ANEU-4001 - Clinical Anesthesiology

ANEU-4001 - Clinical Anesthesiology

Elective Title: Clinical Anesthesiology
Course Number: ANEU-4001
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2-3
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Sarah Shabot, MD Periods Offered: 1-7; 9-13 excluding holiday period 8 
Coordinator: Kathryn Gwinn Other Faculty:
Location to Report on First Day:
Anesthesia Dept. Peaches & Shrub Kempner Classroom 5.510 Jeanie Sealy Hospital, Kathryn Gwinn

1. To provide an understanding of the principles of perioperative medicine needed to identify and manage physiological perioperative stress as related to surgical and anesthetic interventions and modified by coexisting disease.
2. To help develop skills relating to perioperative procedures of airway management and vascular access.
3. To provide an understanding of the principles and components of clinical anesthesia needed to provide insensibility, analgesia, amnesia, and immobility.

Students will learn airway management, intubation techniques, start IVs, and deliver anesthetics under supervision.

Description of course activities
At orientation students are loaned textbooks, "Basics of Anesthesia" by Stoelting and Miller and "Anyone Can Intubate: a practical step-by-step guide for health professionals" by Christine E. Whitten.and given a schedule of reading assignments for the rotation. Students are assigned to faculty or residents on a weekly basis. They are also assigned to one week Shriners Hospital. Students actively participate with the resident or faculty in perioperative management of surgical patients. Typically students arrive at the hospital at 0615-0630 for OR preparation prior to attendance at daily departmental Grand Rounds at 0645 hours held in the Peaches & Shrub Kempner classroom 5.510. Students also participate in simulator exercises for airway management. No night or weekend calls.

Type of students who would benefit from the course
This rotation is not designed solely for those interested in an anesthesiology residency. Nearly all physicians will care for patients who will need to undergo anesthesia for surgical procedures. It is important for these physicians to understand the perioperative stresses involved and what is needed to prepare patients in order to reduce their risk of complication. In addition, knowledge and skills gained are valuable in diagnosis and treatment of patients in need of emergent resuscitation (airway, breathing, and circulation).

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6:15 4:00
Tuesday 6:15 4:00
Wednesday 6:15 4:00
Thursday 6:15 4:00
Friday 6:15 4:00
Saturday n/a n/a

 Average number of patients seen per week: 15
 Call Schedule: None

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Residents, Fellows, Faculty one-on-one during cases.
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Attendance at daily Grand Rounds lectures, resident lectures, journal club, and twice weekly student lecture. Daily presence in the operating room for participation in pre-intra and postoperative patient management of the surgical patient during anesthesia.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Students are given a Technical Skills Check List. They are required to complete the five hands-on skills and obtain the resident or faculty`s signature.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.