Curriculum

Transition to Discipline

1 Block

Leads

Dr. Claudia Gomez (Civic) & Dr. Kristen Gadbois (General)

Welcome Message

The first Stage of Training of your residency will be the Transition to Discipline stage. Over the course of this first month we will introduce you to the Department of Anesthesia at the University of Ottawa. Our goal is that you become oriented to both the logistics and clinical environment where you will complete the bulk of your Anesthesia Training.

Academic Curriculum

Academic Sessions

• Anesthesia Orientation Day
• Anesthesia Machine Check 1 & 2
• Orientation to CBD
• SIMS Question & Answer
• Introduction to the CanMEDS Roles

Assessment Tools

• Submitted the required number of CCATs (12)
• Demonstrated evidence of self-learning
• Compliant with Resident Logbook
• Submit a CCAT which comments upon your ability to complete the following 7 tasks under supervision. Multiple tasks can be commented upon in one CCAT:
• Perform a complete preoperative assessment with appropriate presentation to the staff Anesthesiologist
• Perform a complete PACU handover to the PACU nurse under supervision • Perform a peripheral intravenous cannulation under supervision
• Perform independent bag mask ventilation under supervision
• Perform the insertion of a laryngeal mask airway under supervision
• Perform endotracheal intubation under supervision
• Perform insertion of a spinal anesthetic using the spinal assessment tool under supervision.
• Complete the AKT 1 pre-test
• Submit a completed Transition to Discipline Tasks tracker

Mandatory Resources (via One45)

• Department of Anesthesiology - Resident Orientation Guide & Residents Survival Guide
• Transition to Discipline Outline for Residents
• Transition to Discipline Tasks
• Transition to Discipline Requirements for Completion

Foundations

10 Blocks

Lead

Dr. Simone Crooks, Dr. Claudia Gomez & Dr. Kristen Gadbois

Welcome Message Rotations

Boot Camp: Blocks 2-4

Clinical: Blocks 5-11

Sample Schedule - Boot Camp

EPAs & Milestones

• Management and support of airway and ventilation
  • Demonstrates direct laryngoscopy and supraglottic device insertion
  • Demonstrates understanding oxygen delivery systems
  • Demonstrates surgical airway techniques
  • Demonstrates advanced indirect airway management including airway topicalization for awake techniques
• Management of major vascular surgery
  • Demonstrates understanding of the assessment of the patient with vasculopathy
• Management of cardiac surgery using cardiopulmonary bypass
  • Demonstrates understanding of anesthetic considerations of coronary artery disease and valvular disease including relevant pharmacotherapy
  • Demonstrates understanding of the assessment of the adult with cardiac disease
• Management of cardioversion/cardiac catheterization
  • Demonstrates an understanding of assessment of the patient with cardiovascular disease
• Management of common uncomplicated general anesthesia
  • Demonstrates understanding the implications of physiology and pharmacology on common uncomplicated anesthetics
  • Demonstrates a comprehensive preoperative assessment and optimization
  • Demonstrates comprehensive anesthesia care of uncomplicated OR cases in the patient simulator
• Management of high risk non-cardiac surgery (including hepatobiliary, pheochromocytoma, ureteroileal conduits, sarcoma, major head and neck)
  • Demonstrates an understanding of anesthesia implications of hepatic and pancreatic insufficiency, of pheochromocytoma, cancer
  • Demonstrates a comprehensive anesthesia assessment for high risk surgery
  • Demonstrates understanding of surgical considerations including fluid management, blood transfusions, temperature, positioning, post operative disposition
• Management of analgesia and anesthesia of a parturient
  • Demonstrates understanding the risks, benefits, and complications of labour analgesia
  • Demonstrates ability to labour analgesia options to parturient
• Management of the high risk parturient
  • Demonstrate understanding pathophysiologic implications of pregnancy related diseases and their treatment
• Manage the resuscitation of the newborn
  • Demonstrate understanding of maternal-fetal management conflicts
  • Demonstrates understanding of anesthesia and analgesia choices with consideration of fetal well being
• Management of peri-operative pain
  • Demonstrates understanding principles of acute peri-operative pain management
  • Demonstrates understanding principles of acute-on-chronic perioperative pain management
• Management of pediatric anesthesia
  • Demonstrates assessment of the child including common syndromes and comorbidities, learning difficulties and anxiety
• Management of the neonate anesthesia and the premature or ex-premature infant
  • Demonstrates understanding of neonatal anatomy, physiology and pharmacology
• Perioperative medical management of the surgical patient
  • Demonstrates understanding of anesthesic considerations for major highly prevalent co-existing diseases
• Management of peripheral nerve blocks
  • Demonstrates understanding of the difference local anesthetic classes
  • Demonstrates understanding of local anesthetic toxicity
  • Demonstrates understanding of contraindications to peripheral nerve blocks
• Management of central neuraxial anesthesia
  • Demonstrates understanding of the contraindications to central neuraxial anesthesia
  • Demonstrates understanding of the risks and benefits of central neuraxial anesthesia
  • Demonstrates understanding the pharmacology of agents used in neuraxial blocks
• Management of lung/esophageal surgery/disease
  • Demonstrates a complete and comprehensive preoperative assessment
  • Demonstrates understanding the indications and contraindications of one lung ventilation (OLV)
• Management of mediastinal mass
  • Demonstrates and comprehensive anesthesia preoperative assessment for a patient with mediastinal mass
  • Demonstrates an understanding of the pathophysiologic effects of a mediastinal mass
• Management of vascular access perioperatively
  • Demonstrates understanding rationale colloid administration
  • Demonstrates understanding guidelines for rational administration blood products and blood product derivatives
  • Demonstrates understanding complications of blood product administration
  • Demonstrates intra-arterial needle via radial artery for sampling

