Society for Ambulatory Anesthesia Competency-based Curriculum for Fellowship Education in Ambulatory and Office-Based Anesthesia

    Created by SAMBA Taskforce on Ambulatory and Office –based Anesthesia:

    Chair: Shireen Ahmad, M.D.

    Members: Barbara S. Gold, M.D.; Beverly K. Phillip, M.D.; Douglas G. Merrill, M.D.;Burton S. Epstein, M.D.; Frances F. Chung, M.D.; Tong J. Gan, M.D.; Girish P. Joshi, M.D.; D. Janet Pavlin, M.D.; Jeffrey B. Brand, M.D.; Jeffrey L. Apfelbaum, M.D.; John A. Dilger, M.D.; Kathrine E. McGoldrick, M.D.; Kumar G. Belani, M.D.; Lee A. Fleisher, M.D.; Lucinda L. Everett, M.D.; Maryann Vann, M.D.; Walter G. Maurer, M.D.; Meena S. Desai, M.D.; Patricia A. Kapur, M.D.;Peter M. Glass, M.D.; Raafat S. Hanallah, M.D.; Rebecca S. Twersky, M.D.; Thomas W. Cutter, M.D.

    Approved by SAMBA Board of Directors: October, 2009

    The overarching goal of the ambulatory and office-based anesthesia fellowship is to provide the trainee with an organized, comprehensive, advanced educational experience, in ambulatory anesthesia. Training will provide opportunities to develop organizational and managerial skills necessary for administration of an ambulatory facility and to conduct of clinical research.

    Goals:

    • To become knowledgeable regarding the appropriate selection of patients for ambulatory surgery.
    • To become knowledgeable and proficient in the anesthetic management of a wide variety of ambulatory general surgery cases.
    • To have a detailed knowledge of pharmacology of anesthetic agents and their appropriate use in ambulatory surgery.
    • To become familiar with the prevention and management of common causes of unanticipated admission in ambulatory surgery.

    Objectives:
    Upon completion of ambulatory anesthesia fellowship training, the fellow will:

    • Demonstrate the ability to screen patients appropriately for ambulatory surgery with sedation / analgesia, general and regional anesthesia.
    • Demonstrate the ability to discuss the advantages and disadvantages of various anesthetic techniques with surgeon and patient.
    • Demonstrate knowledge of pharmacology of anesthetic agents and their appropriate use in ambulatory surgery.
    • Demonstrate knowledge of the common causes of unanticipated admission in ambulatory surgery and of the appropriate methods for prevention and management of these adverse events.

    PATIENT CARE CORE COMPETENCY OBJECTIVES

    • To develop the skills necessary to provide compassionate, appropriate and effective care for patients undergoing a variety of ambulatory surgical procedures with minimal faculty guidance.
    • To develop communicating skills that will facilitate interaction with patients and be useful in gathering essential and accurate information that is necessary to provide effective patient care.
    • To develop the ability to make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, scientific evidence and clinical judgment
    • To develop the ability to work with other health care professionals, including those from other disciplines, to provide patient-focused care.

    PRACTICE-BASED LEARNING AND IMPROVEMENT CORE COMPETENCY OBJECTIVES

    • To identify areas of weakness in evidence-based practice and develop a plan to address these issues.
    • To locate, appraise and utilize scientific evidence related to ambulatory anesthesia.
    • To develop skills in the use of information technology, particularly online reference searching through MEDLINE, CINAHL, PSYCHINFO, etc.
    • To develop skills to critically appraise the medical literature related to ambulatory anesthesia topics.

    INTERPERSONAL AND COMMUNICATION SKILLS CORE COMPETENCY OBJECTIVES

    • To develop effective written communication skills within the setting of ambulatory anesthesia.
    • To develop effective oral presentation skills in topics related to ambulatory anesthesia.
    • To develop effective leadership skills and the ability to work with the surgical team in a rapid turnover setting to facilitate the ultimate goal which is to improve patient outcomes and care.

    PROFESSIONALISM CORE COMPETENCY OBJECTIVES

    • To maintain the highest possible standards of ethical behavior and to incorporate the principles of ethics into the practice of anesthesiology.
    • To develop respectful and altruistic attitudes towards patients, their families, and other members of the health care team.
    • To protect the confidentiality, dignity and interests of patients, their families, and staff.

    SYSTEMS-BASED PRACTICE CORE COMPETENCY OBJECTIVES

    • To develop a willingness to become involved in creative partnerships to improve health care and system performance within the anesthesiology department and hospital health care system.
    • To develop an understanding of cost-benefit analysis and resource allocation in the ambulatory anesthesia setting.
    • To develop an attitude of being an advocate for the patient within the ambulatory surgery setting.

    MEDICAL KNOWLEDGE CORE COMPETENCY OBJECTIVES

    • To develop a working knowledge of anesthetic techniques, evidence-based practice, and quality improvement issues related to ambulatory and office based anesthesia.
    • To become facile in the medical literature related to ambulatory and office based anesthesia.

    LEARNING OBJECTIVES of the SUBSPECIALTY ROTATIONS:
    Ear, Nose and Throat Surgery:

    • To develop a knowledge regarding special aspects of preoperative preparation of patients scheduled for outpatient ENT surgery.
    • To develop a knowledge of the appropriate selection of anesthetic agents and techniques for ENT surgery.
    • To develop a knowledge regarding safe and effective anesthetic management of endoscopic examination / surgery on upper airway.
    • To develop a knowledge regarding safe and effective anesthetic management of the patient undergoing outpatient thyroid surgery.
    • To develop a knowledge of the safe and effective use of regional anesthesia for face and neck surgery.
    • To develop a knowledge regarding anesthetic management of complications of common outpatient ENT procedures.

