ANEU-4005 - Acting Internship in Anesthesiology - Galveston

ANEU-4005 - Acting Internship in Anesthesiology - Galveston

Elective Title: Acting Internship in Anesthesiology - Galveston
Course Number: ANEU-4005
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: C-form required - Clinical Anesthesiology (ANEU-4001), Cardiothoracic Anesthesiology (ANEU-4007), Anesthesiology Career Paths (ANEU-4023), or Clinical Preceptorship (ANEU-1050) Experience. Off campus elective (Methodist - ANEU-4403) will also be accepted.
Responsible Faculty Director: Adam Wacher MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Kathryn Gwinn Other Faculty:
Location to Report on First Day:
Anesthesia Dept. 5th floor Jennie Sealy Hospital Kathryn Gwinn

1. The student will gain skills and knowledge required to function at the level of a beginning anesthesiology intern.
2. The student will understand the principles of preoperative patient evaluation; including decisions regarding laboratory investigation and consultation, implications of chronic medical disease, & elements of a directed H&P.
3. The student will personally administer perioperative anesthesia care with close supervision, beginning with preoperative assessment, equipment preparation, intraoperative management and postoperative stabilization and pain control.
4. The student will become familiar with the management of acute circulatory and respiratory adverse events.

The student will:
1. Personally conduct in consultation with faculty the preoperative evaluation of their patients and assign ASA physical status.
2. Discuss basic principles and techniques of general and regional anesthesia, including risks and benefits of various techniques.
3. Identify specific agents used for induction and maintenance of anesthesia and discuss their advantages and disadvantages (IV agents, Inhalational agents, Neuromuscular blocking agents).
4. Demonstrate basic airway management techniques, including airway evaluation, mask ventilation & direct laryngoscopy.
5. Demonstrate skill at establishing venous access.
6. Discuss indications, techniques and limitations of noninvasive and invasive monitoring.
7. Calculate maintenance and replacement IV fluid requirements for the perioperative period.
8. Demonstrate knowledge of assessment and management of postop pain.

Description of course activities
Students will be given the manual prepared for interns entering the department of Anesthesiology, course syllabus, handouts and loaned textbooks: Basics of Anesthesia, by Stoelting and Miller; Anyone Can Intubate: a practical step-by-step guide for health professionals by Christine E. Whitten. Students will be responsible for doing the preoperative evaluation of the patients whom he or she will care for. He or she will discuss these evaluations with the appropriate faculty or resident in advance and formulate the anesthetic plan. In most cases students will personally perform under supervision all airway interventions, placement of vascular access and regional anesthesia for the patients he or she is assigned. Students will typically arrive at 0600 to 0615 for OR preparation and have overnight call once a week in weeks 2,3, & 4 of the elective with post-call day off.

Type of students who would benefit from the course
This course is a more comprehensive, intense follow-up experience in anesthesiology, building on skills and knowledge obtained in a 3rd or 4th year Clinical Anesthesiology Elective. The design and purpose of this elective is to be of value to the student who desires an intense, hands on experience in anesthetic management of patients. This should be of particular value to the student interested in anesthesiology or fields which involve interactions with anesthesiologists. The course will emphasize the evaluation and management of adult patients undergoing a variety of procedures, from simple to complex.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 0615 4:30
Tuesday 0615 4:30
Wednesday 0615 4:30
Thursday 0615 4:30
Friday 0615 4:30

 Average number of patients seen per week: 15
 Call Schedule: max one call per week

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time varies
Self-Directed Study 0
Data-Collection/Analysis 0
Other 0

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?
    Students have continuous close clinical supervision by faculty or senior residents in the OR. Each procedure, induction, emergence is observed/supervised by anesthesiology faculty.
  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?
    not required
  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)?
    Daily pre-op H&P, anesthetic record, post-op notes.
  B. Format - What guidelines are set for the student's written work?
    Medical Records guidelines.
  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)?
    Students are expected to attend daily morning lectures attended by anesthesiology residents, monthly journal club and grand rounds. Students may be asked to do case related reports or journal searches.

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.
    1. Daily management of surgical patients in the operating room with one-to-one supervision and observation by anesthesia faculty and residents.
2. Written evaluation by supervising anesthesia residents reviewed by course director.
3. Pass/Fail for course determined by course director and entered by course coordinator.

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.
    1. Procedural skill feedback is face-to-face at time skill is practiced.
2. Review of written medical records.

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.
    1. Airway management, mask ventilation
2. Direct laryngoscopy
3. Peripheral IV insertion
4. Placing and basic interpretation of monitors (EKG, pulse oximetry, automated BP, ET CO2)
5. Directed H&P for pre-anesthetic assessment.
6. Sterile technique.
7. Preparation and administration of IV medications.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    1. Central Line placement
2. Arterial Line placement
3. Ventilator management (basic)

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)?
    PGY1 is clinical base (internship). Anesthesiology AI students have responsibilities similar to new PGY2 anesthesiology resident learning patient pre-op assessment, basic airway management skills and anesthesia techniques. AI will attend same didactics as residents. Responsibilities differ in that AI will have one-on-one direct supervision by resident or faculty in the OR at all times.

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?
    This course will expose student to daily activities and expectations for an anesthesiologist to determine if this specialty is a good fit. In addition, procedural skills such as airway management and IV skills are useful for most fields of medicine as an intern.

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?
    Midpoint feedback will be provided to student by course director in a face-to-face feedback session. Student and course director will develop appropriate remediation plan together if indicated.

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.
    Anesthesiology faculty present in the OR vary daily based on assignments. The AI can anticipate working with 5-10 faculty over the month. Great latitude is given the AI in choosing the daily assignments (whether OR or also rotating to OB, Pain Clinic, Shrine, etc.). While the AI may choose to follow a single faculty as much as possible, the student often prefers choosing assignments based on opportunity the case provides for learning or procedures. Faculty in the OR closely supervise 2 rooms and are present for induction, procedures, and emergence from anesthetic. The AI will work closely with the resident assigned to the room for the day.