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ShareCA-1 Year Overview
During the first six months, residents are taught to:
- Understand basics of anesthesia machine and routine monitors (pulse oximetry, capnography, circuits, oscillometric blood pressure cuffs, and electrocardiogram)
- Understand basics of neuromuscular blockade (relaxants, train-of-four monitoring, reversal)
- Understand use of routine vasoactive drugs
- Understand the indication for commonly used anesthetic drugs
- Understand major hemodynamic and respiratory effects of routine anesthetic agents and their indications
- Understand comprehensive examination and classification of the airway
- Understand key preoperative findings in history, physical, and laboratory work
- Understand application of Universal Precautions and aseptic technique
- Advanced Cardiac Life Support certification
Case management
- Manage ASA physical status 1 patients with minimal assistance for uncomplicated surgery, including induction, maintenance, emergence, and transport to the post anesthesia care unit
- Accurately estimate fluid (blood/colloid/crystalloid) requirements in routine cases
- Identify basic intraoperative problems (hyper-/hypotension, hypoxia, hypercapnia, arrhythmias, anuria, acidosis, laryngospasm) and formulate differential diagnoses and treatment plans
- Recognize key anatomic landmarks, indications/contraindications, and potential complications of regional blocks (spinal, epidural, axillary, intravenous regional)
Technical skills
- Set up a case in reasonable time (machine check, drugs, airway equipment)
- Ventilate lungs via mask, and tracheal intubation of patients with easy to moderately difficult airways
- Place peripheral intravenous, arterial, and central catheters with minimal assistance
- Perform aforementioned regional blocks on suitable patients with assistance
- Keep legible and accurate intra-, pre- and postoperative records
- Operate basic technical monitors and pressure transducers and troubleshoot simple technical malfunctions
Oral skills
- Communicate effectively with patient
- Deliver concise, organized case presentation to staff that includes important pre-anesthetic concerns
- Formulate and describe in detail a plan for anesthetic management of ASA physical status 1-3 patients including anticipated problems and their solutions
Last six months of the year, residents are taught to:
- Understand physiology of significant cardiovascular events (compression of vena cava by surgeons, hypovolemia, hypervolemia, pulmonary embolism, ischemia, myocardial depression)
- Understand aspects of neuroanesthesia (management of increased intracranial pressure for craniotomy), vascular anesthesia (changes with aortic cross clamp), and orthopedic anesthesia (fat emboli)
- Understand choice of regional versus general anesthesia and need for selective invasive monitoring
- Understand basics of obstetric anesthesia (physiologic changes of pregnancy, techniques for cesarean section, special precautions)
- Understand how to obtain and apply information from a pulmonary artery catheter
Case management
- Manage, under supervision, patients with difficult airways who are undergoing elective surgery
- Perform emergency airway management with reasonable skill (rapid sequence vs. awake intubation) in the operating room and the intensive care unit
- Manage ASA physical status 3 patients for uncomplicated surgery with assistance
- Initiate management of trauma cases and other emergencies in propersequence (airway, intravenous access, monitoring)
- Manage Cesarean section by general or regional anesthesia with assistance
- Manage patients in the post anesthesia care unit with assistance (assure adequacy of airway or adjust ventilation; manage pain, hemodynamics and fluids; and determine readiness for discharge)
- Develop and implement a rational plan for tracheal intubation of patients in the intensive care unit
Technical skills
- Insert central and arterial catheters independently most of the time
- Insert a pulmonary artery catheter with direction
- Perform spinal and lumbar epidural anesthesia without assistance in most patients
- Perform fiber optic or awake tracheal intubation with assistance
Oral skills
- Cogently discuss management plan with anesthesiology staff or surgeon for ASA physical status 3 patients
- Defend choice of monitoring
- Defend choice of anesthetic technique and drugs used with discussion of options
- Recognize when to proceed, investigate further, or cancel a case
- Participate actively in teaching medical students
