ANAESTHESIOLOGY

DEFINITION:Anesthesia is a medical specialty which includes patient assessment and provision of life support, amnesia, and analgesia for both surgical procedures and childbirth; assessment and management of critically ill patients; and the assessment and management of patients with acute and chronic pain.

GENERAL OBJECTIVES:Upon completion of training, a resident is expected to be a competent specialist anesthesiologist, capable of assuming a consultant's role in the specialty. The specialist must acquire a working knowledge of the theoretical basis of the specialty, including its foundations in the basic medical sciences and research. Training must also encompass the provision of anesthesia services for all age groups in varied clinical situations. Performance must, therefore, reflect the anesthesiologist's knowledge of surgery, intensive care and resuscitation, the management of acute and chronic pain and includes assessment and provision of appropriate care of the mother and neonate in obstetrics. The resident must demonstrate a thorough knowledge of how perioperative management should be modified in the presence of concurrent medical problems.

SPECIFIC OBJECTIVES:On completion of program, the consultant will have acquired the following competencies and will function effectively as:

Medical Expert/Clinical Decision-maker

General Requirements

• Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
• Access and apply relevant information to clinical practice.
• Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements

• Demonstrate knowledge of the basic sciences as applicable to anesthesia, including anatomy, physiology, pharmacology, biochemistry and physics.
• Demonstrate knowledge of general internal medicine with particular reference to the cardiovascular, respiratory, renal, hepatic, endocrine, hematologic and neurologic systems.
• Demonstrate knowledge of age related variables in medicine as they apply to neonatal, pediatric, adult and geriatric patient care.
• Demonstrate knowledge of the principles and practice of anesthesia as they apply to patient support during surgery or obstetrics.
• Demonstrate clinical skills necessary for basic resuscitation and life support as practiced in critical care facilities.
• Demonstrate knowledge of the principles of management of patients with acute and chronic pain.
• Demonstrate knowledge of the role of the consultant anesthesiologist in the provision of safe anesthetic services within both community and teaching facilities.
• Demonstrate clinical skills necessary for the independent practice of anesthesia, including preoperative assessment, intraoperative support and postoperative management of patients of any physical status, all ages and for all commonly performed surgical and obstetrical procedures.
• Demonstrate clinical skills necessary to general internal medicine and intensive care including the ability to investigate, diagnose, and manage appropriately factors that influence a patient's medical and surgical care.
• Recognize that prior to provision of anesthetic care specific medical intervention and modification of risk factors may be required.
• Demonstrate competence in all technical procedures commonly employed in anesthetic practice, including airway management, cardiovascular resuscitation, patient monitoring and life support, general, and regional anesthetic and analgesic techniques and postoperative care.
• Demonstrate knowledge of basic legal and bioethical issues encountered in anesthetic practice including informed consent.

Communicator

General Requirements

• Establish a professional relationship with patients and families.
• Obtain and collate relevant history from patients, and families.
• Listen effectively.
• Discuss appropriate information with patients and families and other members of the health care team.

Specific Requirements

• Demonstrate consideration and compassion in communicating with patients and families.
• Provide accurate information appropriate to the clinical situation.
• Communicate effectively with medical colleagues, nurses, and paramedical personnel in inpatient, outpatient, and operating room environments.
• Demonstrate appropriate oral and written communication skills.
• Ensure adequate information has been provided to the patient prior to undertaking invasive procedures.

Collaborator

General Requirements

• Consult effectively with other physicians and health care professionals.
• Contribute effectively to other interdisciplinary team activities.

Specific Requirements

• Demonstrate ability to function in the clinical environment using the full abilities of all team members.

Manager

General Requirements

• Utilize personal resources effectively in order to balance patient care, continuing education, and personal activities.
• Allocate finite health care resources wisely.
• Work effectively and efficiently in a health care organization.
• Utilize information technology to optimize patient care, and life long learning.

Specific Requirements

• Demonstrate knowledge of the management of operating rooms.
• Demonstrate knowledge of the contributors to anesthetic expenditures.
• Demonstrate knowledge of the guidelines concerning anesthetic practice and equipment.
• Record appropriate information for anesthetics and consultations provided.
• Demonstrate principles of quality assurance, and be able to conduct morbidity and mortality reviews.

