Anesthesia — Foundation of Discipline

F6a Anticipating, preventing and managing common or expected intraoperative events and physiologic changes during non-complex cases

Key Features:
- The observation of this EPA is divided into two parts: patient care; reflection on
patient safety.
- This EPA focuses on
o Recognition and independent management of common or anticipated intraoperative events such as hypo/hypertension, tachycardia, bradycardia, bronchospasm, hypoxemia, ischemia, circuit disconnection, patient awareness and effects of medications (Part A)
o Broader thinking around system issues contributing to adverse events and how patient safety could be improved (Part B). The observation of the reflection on patient safety is based on the resident’s submission to a supervisor of a description of a patient safety incident or near miss, reflecting on contributing factors, potential improvements to enhance patient safety, and the intrinsic CanMEDs roles (professional, collaborator, communicator, health advocate, leader, and scholar). This must include debriefing the reflection with the supervisor.
Relation with other EPAs: This EPA builds on knowledge and skills demonstrated through completion of EPA TTD «monitoring adult patients»

Form

F1: Observation

Milestones

• ME 1.4. Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance

• ME 2.4. Develop and implement initial management plans

• ME 4.1. Establish appropriate follow-up for common intraoperative problems

• ME 2.2. Anticipate the most likely intraoperative events and physiologic changes based on the patients’ medical history and type of surgery

• ME 2.4. Develop strategies, including optimal monitoring, to favour prevention and early diagnosis of intraoperative events and physiologic changes

• ME 3.3. Consider urgency, and potential for deterioration, in advocating for the timely execution of a procedure or therapy

• ME 3.4. Perform common procedures in a skillful, fluid, and safe manner including appropriate infection control measures and using protective equipment

• ME 5.2. Demonstrate situational awareness

• COM 5.1. Organize information in appropriate sections within an electronic or written medical record

• COM 5.1. Record intraoperative events in a complete and accurate manner

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

• COL 1.3. Apply effective communication strategies with members of the operating room team to optimize response to perioperative events in a timely manner

• COL 3.2. Summarize the patient’s issues in the transfer summary, including plans to deal with the ongoing issues

• P 1.1. Complete assigned responsibilities in a timely fashion

Context Variables

• Type of event (single-choice)
  • ischemia
  • hypoxemia
  • bradycardia
  • other event
  • tachycardia
  • bronchospasm
  • hypo/hypertension
  • patient awareness
  • circuit disconnection
  • effects of medications
• Category of event (single-choice)
  • management
  • anticipation/prevention
  • no anticipation with management
• Surgical procedure (free-text)

Requirements

• Collect a minimum of 5 observations (minimum 5)