Anesthesia — Core of Discipline

C10 Providing perioperative anesthetic management for pediatric patients with more complex cases

- This EPA includes all aspects of care including preoperative assessment, investigation/optimization if needed, informed consent with patient and family, anesthetic management and determination of postoperative disposition.
- The focus of this EPA is on the intraoperative and postoperative management.
- The case may be considered complex due to either the patient having multiple medical co-morbidities or the procedure involving complex management.
- This EPA may be observed in children under the age of one, but this is not required.
- This EPA may be observed in complex pediatric cases.

Form

F1: Observation

Milestones

• ME 1.1. Demonstrate commitment and accountability for patients in their care

• ME 1.3. Apply clinical and biomedical sciences to manage presentations in pediatric patients

• ME 1.6. Adapt care as the patient’s clinical condition evolves

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

• ME 2.4. Establish a comprehensive perioperative anesthetic management plan, taking into consideration the wishes of the patient and their family, the impact of the patient’s co-morbidities, available resources, and the needs and urgency of the procedure

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

• ME 3.4. Perform the anesthetic management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• ME 3.4. Establish and implement a plan for post-anesthesia care

• ME 5.2. Apply the principles of situational awareness to clinical practice

• COM 5.1. Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

• COL 1.2. Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care

• COL 1.3. Engage in respectful shared decision-making with physicians and other colleagues in the health care professions.

• COL 2.2. Implement strategies to promote understanding, manage differences, and resolve conflict in a manner that supports a collaborative culture

• COL 3.2. Demonstrate safe handover of care, both verbal and written

• L 2.1. Allocate health care resources for optimal patient care.

• HA 1.2. Work with patients and their families to increase opportunities to adopt healthy behaviours

• S 3.3. Critically evaluate the integrity, reliability, and applicability of health-related research and literature

• P 1.1. Exhibit appropriate professional behaviours

• P 2.1. Demonstrate accountability to patients, their families, society, and the profession by responding to societal expectations of physicians.

Context Variables

No context variables defined.

Requirements

• Direct observation and review of clinical documentation by supervisor
• Timing: emergency; elective
• Type of surgery: general surgery; urology; otolaryngology; orthopedic surgery; plastic surgery; ophthalmology; dental surgery; other surgery
• Patient comorbidity: cardiovascular disease; endocrine disorders; respiratory disease, obstructive sleep apnea (OSA), neuromuscular and musculoskeletal disease, neurological diseases; hematological disorders; infectious diseases; none
• Type of anesthesia; general; neuraxial; regional; MAC
• Patient age:
• Collect observations from a large breadth of training experiences including different types of procedures and patient comorbidity with the expectations not all will be achieved, with a minimum of 5 observations of achievement
• At least two patients under the age of three
• For achievement, the complexity of cases should be in line with what is expected to be managed by an anesthesiologist who does not have pediatric anesthesiology training. However, observations should also be completed for more complex cases.