ANEU-4002 - Obstetrical Anesthesiology

ANEU-4002 - Obstetrical Anesthesiology

Elective Title: Obstetrical Anesthesiology
Course Number: ANEU-4002
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: none
Responsible Faculty Director: Allison Mullins, M.D. Periods Offered: 1-13 including holiday period 8 
Coordinator: Lyndsey Phillips Other Faculty:
Location to Report on First Day:
Report to Anesthesia Resident in L&D, 3rd floor JSH at 7:00am

See objectives

1. To prepare the medical student for the practice of medicine, regardless of specialty, by instruction in the preparation of the parturient for anesthesia.
2. To learn the basic principles and components of obstetrical anesthesia in order to provide the parturient with insensibility to pain and relief of the stress of labor and delivery.
3. To learn the basic physiology of pregnancy, labor and delivery, and to learn perinatal pharmacology of analgesia during labor and delivery.
4. To familiarize medical students with methodology, techniques, indications, and limitations of both invasive and noninvasive monitoring for interpretation and anesthetic intervention during labor and delivery for both simple and high risk parturients.
5. To recognize life threatening medical emergencies resulting in alterations in airway,breathing and circulation, for both simple and high risk parturients, during labor and delivery, obstetrical emergencies during labor and delivery, and the anesthetic management of both regional and general anesthesia for parturients so affected.
6. To learn basic principles of the resuscitation of the newborn.
7. To personally administer (optional) regional anesthesia, beginning with the preanesthetic assessment, placement of either subarachnoid and/or epidural neural blockade, for analgesia during labor and delivery and through recovery of the patient's protective reflexes.

Description of course activities
Student participation is under the direct supervision of residents and faculty. Students do not do rapid sequence general anesthesia inductions and tracheal intubations since this requires expertise and speed not usually obtainable from students. However, students will, under direct supervision of anesthesia residents and faculty, learn to do spinals and epidurals for vaginal delivery. After students have demonstrated reasonable skill, they may perform regional anesthesia for C-section patients. No night or weekend call.

Type of students who would benefit from the course
The design of this elective is to be of value to all students interested in Anesthesiology, Obstetrics and Gynecology, and Primary Care Medicine.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 7:30a.m. 4:30p.m.
Tuesday 7:30a.m. 4:30p.m.
Wednesday 7:30a.m. 4:30p.m.
Thursday 7:30a.m. 4:30p.m.
Friday 7:30a.m. 4:30p.m.

 Average number of patients seen per week: 15
 Call Schedule: No call

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time N/A
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?
    Daily, each case.
  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?
    All OB anesthesia residents and faculty members present
  B. Frequency / Duration of Presentation(s)?
    One per period
  C. Format - What guidelines are set for the student's presentation?
    Book chapter assignment
  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)?
    Each student completes 3-4 preoperative evaluations and H&P's a day. The student presents the case to the resident and then Faculty and also mostly follow the case to post operative period. Each student is also requested to keep a log of all the cases, including the procedures they were involved in.
  B. Format - What guidelines are set for the student's written work?
    format provided
  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)?
    Student lectures, journal club, daily Grand Rounds lectures. Journal club is presented on last Friday of every month, by the Senior Resident for the month. Students attend this journal club.

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.
    Each medical student is also assigned a lecture topic at the beginning of the month and they present this to OB Anesthesia group during their last week. This is usually a PowerPoint presentation of 15-20 minutes.

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.