Anesthesia — Foundation of Discipline

F2a Providing perioperative anesthetic management for non-complex cases in adult patients

Key Features:
- This EPA focuses on doing the anesthetic care in its entirety. This includes
preoperative assessment, investigation/optimization if needed, informed consent, anesthetic management, postoperative management and determination of postoperative disposition.
- This EPA is a critical task of the discipline: accordingly, the assessment plan is recurrent, rigorous, and robust – it is divided into three parts: direct observation, with formative longitudinal observation for progression; multisource feedback; and review of the breadth of clinical experience as documented in the resident’s logbook.
- This EPA can be completed for any anesthetic case. In comparison to a daily assessment form, its focus is on the performance during a specific case versus the performance during the whole day.
- This EPA should be observed in a breadth of patients and procedures. They can be ambulatory in nature or require hospital admission postoperatively, and can be urgent or emergent cases.
- Observations of this EPA should be collected each time the resident is participating in a block of time in an anesthesia training experience to gather longitudinal information on the resident’s performance both before and after achievement of entrustment.
Relation with other EPAs: This EPA builds upon the EPA on «using the anesthetic assessment to generate the anesthetic considerations and the management plan» .

Form

F1: Observation

Milestones

• ME 2.2. Perform a focused history, including a review of electronic medical records, and physical exam including regional areas where invasive procedures may be planned, review investigations, and interpret their results for the purpose of preoperative assessment and optimization of patient prior to surgery

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

• ME 3.1. Describe the indications, contraindications, risks, and alternatives for the anesthetic management of the patient

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

• ME 3.2. Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies

• ME 3.3. Determine the urgency of the procedure

• ME 2.2. Determine the patient’s readiness for surgery and judge the appropriate optimization of the emergency patient

• ME 3.4. Perform all case management skills with appropriate proficiency including adapting to unanticipated findings or changing clinical circumstances, anticipation and management of issues around induction, maintenance, emergence of anesthesia, and pain management

• ME 5.2. Use cognitive aids such as procedural checklists, structured communication tools, or care paths, to enhance patient safety

• ME 5.2. Demonstrate situational awareness

• COM 5.2. Demonstrate an understanding of the anesthetic guidelines of practice and
  their appropriate application

• COM 1.1. Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion

• COM 5.2. Communicate effectively using a written health record, electronic medical record, or other digital technology

• 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 1.1. Establish and maintain positive relationships with physicians and other colleagues in the health care professions

• COL 3.2. Provide handover of anesthetic care to the recovery unit and communicate with the receiving physicians or health care professionals during transitions in care, clarifying issues after transfer as needed

• L 4.2. Demonstrate leadership skills in the peri-operative environment including participation in “time-out” sessions

• S 1.2. Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

• S 1.2. Review post-operative patient follow-up as a source of information on one’s own performance and opportunities for learning and improvement

• S 1.2. 20 S 1.2 Identify opportunities for learning and improvement by regularly reflecting on and assessing one’s own performance using various internal and external data sources

• P 1.1. Exhibit appropriate professional behaviours

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

• P 4.1. Manage the impact of physical and environmental factors on performance and on patient well-being during anesthetic management

Context Variables

• Observation (single-choice)
  • direct
  • indirect
• Type of anesthesia (single-choice)
  • general
  • regional
  • neuraxial
  • monitored anesthesia care (MAC)
• Priority of surgery (single-choice)
  • urgent
  • elective
• Type of surgical procedure (single-choice)
  • trauma
  • urology
  • gynecology
  • ophthalmology
  • other surgery
  • otolaryngology
  • general surgery
  • plastic surgery
  • orthopedic surgery

Requirements

• Collect a minimum of 20 observations