Health Advocate

General Requirements

• Identify the important determinants of health affecting patients.
• Contribute effectively to improved health of patients and communities.
• Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements

• Provide direction to hospital administrators regarding compliance with national practice guidelines and equipment standards for anesthesia.
• Recognize the opportunities for anesthesiologists to advocate for resources for chronic pain management, emerging medical technologies and new health care practices in general.

Scholar

General Requirements

• Develop, implement, and monitor a personal continuing education strategy.
• Critically appraise sources of medical information.
• Facilitate learning of patients, students, and other health professionals.
• Contribute to the development of new knowledge.

Specific Requirements

• Develop criteria for evaluating the anesthetic literature.
• Critically assess the literature using these criteria.
• Describe the principles of good research.
• Using these principles, judge whether a research project is properly designed.

Professional

General Requirements

• Deliver highest quality care with integrity, honesty and compassion.
• Exhibit appropriate personal and interpersonal professional behaviours.
• Practice medicine ethically consistent with the obligations of a physician.

Specific Requirements

• Periodically review his/her own personal and professional performance against national standards.
• Include the patient in discussions concerning appropriate diagnostic and management procedures.
• Respect the opinions of fellow consultants and referring physicians in the management of patient problems and be willing to provide means whereby differences of opinion can be discussed and resolved.
• Show recognition of limits of personal skill and knowledge by appropriately consulting other physicians and paramedical personnel when caring for the patient.
• Establish a pattern of continuing development of personal clinical skills and knowledge through medical education.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in the specialty. The program must be organized such that residents are given graded responsibility, under appropriate supervision, according to their level of training, ability and experience.

The content and organization of each accredited program in anesthesia must be consistent with the specialty training requirements.

Each accredited program in anesthesia must be organized so that each resident is given appropriate graded responsibility. In anesthesia this will be through increasing independence and responsibility under appropriate supervision progressing to the level of senior resident at which time he or she will demonstrate a level of knowledge, clinical skills, technical skills and attitudes consistent with independent consultant practice.

In addition to offering the components noted in the specialty training requirements all accredited programs in anesthesia must offer an elective community-based learning experience.

RESOURCES: There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in anesthesia.

In those cases where a university has sufficient resources to provide most of the training in anesthesia but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

1. Teaching Faculty
   1. There must be a sufficient number of qualified and dedicated teaching staff to supervise residents at all levels and in all aspects of anesthesia and provide teaching in the basic and clinical sciences related to anesthesia.
   2. There must be an adequate number of qualified teaching staff to provide for training in regional anesthesia and analgesia, diagnostic and therapeutic nerve blocks, and the management of pain.
   3. There must be a faculty member whose responsibility it is to facilitate the involvement of residents in research.

2. Number and Variety of Patients

There must be a sufficient number and variety of patients available to the program to provide each resident registered in the program with the opportunity to meet the following specific objectives:

1. to permit residents to be exposed to the provision of anesthesia services across all age groups and over the full range of surgical specialties including cardiac surgery, general surgery, major head and neck surgery, multiple trauma, neurosurgery, obstetrics and gynecology, orthopedic surgery, ophthalmology, otolaryngology, plastic surgery, thoracic surgery, urology, and vascular surgery;
2. to provide for training in regional anesthesia and analgesia, diagnostic and therapeutic nerve blocks, and the management of pain;
3. to provide a broad experience for residents in consultations on the perioperative management of patients of all ages and physical status, in both elective and emergency situations, and in the fields of cardiorespiratory support and pain relief;
4. to provide experience in adult internal medicine and those subspecialties of particular importance to the anaesthetist. These may include cardiology, respiratory medicine, neurology, hematology, nephrology, endocrinology and metabolism, and infectious diseases;
5. to provide opportunity for residents to manage critically ill patients in a variety of critical care settings embracing adult, pediatric and perinatal patients, including those who have sustained multiple trauma;
6. to provide broad training in anesthesia for emergency operations of a major nature;
7. to provide training in the anesthetic management of patients for ambulatory surgery.
2. Organization of Resources
   1. Clinical Resources
      1. In-patient Services

