Anesthesia — Core of Discipline

C1 Using the anesthetic assessment to generate the anesthetic considerations and management plan, including prioritization and optimization, for patients with complex medical issues or surgeries

- The focus of this EPA is the interpretation of clinical data to identify and prioritize
anesthetic considerations related to patient and surgical issues, and subsequent proposal of an anesthetic management plan encompassing preoperative, intraoperative and postoperative phases of care.
- Complex medical issues include: cancer, cardiovascular disease, connective tissue disease, diabetes mellitus, end organ disease, endocrine disorders, frailty, significant hematological disorders, infectious diseases, morbid obesity, neurological diseases, neuromuscular and musculoskeletal disease, obstructive sleep apnea (OSA), organ transplantation and advanced significant respiratory disease.
- This EPA may be observed during inpatient consultation, outside the OR, or in the preoperative clinic setting, and for scheduled or urgent/emergent surgery.
- Sound judgment and insight is an important part of this EPA.

Form

F1: Observation

Milestones

• ME 1.1. Apply clinical and biomedical sciences to manage perioperative assessment in complex patients

• ME 2.2. Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements

• ME 1.6. Seek assistance in situations that are complex or new

• ME 2.1. Consider clinical urgency, feasibility, availability of resources, and comorbidities in identifying and resolving conflicting anesthetic priorities

• ME 2.2. Select and interpret relevant perioperative investigations and integrate the results to assess risk and to appropriately modify perioperative management plan

• ME 2.4. Develop an anesthetic management plan, demonstrating sound judgment and insight

• ME 2.4. Assess perioperative risk and apply risk reduction strategies

• ME 3.1. Integrate all sources of information to develop a management plan that is safe, patient-centred, and considers the risks and benefits of all approaches

• ME 3.2. Use shared decision-making in the consent process, taking risk and uncertainty into consideration

• COM 1.5. Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately

• COM 1.6. Tailor approaches to decision-making to a patient’s and/or family’s capacity, values, and preferences

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

• COL 1.2. Consult as needed with other health care professionals, including other physicians

• COL 1.3. Communicate effectively with physicians and other colleagues in the health care professions

• L 2.1. Use clinical judgment to minimize wasteful practices

• HA 1.2. Apply the principles of behaviour change during conversations with patients
  about adopting healthy behaviours

• S 1.2. Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance

• P 2.1. Demonstrate a commitment to maintaining and enhancing competence

Context Variables

• Location (single-choice)
  • OR
  • ward
  • preop clinic
• Timing of surgery (single-choice)
  • urgent
  • elective
  • emergent
• Type of procedure (single-choice)
  • urology
  • gynecology
  • neurosurgery
  • ophthalmology
  • otolaryngology
  • cardiac surgery
  • general surgery
  • plastic surgery
  • thoracic surgery
  • vascular surgery
  • orthopedic surgery
• Level of complexity (single-choice)
  • high
  • moderate
• Type of observation (single-choice)
  • direct
  • indirect
• Type of co-morbidity (single-choice)
  • cancer
  • frailty
  • morbid obesity
  • diabetes mellitus
  • end organ disease
  • endocrine disorders
  • infectious diseases
  • neurological diseases
  • organ transplantation
  • cardiovascular disease
  • connective tissue disease
  • obstructive sleep apnea (OSA)
  • significant hematological disorders
  • advanced significant respiratory disease
  • neuromuscular and musculoskeletal disease

Requirements

• Collect observations from a large breadth of training experience with the expectations not all will be achieved, with a minimum of 10 observations of achievement