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  1. 1. Intensive Care Rotation University of Saskatchewan Anesthesia Training Program OBJECTIVES OF TRAINING AND SPECIALTY TRAINING REQUIREMENTS IN ANESTHESIA Revised 2006 - 2007 INTENSIVE CARE ROTATION The specialty of Anesthesiology has strong historical ties to the creation and development of the field of Critical Care Medicine. The techniques and theory of Anesthesiology are used continuously in the Intensive Care Unit. By practicing these skills in a non-OR setting with a population of patients undergoing acute changes in physiology requiring rapid diagnosis and intervention, the anesthesiology resident has vast opportunity to increase his or her skill set. Knowledge and experience gained through the management of critically ill patients will be of value to the anesthesiologist in his or her daily practice. Opportunity to follow surgical patients through the immediate peri-operative period will be provided, further emphasizing the role of the anesthesiologist as a peri-operative specialist. CanMeds 2000 areas of competencies: MEDICAL EXPERT General Requirements • Demonstrate diagnostic and therapeutic skills for ethical and effective patient care • Access and apply relevant information to clinical practice • Demonstrate effective consultation services with respect to patient care, education, and legal opinions Specific Requirements Knowledge (Basic and Applied) • The resident must be able to demonstrate basic and applied knowledge in the following areas: 1. Neurological Disease: i. Management of the patient with increased intracranial pressure, head injury, subarachnoid hemorrhage, spinal cord injury ii. Recognition and management of psychiatric effects of critical illness iii. Principles of pain management and sedation in critically ill patients iv. Diagnosis and management of the patient with brain death including organ preservation and procurement 2. Cardiovascular Disease i. Cardiopulmonary resuscitation, including an understanding of the basic and complex arrhythmias 1
  2. 2. Intensive Care Rotation University of Saskatchewan Anesthesia Training Program ii. Pharmacological and mechanical support of circulation iii. Understanding of the pathophysiology, diagnosis, and management of the shock states, sepsis and the systemic inflammatory response syndrome iv. Fluid resuscitation and support of massive blood loss v. Placement and management of arterial, venous, and pulmonary artery catheters and interpretation of the data they provide vi. Understanding of heart-lung interactions 3. Respiratory Disease i. Airway maintenance and management in the critically ill patient ii. Mechanical ventilation (invasive and non-invasive modes), including principles of lung protective strategies and ventilator weaning iii. Assessment and evaluation of pulmonary function iv. Pathophysiology of respiratory failure 4. Gastrointestinal i. Management of the patient undergoing abdominal surgery or trauma, including complications 5. Renal i. Recognition and management of renal dysfunction ii. Interaction of drugs, nephrotoxins, and the kidney 6. Endocrine/metabolic i. Knowledge of endocrine disorders common to the critically ill, including hypoglycemia, hyperglycemia, adrenal and thyroid disorders ii. Interpretation of laboratory values, with understanding of acid-base and electrolyte abnormalities iii. Principles of enteral and parenteral nutrition 7. Hematologic i. Understanding of coagulation, fibrinolysis, and disorders of the same ii. Pathophysiology and management of neutropenia, anemia, and thrombocytopenia iii. Principles of transfusion therapy in the critically ill 8. Ethics/end of life care i. Understanding of the ethical issues surrounding institution, continuation, and withdrawal of life-sustaining therapies ii. Discuss and demonstrate consideration of ethical and legal aspects of critical care iii. Demonstrate an understanding and application of principles of end of life care 9. Trauma i. Ability to evaluate and prioritize the management of the trauma patient ii. Transportation of the critically ill patient 2
  3. 3. Intensive Care Rotation University of Saskatchewan Anesthesia Training Program Skills The resident shall demonstrate understanding and technical proficiency with the following areas: • Airway management out of the operating room • Oxygen delivery systems • Non-invasive and invasive hemodynamic monitoring systems • Ability to acquire, interpret, and communicate information in the intensive care unit COMMUNICATOR General: • Establish therapeutic relationships with patients/families • Obtain and synthesize relevant history from patients/families/communities • Listen effectively • Discuss appropriate information with patients/families and the health care team Specific: • Develop effective communication and interpersonal skills with patients, family members, and other health care providers • Transfer information to patients, families, and support systems in a humane and understandable manner • Participate in discussions with patients, families, and members of the health care team regarding conflicts in patient management COLLABORATOR General: • Consult effectively with other physicians and health care professionals • Contribute effectively to other interdisciplinary team activities Specific: • Develop and effect a care plan for each critically ill patient • Understand the roles, expertise, and limitations of the members of the critical care team • Participate in patient management as both a team leader and member • Manager General: • Utilize resources effectively to balance patient care, learning needs, and outside activities • Allocate finite health care resources wisely • Work effectively and efficiently in a health care organization 3
  4. 4. Intensive Care Rotation University of Saskatchewan Anesthesia Training Program • Utilize information technology to optimize patient care, life-long learning and other activities Specific: • Demonstrate an understanding of the importance of the Intensive Care Unit in coordinating and facilitating care of patients from outside of the unit (triage of the operating and emergency rooms, patient transfers from inside and outside of Saskatoon District Health) • Coordinate patient activities within the intensive care unit HEALTH ADVOCATE General: • Identify the important determinants of health affecting patients • Contribute effectively to improved health of patients and communities • Recognize and respond to those issues where advocacy is appropriate Specific: • Recognize the external factors that impact on a patient’s outcome from critical illness (poverty, education, obesity, personal habits etc) SCHOLAR General: • Develop, implement and monitor a personal continuing education strategy • Critically appraise sources of medical information • Facilitate learning of patients, housestaff/students and other health care professionals • Contribute to development of new knowledge Specific: • Identify personal knowledge deficits, and create a plan of action to fill the resident’s need • Perform a literature search, critically appraise the literature, and use principles of evidence based medicine in the ICU • Participate in the education of all other members of the critical care team PROFESSIONAL General: • Deliver highest quality care with integrity, honesty and compassion • Exhibit appropriate personal and interpersonal professional behaviors • Practice medicine ethically consistent with obligations of a physician Specific: 4
  5. 5. Intensive Care Rotation University of Saskatchewan Anesthesia Training Program • Demonstrate a continuous assessment of one’s ability and competence in the practice of anesthesiology and critical care medicine • Develop personal techniques to balance personal and professional obligations and boundaries 5
  6. 6. Intensive Care Rotation University of Saskatchewan Anesthesia Training Program • Demonstrate a continuous assessment of one’s ability and competence in the practice of anesthesiology and critical care medicine • Develop personal techniques to balance personal and professional obligations and boundaries 5

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