There must be:

• well equipped and adequately staffed operating and recovery rooms;
• an accredited residency program in internal medicine and a liaison which ensures that rotations arranged for anesthesia residents are appropriately structured;
• an anesthesia consultation service which provides clinical risk assessment and perioperative management of patients in both elective and emergency situations;
• a consultation service and facilities for the management of chronic pain;
• intensive care units organized for teaching with an appropriate level of responsibility under expert supervision, where constant attention is paid to the particular educational needs of the resident in anesthesia;
• ready access to all appropriate laboratory facilities.

There should be:

• a consultation service and facilities for the management of acute pain.
1. Ambulatory Services

There must be:

• facilities for ambulatory surgery;
• a consultation service or clinic for the preoperative assessment of patients for ambulatory surgery and same-day admission.
2. Community Experiences

Each accredited program in anesthesia must offer an elective opportunity for each resident to have experience in the anesthesia as practised in a community hospital.

2. Supporting Facilities and Services

There should be:

• active services in general surgery, obstetrics and gynecology, pediatrics and diagnostic radiology.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Service demands must not seriously interfere with the ability of the residents to follow the academic program.

The educational program must provide opportunities for residents to learn and demonstrate:

1. Basic and clinical sciences relevant to anesthesia

Knowledge

• of the basic sciences as applicable to anesthesia, including anatomy, physiology, pharmacology, biochemistry and physics;
• of internal medicine with particular reference to the cardiovascular, respiratory, renal, hepatic, endocrine, hematologic and neurologic systems;
• of age-related variables in medicine as they apply to neonatal, pediatric, adult and geriatric patient care;
• of the principles and practice of anesthesia as they apply to patient support during surgery or obstetrics;
• of the basics of resuscitation and life support as practised in critical care facilities;
• of the principles of management of patients with acute and chronic pain; of the role of the consultant anesthetist in the provision of safe anesthetic services within both community and teaching facilities;
• of the indications for laboratory studies and their interpretation;
• of the physics and mechanics of anesthetic equipment and its care and maintenance;
• of inhalation therapy and electrical safety.

The Clinical Skills

• necessary to the independent practice of anesthesia, including preoperative assessment, intra-operative support and post-operative management of patients of all physical statuses, all ages and for all commonly performed surgical and obstetric procedures;
• necessary to general internal medicine and intensive care including the ability to investigate, diagnose, and manage appropriately factors that influence a patient's medical and surgical care.

The Technical Skills

• necessary to provide competence in all procedures commonly used in anesthetic practice, including airway management, cardiovascular resuscitation, patient monitoring and life support, general and regional anesthetic and analgesic techniques and post-operative care.

Judgmental Skills

• to select the anesthetic management appropriate to the clinical situation and the ability to recognize one's personal, professional and practical limitations to safe anesthetic practice.

2. Biomedical ethics
   • an understanding of the ethical and medical-legal requirements and responsibilities of the practice of anesthesia;
   • a compassionate interest in and overall understanding of the patient.
3. Communication skills, including teaching
   • the ability to communicate effectively with the patient, the patient's family, colleagues and the whole patient care team;
   • the ability to function as a member of the health care team;
   • the ability to teach, including patients, health care staff, junior colleagues and peers.
4. Quality assurance/improvement
   • an understanding of the principles and their application relating to the improvement of quality of care and resource utilization;
   • an understanding of the obligation of continuing self-education and the teaching of others.
5. Research, including critical appraisal of the literature
   • an appreciation of the role of research in the critical analysis of scientific developments related to the specialty.

SPECIALTY REQUIREMENT:

Approved residency training including:

1. Basic clinical training.
2. Approved training including:
   1. Approved resident training in anesthesia.
   2. Approved resident training in general internal medicine

PROGRAMS (WITH TRAINING REQUIREMENTS):

Diplomas(Dip):

Six months of approved residency training.

Doctor of Medicine(M.D):

Eighteen months of approved residency training.

Doctor of Philosophy(Ph.D):

Forty eight months(four years)of approved residency training.