Anesthesia — Foundation of Discipline

F1 Using the anesthetic assessment to generate the anesthetic considerations and management plan including postoperative disposition, and obtaining informed consent, for non-complex patients and non-complex surgery

Key Features:
- 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.
- This EPA includes the communication skills of obtaining informed consent. Examples include consent for general, neuraxial or other regional anesthesia, and need for blood products.
- Legibility of the chart is mandatory.
- This EPA may be observed in the preoperative clinic and/or immediately prior to
routine scheduled outpatient procedures.
Relation with other EPAs: This EPA is not about the data gathering aspect of preoperative assessments (see EPA TTD «performing preoperative assessment» that must be completed prior to this EPA). Instead, it is the interpretation of the data to identify the anesthetic considerations and to propose a management plan.
Does not apply to patients who have an anticipated difficult airway (see EPA Foundations «identifying and preparing for difficult airway») nor to pediatric patients (see EPA Foundations «performing preoperative assessment for pediatric patients»)
This EPA is a step that should be accomplished prior to the achievement of the EPA Foundations «providing perioperative anesthetic management»

Form

F1: Observation

Milestones

• ME 1.1. Demonstrate compassion for patients

• ME 1.3. Apply clinical and biomedical sciences to manage patient presentations in anesthesiology, internal medicine, and surgery

• ME 1.3. Demonstrate an understanding of common non-complex surgical procedures and how surgical requirements impact upon anesthetic management

• ME 1.5. On the basis of patient-centered priorities, seek assistance to prioritize multiple competing tasks that need to be addressed

• ME 2.2. Synthesize patient information into prioritized anesthetic considerations, including considerations relevant to the surgical procedure

• ME 2.4. Establish patient-centred anesthetic management plans, including preoperative investigations and optimization, intraoperative monitoring, use of regional anesthesia, or need for blood products, and the postoperative period

• COM 1.6. Assess patient’s capacity to understand and appreciate the issues and risks, participate in decision-making and provide informed consent

• ME 3.1. Determine the most appropriate anesthetic management in relation to patient’s condition and surgical procedure

• ME 3.2. Demonstrate knowledge of the potential risks and benefits of the procedure and/or intervention, and the specific risks for the patient

• COM 3.1. Convey information about the procedure, risks, benefits and alternatives to the patient clearly

• COM 4.3. Answer questions from the patient and family

• COM 5.1. Document informed consent for commonly performed anesthesia
  procedures and therapies

• COM 5.1. Ensure the anesthetic chart is legible and well organized

• COL 2.2. Communicate clearly and directly to promote understanding, manage differences, and resolve conflicts

• S 1.1. Recognize gaps in competencies and seek corrective solutions

• S 1.1. Accept feedback readily and incorporate suggestions for improvement

• S 1.1. Engage in self-reflection and self- assessment to improve performance

• S 3.4. Incorporate evidence-based medicine into clinical practice

• P 2.2. Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

• P 3.1. Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing consent

Context Variables

• Age of patient (free-text)
• Type of procedure (single-choice)
  • trauma
  • urology
  • gynecology
  • ophthalmology
  • other surgery
  • otolaryngology
  • general surgery
  • plastic surgery
  • orthopedic surgery
• Type of observation (single-choice)
  • direct
  • indirect
• Observation of consent (single-choice)
  • done
  • not done
• Observation of consent (language barrier) (single-choice)
  • no
  • yes
• Observation of consent (cognitive impairment) (single-choice)
  • no
  • yes
• Observation of consent (substitute decision maker) (single-choice)
  • no
  • yes

Requirements

• Collect a minimum of 8 observations (minimum 8)
• At least 3 involving consent