Download Expectations Regarding Incremental Achievement of Goals and

Expectations Regarding Incremental Achievement of Goals and
Objectives Based on Training Level (PGY2 – PGY5)
The Core Anesthesia knowledge content objectives to be acquired during the training
program are identified in a separate document. The specific knowledge content items
identified represent the expected knowledge content that should be acquired during the
training program by the anesthesia resident as a Medical Expert/Clinical Decision Maker
(CanMEDS role). Every attempt will be made to provide a comprehensive well-rounded
clinical learning experience. It is expected that the resident may not have clinical
exposure to some areas identified as core knowledge, and that certain areas may not be
covered in a structured learning format such as a seminar or rounds. The resident is
however responsible for reviewing and acquiring the Core Knowledge Objectives
material and may need to utilize self-directed reading and/or request exposure to specific
clinical cases if deficiencies are perceived. Residents are referred to the National
Curriculum Document found on the department website for an exhaustive list of the
required knowledge under the role of Medical Expert.
The acquisition of the core material will occur over the five-year training program at
various stages and rates with specific areas of knowledge being acquired during the
corresponding seminar in the academic day program. The depth of comprehension is
expected to increase as residents become more senior. The PGY1 year is a multidisciplinary year meant to help develop a broad based understanding of other medical and
surgical specialties. Thus there are no guidelines for anesthesia objectives for the end of
PGY1. As a general statement, by the end of PGY2, a resident should have the
knowledge and skills necessary to function independently in a low-risk setting. During
the PGY3 and PGY4 years, residents concentrate on critical care and subspecialty
internal medicine rotations, general adult and subspecialty anesthesia rotations building
their knowledge base in these areas. Since the distribution of these rotations is determined
by resident choices, the PGY 3 and 4 years will be considered together. The PGY5 year is
the final year of intensive anesthesia exposure. The overall goal of this year is to
complete the transition from functioning independently in a low-risk environment to
being a full-fledged consultant.
Within each of these time periods, this guideline is organized into three areas of
objectives: knowledge, skills and level of responsibility. The knowledge and skills
objectives are self-explanatory. This document is intended to give an overview of each
year, to give context to evaluators and learners. It does not replace the more detailed
goals and objectives for each rotation, which may be found in the Goals and Objectives
and Rotation Information Manual.
The level of responsibility expected refers to the level of autonomy that a resident should
be able to be given at the specified level of training. This is provided for the purposes of
evaluation. The decision of how much supervision to provide in a given clinical situation
is based on the resident’s actual performance. It cannot be assumed that any individual
resident can safely be afforded the level of responsibility outlined here purely on the basis
of time in training. For these purposes, this document should be viewed as the reflecting
minimum supervision that would be expected.
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Direct Supervision - the presence and assistance of staff during induction,
emergence, critical events, and short periods of independent monitoring with
immediate staff availability
Indirect Supervision - staff may be present but is definitely immediately available
during induction, emergence and critical events. Residents will have periods of
independent monitoring with staff available
Independent- performance of all aspects of care with no staff input. Staff is
available to provide opinions and feedback.
The broadest outline of the overall expectations would describe each year’s goals as:
PGY 1
PGY 2
PGY 3-4
PGY 5
Foundational Knowledge
Basic science
Broad understanding of anesthetic planning and choices
Autonomy for Low-Risk
This is the same standard as for FP- anesthesia trainees for adult and OB
Subspecialty Knowledge
Development of breadth of subspecialty, ICU and Medicine knowledge
Gradual increase in acuity and complexity of cases
Consultant
Comprehensive pre, intra- and postoperative care planning and delivery for
all degrees of patient and case complexity
The following sections describe the knowledge and skills expected at each of these levels
in sufficient detail to guide evaluation and learning as the training progresses.
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PGY2The resident will be expected to be able to provide anesthesia for low-risk surgery to
ASA 1 & 2 patients autonomously, as expected of FP-Anesthesia trainees at the same
level of experience, with the exception of pediatric anesthesia. In order to do that the
following knowledge and skill objectives must be met:
Knowledge Objectives:
1. A clear understanding of the pharmacology of anesthetic and resuscitative drugs,
and a developing knowledge of the functional anatomy, physiology, and
pathophysiology as applied to the practice of anesthesia.
2. A clear understanding of the function of anesthesia machines and circuits, and
checkout procedures.
3. A clear understanding of the differential diagnosis, investigation and treatment of
common perioperative problems such as common disorders in respiratory and
hemodynamic parameters (e.g. hypotension, hypertension, bradycardia, tachycardia,
arrhythmias, high AWP, desaturation, hypercapnia, laryngospasm etc).
Skills Objectives (with minimal assistance):
1. Perform a set-up and checkout procedure for an anesthetic machine and anesthetic
equipment (including invasive monitoring equipment preparation).
2. Replace an oxygen / air cylinder on the anesthetic machine.
3. Prepare both routine and resuscitative anesthetic medications.
4. Secure routine and ‘large’ bore intravenous access in the adult patient.
5. Establish invasive arterial line access.
6. Perform a rapid sequence induction utilizing cricoid pressure.
7. Select an appropriate sized LMA and perform LMA placement.
8. Select an appropriate sized ETT and perform oral intubation in the normal adult
airway.
