Anesthesia — Core of Discipline

C9 Assessing, investigating, optimizing and formulating anesthetic plans for more complex pediatric cases

- This EPA focuses on preoperative assessment and its use in identifying and prioritizing anesthetic considerations, as well as the optimization and preparation of the patient for surgery
- This EPA includes the communication skills of obtaining informed consent in pediatric population.
- This EPA includes comprehensive documentation in the medical record
- The case may be considered complex due to either the patient having multiple medical co-morbidities or the procedure involving complex management (e.g. scoliosis surgery, pediatric lung isolation, multiple procedures in different locations, procedures with the potential for massive blood loss, etc.)
- This EPA may be observed in children under the age of one, but this is not required

Form

F1: Observation

Milestones

• ME 1.3. Apply clinical and biomedical sciences to manage perioperative assessment in complex patients

• ME 1.4. Perform clinical assessments that address the breadth of issues in each case.

• ME 2.2. Select and interpret appropriate preoperative investigations based on the planned procedure and patient’s comorbidities

• ME 2.2. Synthesize patient information to determine the most appropriate anesthetic management plan

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

• ME 2.2. Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan

• ME 2.3. Share concerns, in a constructive and respectful manner, with patients and their families about their goals of care when they are not felt to be achievable

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

• ME 3.2. Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy

• ME 4.1.2. Determine the need and timing of consultation with other specialists

• COM 1.1. Communicate in a manner that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion

• COM 1.4. Respond to patients’ non-verbal communication and use appropriate non verbal behaviours to enhance communication with patients

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

• COM 2.1. Actively listen and respond to patient cues

• COM 1.5. Manage the flow of challenging patient encounters, including those withangry, anxious or distressed individuals

• 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

• 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

Context Variables

No context variables defined.

Requirements

• Direct or indirect observation and review of clinical documentation by supervisor
• Type of observation: direct; indirect
• Type of comorbidity: cardiovascular disease; endocrine disorders; respiratory disease; obstructive sleep apnea (OSA); neuromuscular and musculoskeletal disease; neurological diseases; hematological disorders; infectious diseases
• Type of surgery: general surgery; urology; otolaryngology; orthopedic surgery; plastic surgery; ophthalmology; dental surgery; other surgery
• Patient age:
• Location: preop clinic; ward; OR
• 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 3