1. Course Guide JH Aug 2011

2.  Introduction  Welcome  The roles of the Anesthesiologist  Orientation  Hours of attendance  Code of conduct  Learning Resources  Objectives

3.  This is a guide for the Undergraduate Electives Course in Anesthesia.  Its purpose is to provide a course outline for students and tutors.  By creating a structured approach we hope to provide a consistent experience for students learning the basics of anesthesia.

4.  Welcome to this two week introduction to Clinical Anesthesiology.  During your short exposure to this specialty we hope to give you some idea of the true scope of anesthesia; it encompasses many areas of medicine as well as clinical physiology and pharmacology.  Anesthesiologists learn to use technical and analytical skills to look after patients in many situations – some are routine and others very challenging.  Anesthesiologists must also hone their humanitarian skills, since patients coming to the OR are often at their most vulnerable.  The course will be relevant to many medical specialties and is not solely aimed at students considering anesthesia residency.

5. During this rotation you will see that the Anesthesiologist has many roles to fulfill. The Royal College of Physicians and Surgeons encourages physicians in clinical and academic practice to strive for excellence in all of these roles.

6.  There are currently three sites for elective placement.  Please click on your assigned site(s) for orientation information:  Health Sciences OR  St. Clare’s OR  Janeway Child Health OR

7.  If after reviewing the orientation package for your site you are still unclear regarding the location, please contact the administrative assistant at that site prior to the first day.  On the first day you should go to the main OR desk of your rotation site to meet with the site coordinator. You will be given access to a locker and a brief orientation to the site. Instructions and materials that are not already available on D2L will be provided then also.

8.  Students will be expected to report to their assigned sites at 07:45 Monday- Friday of the rotation.  Students will generally be dismissed by 16:00, but this may vary depending on the assigned list.  Students will be expected to attend M&M/resident rounds on Tuesday mornings from 07:00- 08:30 in lecture theatre A at the MUN medical school.  Students will be required to attend anesthesia academic half day on Thursday afternoon from 13:00- 16:00.  If you are going to be absent or late on any day of your rotation, you will need to notify the site coordinator in advance or by phone on the day of absence with a reasonable excuse. If you are absent on multiple occasions this will be reflected in your evaluation. (Medical absence will be accepted with a doctor’s note)

9.  Professionalism and Respectful Workplace  All students are expected to demonstrate respect for the patients and staff encountered during the rotation.  We also expect all students to be treated with respect during their rotation.  Eastern Health has clear policies regarding: Maintenance of patient confidentiality. Mutual respect in the workplace.  If you have concerns regarding lapses in these areas, please address them with your site coordinator.

10.  Professionalism cont’d  Attendance and punctuality are mandatory.  Students are expected to be aware of the limitations of their role in the operating room and to be diligent in the OR environment.

11.  Dress code  When in the OR, students must respect the rules of the sterile environment and wear greens, mask, gloves and booties.  If you have not previously been in the OR, please notify us so we can make you aware of appropriate protocol.  You are expected to bring your stethoscope to the OR. Other medical instruments are not mandatory.

12.  Exposure to anesthesia learning in the following areas:  Adult OR  Pediatric OR  Teaching at the bedside in the OR:  Clinical teaching modules to cover basic anesthesia knowledge.  Enabling objectives for technical skills.  Case based clinical teaching  Independent learning:  Reference material- texts and web-based  Simulator based learning:  Low and high fidelity simulation to facilitate technical skills, crisis resource management, and critical anesthesia events.  Didactic learning:  Attendance at M&M/ resident lecture rounds  Attendance at anesthesia academic half day.

13.  The CANMEDS objectives will be promoted in conjunction with the teaching objectives of the course. (Not all CANMEDS objectives will be applicable)  By the end of the rotation the technical, academic and clinical objectives described in the following pages should have been covered either through clinical teaching or independent learning.

14.  Technical skills: These are listed in table format and should be documented during the course of the elective. This table is included in your daily log.  An attempt has been made to correlate this list with the required clerkship list.  Note the skills that are required to be performed as opposed to those that may be observed only.

15.  Academic and Clinical skills:  Preoperative evaluation and clinical skills  Airway and ventilation  Fluid and volume resuscitation, electrolyte balance and acid-base  Pharmacology of anesthetic drugs  Principles of general anesthesia  Principles of regional anesthesia  Pain management  Monitoring in anesthesia  Intra operative management and problems  Post operative management

16.  Students should be able to:  Obtain a relevant medical, surgical and anesthetic history and perform a focused pre-operative examination on the patient. ( Airway assessment, and awareness of factors predisposing to difficult intubation are of particular importance.)  Provide a summary of pre-operative assessment and formulate a relevant problem list.  Have some understanding of the indications for both routine and special pre-operative investigations.  Understand the basis of an anesthetic plan and how it relates to the clinical work-up of the patient, and the ASA classification of pre-operative physical status.

17.  Know the anatomy of the airway and basic airway assessment.  Be familiar with the various techniques of airway management and equipment involved in routine and difficult intubation.  Review basic respiratory physiology in the context of anesthesia.  Be familiar with the principles of manual and mechanical ventilation.

18.  Know the main principles of:  Fluid replacement and volume resuscitation (crystalloid, colloid, blood transfusion)  Electrolyte and acid-base balance

19.  Have a basic knowledge of the pharmacokinetic and pharmacodynamic principles of drugs commonly involved in anesthesia including:  Intravenous agents (sedative/ hypnotics, narcotics, muscle relaxants)  Volatile agents.  Local anesthetics

20.  Understand the principles of general anesthesia and the delivery of volatile anesthetics.  Have a basic understanding of the structure, function and safety features of the anesthesia machine.

21.  Be familiar with the concept of local and regional anesthesia and commonly used local anesthetic agents.  Be familiar with perioperative pain management techniques and drugs.

22.  Be familiar with the major CAS (Canadian Anesthesiologists’ Society) monitoring standards and be able to interpret basic information gained from the monitoring of:  Blood pressure  Pulse oximetry  ECG  Capnography  Ventilation (parameters, spirometry)  Temperature  Invasive pressure monitoring ( CVP, arterial line)

23.  Gain an appreciation for the basic management of common intra-operative problems such as:  Hypoxia, hypercarbia,  Hyper/hypotension, cardiac arrhythmias,  High and low airway pressure alarm.  Have an understanding of the requirements for safe emergence from general anesthesia and common problems and complications in the PORR.  Post –op nausea and vomiting, pain etc.