9. Prescribe appropriate ventilatory parameters for mechanical ventilation.
10. Assess the patient for appropriate timing of extubation.
11. Know and use appropriate doses of local anesthetic agents.
12. Perform spinal and lumbar epidural anesthesia.
13. Perform a Bier block.
14. Check blood, set up a blood administration system, and administer blood products.
15. Conduct intravenous conscious sedation.
16. Demonstrate a growing proficiency and development in regional block techniques
utilizing dynamic ultrasound guidance.
17. Utilize appropriate monitors and supplemental oxygen for transportation of
critically ill adult patients.
18. Prescribe appropriate postoperative oxygen, analgesics and anti-emetic therapy.
Responsibility:
By the end of PGY2, the RCPS anesthesia resident should be able to independently
manage perioperative planning and delivery of anesthesia for ASA 1 & 2 adult and
obstetrical cases, with the exception of pediatrics, and cases of surgical score 4-5.
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PGY 3 and 4
In addition to the PGY 2 objectives, the anesthesia resident will be expected to be able
to meet the following objectives by the end of PGY4:
Knowledge objectives:
1. Demonstrate an increasing depth of knowledge of all areas of anesthesia including
conduct of anesthesia in off-site and special (eg. MRI) locations.
2. Demonstrate an ability to provide an appropriately focused and comprehensive
anesthetic assessment/consultation and propose a reasonable perioperative
management plan.
Skills objectives: (with minimal assistance)
1) Perform, and demonstrate understanding of the indications, limitations, and potential
complications of:
a) nasal intubation
b) video laryngoscopy
c) bougie assisted stylet intubation
d) central line access via the internal jugular vein with dynamic ultrasound guidance
e) PA catheter placement (including deriving indices of cardiac performance)
f) Upper and lower limb nerve blocks using dynamic ultrasound guidance
g) Local infiltration (including safe doses of LA)
2) Setup and administer anesthetic and vasoactive drug infusion administration systems.
3) Demonstrate a clear understanding of the management of the difficult airway.
a) Perform topical airway anesthesia including:
i) nebulized local anesthesia
ii) topical anesthesia / vasoconstriction of the nasal airway
iii) superior laryngeal nerve blocks
iv) transtracheal injection of local anesthesia
b) Perform fibreoptic intubation with appropriate intravenous conscious sedation,
oxygenation and monitoring.
4) Demonstrate an increasing proficiency in the use of:
a) the Fastrak intubating LMA & other supraglottic devices
b) lung isolation techniques including double lumen ETT placement
c) thoracic epidural
d) brachial plexus blocks, lower limb blocks, peripheral nerve blocks & TAP blocks
with dynamic ultrasound guidance
e) subclavian and femoral venous access with dynamic ultrasound guidance
Responsibility:
By the end of PGY4, the resident should be able to provide complete perioperative
planning and delivery of anesthetic care for uncomplicated subspecialty surgery cases up
to surgical score of 5.
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PGY5
By the end of this year, the resident will be expected to be able to demonstrate:
Knowledge Objectives
1. An acquired breadth and depth of knowledge that is close or equivalent to that of a
consultant anesthesiologist.
2. Knowledge of all Anesthesia Core Knowledge Content Objectives.
Skills Objectives:
In addition to the above technical skills, at the completion of the PGY5 year the resident
will be expected to (with minimal assistance):
1. Demonstrate an increasing confidence and proficiency in performing a:
- Upper limb & lower limb
- Having a working knowledge of available interventions appropriate for
chronic pain therapy (e.g. Ablative blocks, Facet blocks, trigger point
injections, neuraxial steroid injections etc.)
2. Demonstrate confidence and proficiency in assessing the patient with a difficult
airway and proposing and carrying out an appropriate plan (including the obstetrical
patient requiring general anesthesia for emergency operative delivery).
Responsibility
By the end of the PGY 5 year, the resident should be able to perform at the level of an
independent consultant in all clinical scenarios. This does not mean never requiring help,
but rather requiring help only in exceptional situations, as would be expected of a staff
anesthesiologist.
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Adult Anesthesia
Year
Direct Supervision
Indirect Supervision
Independent
PGY5
Periods of
Anesthesia
0-3
4-6
7-12
13-16
16-20
20+
All
All others
ASA 5 or SS 4-5
ASA 5 or SS 4-5
ASA 5 or SS 4-5
-
ASA 1-2 and SS 1-3
ASA 3-4 and SS 1-3
ASA 4 and SS 1-3
ASA 4 and SS 1-4
-
ASA 1-2 and SS 1-3
ASA 1-3 and SS 1-3
ASA 1-3 and SS 1-4
All
Year
PGY1
PGY2
Periods of OB
0
1
Direct Supervision
All activities
All Cesarian Section
in ASA> 3
PGY1-2
PGY3-4
Obstetrical Anesthesia
Indirect Supervision
Difficult epidurals (morbidly
obese, difficult landmarks)
Independent
Epidurals for analgesia
Venous access
Neonatal resuscitation
Arterial line
Epidural blood patch
PGY3-4
1
C/S under GA
C/S ASA 3-5 under regional
C/S in ASA1-2
C/S ASA 1-2
Neonatal resuscitation
Difficult epidurals
Blood patch
PGY5
2
C/S GA
C/S regional for high risk
Pediatric Anesthesia
Periods of Pediatric Anesth
0-1
1-2
2-4
4-6
Direct Supervision
All
All others
SS 4-5, ASA 4-5
-
Indirect Supervision
ASA 1-2 >2yo
SS 1-3, ASA 1-3
SS 4-5, ASA 4-5
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Independent
ASA 1-2 >2yo
SS 1-3, ASA 1-3
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