    Ophthalmologic Surgery:

    • To develop a knowledge regarding special aspects of preoperative preparation of patients scheduled for outpatient ophthalmologic surgery.
    • To develop a knowledge of the appropriate selection of sedative and analgesic agents for ophthalmologic surgery.
    • To develop a knowledge regarding regional anesthesia for ophthalmologic surgery.
    • To develop a knowledge regarding management of complications of anesthesia for ophthalmologic procedures.

    General, Urologic and Gynecologic Surgery:

    • To develop a knowledge regarding medical optimization of the patient.
    • To develop knowledge of the appropriate anesthetic technique for the individual surgery and patient’s needs.
    • To develop the ability to execute a safe and effective anesthetic plan in a well prepared and skilled manner, with minimal faculty assistance.
    • To develop a knowledge regarding common causes of prolonged hospital stay or unanticipated admission of the ambulatory surgery patient and methods for avoiding these complications.

    Plastic and Aesthetic surgery:
    In addition to the objectives listed above:

    • To develop an understanding of the special considerations for patients undergoing cosmetic surgery procedures.
    • To understand the anesthetic implications of laser surgery and develop the ability to provide safe and effective anesthesia for patients undergoing the procedures.
    • To understand the clinical implications of tumescent anesthesia and develop the ability to provide safe and effective anesthesia for patients undergoing procedures where this technique is used.
    • To develop a knowledge regarding management of complications of anesthesia for cosmetic surgery procedures.

    Regional Anesthesia:

    • To learn how to select patients for regional anesthesia appropriately and develop the ability to discuss the advantages and disadvantages of regional anesthesia with surgeon and patient.
    • To acquire an in depth knowledge of the anatomy relating to regional blocks and a detailed knowledge of local anesthetic pharmacology.
    • To master the use of ultrasound and peripheral nerve stimulator for placement of nerve blocks.
    • To develop the ability to perform continuous perineural catheter placement and successfully manage catheter related issues.
    • To learn how to supplement partial blocks.
    • To learn how to manage complications of regional blocks

    Preoperative Assessment Clinic:

    • To develop an understanding of the rationale for preoperative testing requirements and any institutional specific protocols.
    • To develop an understanding of the anesthetic and surgical implications of co-morbid conditions, especially in relation to ambulatory surgery.
    • To develop the ability to formulate a cogent assessment of the patient’s preparedness for ambulatory surgery.

    Office Based Anesthesia:

    • To develop an understanding of the appropriate selection of patients and procedures for the office setting.
    • To develop the knowledge to safely and effectively manage the anesthetic care of patients undergoing surgery in the office setting.
    • To gain an understanding of the state regulations, structural, equipment and staffing needs for safe conduct of anesthesia in the office setting.
    • To develop a knowledge of potential adverse events that may occur in the office setting and acquire the knowledge and skills to manage these complications in a safe and effective manner.

    Pediatric Anesthesia:

    • To develop an understanding of the appropriate selection of pediatric patients and procedures for the ambulatory setting.
    • To develop knowledge of the appropriate anesthetic technique for the individual surgery and patient’s needs.
    • To learn how to select patients for regional anesthesia appropriately and develop the ability to discuss the advantages and disadvantages of regional anesthesia with surgeon patient and / patient’s family.
    • To develop the ability to execute a safe and effective anesthetic plan in a well prepared and skilled manner, with minimal faculty assistance.
    • To develop a knowledge regarding common causes of prolonged hospital stay or unanticipated admission of the pediatric ambulatory surgery patient and methods for avoiding these complications.

    Administrative Experience:

    • To provide an opportunity for the development of competency in leadership, management and the organizational skills that are required of a Medical Director.
    • To provide an opportunity for participation in the day to day decision making in the operating rooms and training in organizational team behavior and human resource management.
    • To provide an opportunity for the development of communication skills sufficient to solicit and impart information in a professional and collegial manner that facilitates the achievement of patient care goals to formulate safe and effective care plans.
    • To provide an opportunity for development of the skills necessary to work in a team environment, communicating and cooperating with surgeons, nurses, pharmacists, and all members of the perioperative team.
    • To provide an opportunity for the development and analysis of quality tracking studies.
    • To provide an opportunity for a review of the literature relating to operating room management and healthcare systems.

    Research Experience:

    • To develop an understanding of hypothesis generation and testing, study designs and methodologies and basic statistics frequently utilized in anesthesiology research.
    • To learn to analyze and critique the scientific literature and learn skills necessary to develop a publication-quality manuscript and to prepare and deliver a professional scientific presentation.
    • To learn the essential components of obtaining informed consent as it applies to anesthesiology research and understand the importance of maintaining confidentiality and data security in research.
    •  To gain an understanding of grants and funding of research.

    References:

    • Twersky RS, Philip BK (eds): Handbook of Ambulatory Anesthesia 2nd. ed. Springer Science + Business Media, LLC. 2008.
    • Steele SM, Nielsen KC, Klein SM (eds): Ambulatory Anesthesia & Perioperative Analgesia. McGraw-Hill Companies, Inc.,2005
    • Shapiro FE: Manual of Office-Based Anesthesia Procedures. Lippincott Williams & Wilkins. 2007
    • Gabel RA, Kulli JC, Lee SB, Spratt DG, Ward DS (eds): Operating Room Management. Butterworth-Heinmann. 1999
    • Zbinden AM, Thomson D (eds): Conducting Research in Anaesthesia and Intensive Care Medicine. Butterworth-Heinmann,.2001
    • Gehlbach SH: Interpreting the Medical literature. McGraw-Hill Companies, Inc.,
    • 2006 SAMBA Bibliography of pertinent journal articles : www.sambahq.org Assigned reading by faculty