ANEU-4007 - Cardiothoracic Anesthesiology

ANEU-4007 - Cardiothoracic Anesthesiology

Elective Title: Cardiothoracic Anesthesiology
Course Number: ANEU-4007
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Christopher K. McQuitty, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Lyndsey Phillips Other Faculty: Adam Wacher, MD; Michael Kinsky,MD; Alexis McQuitty, MD;Erin Sreshta, MD; Nukil Patel, MD
Location to Report on First Day:
Should attend Grand Rounds in the Peaches & shrub Kempner Classroom 5.510 Jeanie Sealy Hospital, at 6:45am & then report to the Anesthesia residents on CT following the lecture

To improve the students understanding of advanced hemodynamic monitoring, cardiopulmonary physiology and anesthetic implications, perioperative risk assessment, management of hemodynamic derangement, and management of postoperative thoracic pain

To gain skills and knowledge required to evaluate and manage the perioperative course of a patient with significant cardiac and/or pulmonary disease for high-risk procedures including cardiac, thoracic, and major vascular surgery. This will include:
a. Principles of preoperative evaluation of patients with severe cardiac and pulmonary disease and optimization to minimize perioperative risk.
b. Indications, techniques, and limitations of invasive hemodynamic monitoring including arterial, central venous, pulmonary artery, and transesophageal echocardiography.
c. Acute management of hemodynamic derangements by use of pharmacologic and mechanical devices.
d. Principles and techniques of airway management including lung separation.
e. Principles and techniques of general and regional anesthesia for thoracic procedures.

Description of course activities
The student (along with the assigned resident and faculty) will be responsible for the preoperative evaluation of the patients he/she is assigned to. The anesthetic plan will be discussed and formulated with the faculty and resident. The student will be performing airway, venous and arterial access procedures, central line placement, and regional anesthesia techniques for these cases. The student typically arrives at 6:00 am for initial line placement and conference attendance. Students will attend

Type of students who would benefit from the course
This course is a focused, intense experience in cardiothoracic and vascular anesthesia. The purpose of the elective is to be of value to the student who desires intense experience in the management of patients with critical cardiac and pulmonary diseases, especially in the perioperative period. This should be of particular value to those students interested in anesthesiology, cardiology, cardiac surgery, critical care medicine, and pulmonary medicine. At the conclusion of this elective, the student should understand the principles of preoperative optimization of patients, the implications of chronic and acute cardiac and pulmonary disease processes in the perioperative period, the principles and utility of advanced hemodynamic monitoring, and the management of acute cardiac and respiratory derangements in adult patients.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 6:00 4:30
Tuesday 6:00 4:30
Wednesday 6:00 4:30
Thursday 6:00 4:30
Friday 6:00 4:30
Saturday none
Sunday none

 Average number of patients seen per week: 10-12
 Call Schedule:

Research / Other Course 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?
    daily observation by faculty members
  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?
  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)?
    1. Presence at daily resident lecture and monthly journal club; the goal of which is to familiarize students with the process of journal article analysis. 2. Active participation in daily intraoperative teaching sessions - questions, reasoning skills demonstrated 3. Participation with residents in preoperative visits and procedures as well as intraoperative care

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.
    The student will be evaluated on the basis of daily interactions, teaching sessions, and discussions with faculty and residents and assessment of appropriate progression of knowledge base and clinical skills.
1. Course syllabus, loaned textbooks, A Practical Approach to Cardiac Anesthesia by F. Hensley and D. Martin.
2. Daily morning conferences attended by anesthesiology residents.
3. Weekly morning conference for cardiothoracic and vascular anesthesia residents and fellows (Friday morning).
4. Monthly Cardiothoracic and Vascular Anesthesia Journal Club.
5. Seven days home-based call.

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.