, post op care. Select one of the following topics and discuss the trainees understanding of the issues in context. Assessment Assessment Code CSH_C07 CSH_C08 Discusses the importance of published guidance for the use of conscious sedation use in dentistry Discusses the use of local anaesthesia for dentistry and describes techniques and complications CSH_C09 Discusses dental phobia and the management of patients exhibiting it CSH_C10 Explains the importance of thorough preoperative preparation of dental out-patients, the consent process and aftercare, focusing on medical, social and psychological assessment and evaluation of risk CSH_C11 Discusses the place of intravenous infusions and TCI in out-patient dental practice CSH_C12 CSH_C13 Discusses the limitations imposed by working in the isolation of the non-hospital environment including Discusses the inherent risks associated with the use of infusions and/or multiple drugs with synergistic actions Remote and Rural Anaesthesia Assessment in this area will be organised by the educational supervisors for the placement. Military Anaesthesia The military medical services will undertake appropriate assessment within these acitive service areas AG-50 Blueprint for workplace based assessments against the basic level units of training √ History taking √ √ √ √ Clinical examination √ √ √ Specific anaesthetic evaluation √ √ √ √ Premedication √ √ √ √ Induction of general anaesthesia √ √ √ Intra-operative care including sedation √ √ √ √ Postoperative and recovery room care √ √ √ √ Introduction to anaesthesia for emergency surgery √ √ √ √ Transfer medicine √ √ √ √ Management of respiratory and cardiac arrest √ √ √ √ Control of infection √ √ √ √ Airway management √ √ √ Critical incidents √ √ √ Day surgery √ √ √ √ General, urological and gynaecological surgery √ √ √ √ ENT, maxillo-facial and dental surgery √ √ √ √ √ √ MSF DOPS √ I-CEX CBD ALMAT A-CEX √ ACAT √ Unit of Training The basis of anaesthetic practice Preoperative assessment Basic anaesthesia √ √ Intensive care medicine √ √ Non-theatre √ √ √ √ Obstetrics √ √ √ √ Orthopaedic surgery √ √ √ √ Paediatrics √ √ √ √ √ √ √ Pain medicine √ √ √ Regional √ √ √ Sedation √ √ √ Trauma and stabilisation √ √ √ Child protection Basic sciences to underpin anaesthetic practice Anatomy √ √ Pharmacology √ √ Physiology and biochemistry √ √ Physics and Clinical measurement √ √ Statistical methods √ √ AG-51 √ Blueprint of workplace based assessments mapped against the intermediate level units of training √ Cardiac/Thoracic √ √ √ Airway management √ √ Critical incidents √ √ √ Day surgery √ √ √ √ MSF DOPS √ I-CEX CBD ALMAT A-CEX √ ACAT Anaesthesia for neurosurgery, neuroradiology and neurocritical care Unit of Training Essential units √ General duties General, surgery urological and gynaecological ENT, maxillo-facial and dental surgery √ √ √ √ √ √ √ √ √ √ Management of respiratory and cardiac arrest √ Non-theatre √ √ √ √ Orthopaedic surgery √ √ √ √ Regional √ √ √ Sedation √ √ √ Transfer medicine √ √ √ Trauma and stabilisation √ √ √ Intensive care medicine √ √ √ √ √ √ √ Obstetrics √ √ √ √ Paediatric √ √ √ √ Pain medicine √ √ Ophthalmic √ √ √ Plastics/Burns √ √ √ Vascular surgery √ √ √ Optional units Advanced sciences Anatomy √ √ Applied clinical pharmacology √ √ Applied physiology and biochemistry √ √ Nutrition √ √ Physics and clinical measurement √ √ Statistical basis for clinical trial management √ √ AG-52 √ Blueprint of workplace based assessments mapped against the higher level units of training MSF I-CEX DOPS CBD ALMAT A-CEX ACAT Unit of Training Essential units Anaesthesia for neurosurgery, neuroradiology and neurocritical care √ √ Cardiac/Thoracic √ √ √ Airway management √ √ √ Day surgery √ √ √ √ ENT, maxillo-facial and dental √ √ √ √ √ General, urological and gynaecological surgery √ √ √ √ √ Management of respiratory and cardiac arrest √ √ √ Non-theatre √ √ √ √ Obstetrics √ √ √ √ Orthopaedic √ √ √ √ Regional √ √ √ √ Sedation √ √ √ √ Transfer medicine √ √ √ √ Trauma and stabilisation √ √ Vascular √ √ √ √ √ √ √ √ √ √ √ √ √ General duties Intensive care medicine √ Paediatric √ √ √ √ √ Optional units Pain medicine √ Ophthalmic √ √ √ √ Plastics/Burns √ √ √ √ Anaesthesia in developing countries √ √ √ √ Conscious sedation in dentistry √ √ Military anaesthesia √ √ √ √ Remote and rural √ √ √ √ AG-53 √ √