Academic Curriculum

Learning Cases

Acute Pain

• Foundational Analgesia
• Intermediate Analgesia
• Intravenous Patient Controlled Analgesia
• Perioperative Multimodal Analgesia For Enhanced Recovery After Surgery
• Pre-emptive Multimodal Analgesia

Obstetrical Anesthesia

• Pain Management for the Labouring Parturient
• Postpartum Hemorrhage
• Postpartum Headache
• General Anesthesia for Cesarean Delivery

Perioperative Medicine

• Diabetes Mellitus
• Renal Failure
• Airway Assessment

Regional Anesthesia

• Local Anesthetic
• Neuraxial Anesthesia

Assessment Tools

• Submitted the required number of CCATs (12 per block)
• Each CCAT must contain at least 1 comment on a non-Medical Expert CanMEDS role
• Demonstrated evidence of self-learning
• Compliant with Resident Logbook
• Completed CCAT for each of the following procedures:
• Routine intubation with direct laryngoscopy
• Intubation with glidescope
• LMA insertion
• Arterial line insertion
• Complete set up of arterial line
• Complete set up for hotline fluid warmer
•  Submitted the required number of Epidural Assessments (20)
• Submitted the required number of Spinal Assessments (2)
• Proof of completion submitted for the following exercises:
• 4 Simulated crisis management critical reflections
• Epidural trouble shooting online module
• Sterility online module
• Completed ACLS course
• Completed ATLS course
• Completed simulated assessments for the following:
• Fibre optic bronchoscopy
• Central line
• Arterial line
• Epidural insertion
• Completed Foundations BootCamp Midterm Exam
• Completed Foundations Milestone Tracker

Study Schedule

Equipment (Block 1)

Pharmacology (Block 2)

Physiology (Block 3)

Primer (Block 4)

Patient Safety & CBL

Resources

• Morgan & Mikhail's Clinical Anesthesiology, 5^th edition (2013)
• Anesthesia Core Program Archive
• Foundations Boot Camp Requirements for Completion
•  Foundations Milestones
• Foundations Study Schedule
• TOH Orientation Guide
• Foundations Clinical Checklist

Core

39 Blocks

Lead

Individual Leads for each Module (see Modules)

Welcome Message

This stage of training will form the core component of specialty training in Anesthesiology. We employ a modular based and spiral curriculum to help acquisition of clinical knowledge, skills, and attitudes to ensure that each stage builds upon the next. Our core stage of training is divided into junior (Core1) and senior (Core2) competencies and expectations for graded responsibility. Each module has been carefully crafted by expert faculty, which consists of education leads and their sub-specialty fellowship trained faculty. Progression occurs individually based on a given residents prior experience and clinical exposure throughout the blocks. We requests that residents maintain case calendars and a resident logbook to ensure that they have adequate exposure to the breadth of each specialty. Based on existing program data targets and expert opinion we will strive to maintain a minimum exposure of 16 elective days per sub-specialty cumulatively throughout Core (both 1 and 2) to help achieve the educational requirements outlined within each module. Please see One45 at the outset and conclusion of each rotation to ensure that requirements are understood and completed.

