Anesthesiology

Criteria for Clinical Competency of Anesthesia Residents
Medical College of Wisconsin Affiliated Hospitals

End of first 6 Months, CA-1 Year

Knowledge

• Understand basics of anesthesia machine and routine monitors (pulse oximetry, capnography, circuits, oscillometric blood pressure cuffs, and electrocardiogram)
• Understand basics of neuromuscular blockade (relaxants, train-of-four monitoring, reversal)
• Understand use of routine vasoactive drugs
• Understand the indication for commonly used anesthetic drugs
• Understand major hemodynamic and respiratory effects of routine anesthetic agents and their indications
• Understand comprehensive examination and classification of the airway
• Understand key preoperative findings in history, physical, and laboratory work
• Understand application of Universal Precautions and aseptic technique
• Advanced Cardiac Life Support (ACLS) certification

Case management

• Manage ASA physical status 1 patients with minimal assistance for uncomplicated surgery, including induction, maintenance, emergence, and transport to the post anesthesia care unit
• Accurately estimate fluid (blood/colloid/crystalloid) requirements in routine cases
• Identify basic intraoperative problems (hyper-/hypotension, hypoxia, hypercapnia, arrhythmias, anuria, acidosis, laryngospasm) and formulate differential diagnoses and treatment plans
• Recognize key anatomic landmarks, indications/contraindications, and potential complications of regional blocks (spinal, epidural, intrascalene, axillary, femoral, sciatic, popliteal, ankle)

Technical skills

• Set up a case in reasonable time (machine check, drugs, airway equipment)
• Ventilate lungs via mask, and tracheal intubation of patients with easy to moderately difficult airways
• Place peripheral intravenous, arterial, and central catheters with minimal assistance
• Perform aforementioned regional blocks on suitable patients with assistance
• Keep legible and accurate intra-, pre- and postoperative records
• Operate basic technical monitors and pressure transducers and trouble-shoot simple technical malfunctions

Oral skills

• Communicate effectively with patients
• Deliver concise, organized case presentation to staff that includes important pre-anesthetic concerns
• Formulate and describe in detail a plan for anesthetic management of ASA physical status 1-3 patients including anticipated problems and their solutions

Clinical Competency Criteria Checklist has been implemented for all CA-1s to have a faculty member check off specific tasks that have been completed within the first 6 months of their CA-1 yr.  This will be filed in their permanent file for future review.

End of CA-1 Year

Knowledge

• Understand physiology of significant cardiovascular events (compression of vena cava by surgeons, hypovolemia, hypervolemia, pulmonary embolism, ischemia, myocardial depression)
• Understand aspects of neuroanesthesia (management of increased intracranial pressure for craniotomy), vascular anesthesia (changes with aortic cross clamp), and orthopedic anesthesia (fat emboli)
• Understand choice of regional versus general anesthesia and need for selective invasive monitoring
• Understand basics of obstetric anesthesia (physiologic changes of pregnancy, techniques for cesarean section, special precautions)
• Understand how to obtain and apply information from a pulmonary artery catheter

Case management

• Manage, under supervision, patients with difficult airways who are undergoing elective surgery
• Perform emergency airway management with reasonable skill (rapid sequence vs. awake intubation) in the operating room and the intensive care unit
• Manage ASA physical status 3 patients for uncomplicated surgery with assistance
• Initiate management of trauma cases and other emergencies in proper sequence (airway, intravenous access, monitoring)
• Manage Cesarean section by general or regional anesthesia with assistance
• Manage patients in the post anesthesia care unit with assistance (assure adequacy of airway or adjust ventilation; manage pain, hemodynamics and fluids; and determine readiness for discharge)
• Develop and implement a rational plan for tracheal intubation of patients in the intensive care unit

Technical skills

• Insert central and arterial catheters independently most of the time
• Insert a pulmonary artery catheter with direction
• Perform spinal and lumbar epidural anesthesia without assistance in most patients
• Perform fiber optic or awake tracheal intubation with assistance

Oral skills

• Cogently discuss management plan with anesthesiology staff or surgeon for ASA physical status 3 patients
• Defend choice of monitoring
• Defend choice of anesthetic technique and drugs used with discussion of options
• Recognize when to proceed, investigate further, or cancel a case
• Participate actively in teaching medical students

End of CA-2 Year

Knowledge

• Understand physiology and anesthetic concerns associated with pediatric anesthesia
• Understand obstetric syndromes and their anesthetic implications
• Understand routine open-heart procedures, including prebypass, bypass, and separation from cardiopulmonary bypass
• Indepth understanding of the pharmacology of a variety of vasoactive and anesthetic drugs in depth
• Perform emergency airway maneuvers, including cricothyroidotomy

Case management

• Manage medical diseases in surgical patients (pulmonary, cardiovascular, hepatorenal, endocrine)
• Manage routine pediatric, vascular, thoracic, and neurosurgical cases with assistance

Technical skills

• Perform spinal and lumbar epidural anesthesia in patients with extremes of body habitus
• Insert peripheral intravenous catheters in pediatric patients older than 2 yr
• Perform a variety of regional blocks with frequent success
• Insert a pulmonary artery catheter with minimal assistance
• Assemble and calibrate transducers without assistance
• Manage acute postoperative pain (patient-controlled analgesia, continuous infusions of epidural opioids and/or local anesthetics)

Oral skills

• Cogently discuss management plan with attending and surgeon for ASA physical status 4 patients
• Review literature and participate in discussions for Journal Club
• Perform reasonably on oral board-style examinations
• Lecture to faculty and residents at teaching conferences
• Actively teach medical students
   

End of CA-3 Year

Knowledge

• In depth understanding of the principles of all major subspecialties (ambulatory, cardiac, critical care, endocrine, neurosurgical, obstetrics, pediatrics, acute and chronic pain, thoracic, trauma, vascular)
• Know and address important articles in recent literature

Case management

• Manage independently, with staff availability:
  • ASA physical status 4 patients with multisystem diseases for complex elective or emergency surgery
  • Acute and chronic pain
  • Recovery room care

Technical skills

• Perform all aforementioned anesthetic and invasive monitoring procedures independently

Oral skills

• Attain the qualities and attributes fundamental to performance as a consultant anesthesiologist (according to the American Board of Anesthesiology):
  • Ability to organize and express thoughts clearly
  • Sound judgment in decision-making and application
  • Ability to apply basic science principles to clinical problems
  • Adaptability to rapidly changing clinical conditions
• Supervise and mentor medical students
• Participate actively in teaching fellow residents