Mandatory Rotations

Core 1 (Junior)

Anesthesia

• Acute Pain Service (APS)
• Airway
• Perioperative
• Obstetric
• Clinical Pharmacology
• Regional
• Vascular
• Thoracic
• Neuro
• Pediatric (2 Blocks)
• Cardiac Anesthesia

Critical Care

• Adult Intensive Care unit (2 blocks)
• Cardiac Surgical Intensive Care unit

Off-Service

• Cardiology
• Respirology
• Med-Selective (Consults, Palliative, Geriatric)

Core 2 (Senior)

• Chronic Pain
• Perioperative
• Obstetric
• Clinical Pharmacology
• Regional
• Vascular
• Thoracic
• Neuro
• Pediatric (2 Blocks)
• Cardiac Anesthesia

Critical Care

• Adult Intensive Care (2 Blocks)
• Cardiac Surgical Intensive Care
• Neonatal Intensive Care

Off-Service

• Med-Selective (Transfusion Medicine, IMPAC Clinic)

Individualized Learning Plan (ILP)

We offer 4 blocks of ILP which can be used for electives (Outside Universities, Medicine, Echo, Global Health, Research). Each ILP needs to have specific goals and objectives (G&Os) listed at outset and a supervising physician to determine and ensure successful completion. The program administrator has a list of previous electives undertaken with pre-determined G&Os for your use. Scheduling of these ILP need to be coordinated with your academic coach and require final approval by your Program Director.

Academic Curriculum

See each module for individual Educational Requirements

• Learning Cases
• Core Academic Lecture Series
• Core 2 Exam Builder (Pre and Post Test MCQ)

Assessment Tools

• Submitted the required number of CCATs (12 per block)
• Each CCAT must contain at least 1 comment on a non-Medical Expert CanMEDS role
• Demonstrated evidence of self-learning
• Compliant with Resident Logbook
• Completed NRP course
• Completed PALS Course
• Completed Scholarly Deliverables
  • Presentation at Gary Johnson Research Day
  • Dissemination outside department (Conference, Journal

Summative Assessment

• Anesthesia Knowledge Test (AKT-24) end of PGY-3
• CanNASC (Simulation Exam) –end of PGY-3
• My Portfolio Review by Academic Coach
• Clinical Competency Committee Promotion
• Final Sign-off and Goals for Transition to Practice accepted by PD

Proposed Study Schedule

Should follow according to you clinical module. Please ensure to use the national curriculum framework and academic lecture series to assist you in planning. Academic time will be assigned in your senior years to allow adequate preparation for the Royal College Examinations.

Resources

• Required Textbooks
• Learning Cases
• Academic Core Seminar series

Transition to Practice

6 Blocks

Lead

Dr. Daniel Dubois, MD, FRCPC

Welcome Message

The last stage of residency is the most interesting and important stage of the CBD training program. The goal of transition to practice (T2P) is to provide opportunities for ongoing learning, clinical experience and appropriate decisions related to graded independence. This will ensure that residents who leave our program are competent, confident and satisfied to enter independent consultant practice. It will also allow the program to have the same confidence in making the right decision to sign off on the Final In-Training Evaluation Report (FITER). Over the course of transition to practice residents will be assigned to increasingly complex cases with immediate supervision in addition to independent practice days with indirect oversight.

Entrustable Professional Activities

• Managing all aspects of care for patients presenting to a preoperative clinic, including organizational aspects of the daily workload in terms of time management, advocacy and allocation of resource    (PAU)
• Managing all aspects of care for admitted patients referred for consultation to the Anesthesiology service  (On-Call)
• Managing all aspects of patient care for an afterhours list (overnight, weekend), including postanesthesia care unit management and the organizational aspects related to the management of the operating room case load   (On-Call)
• Managing all aspects of patient care for a scheduled day list, including the organizational aspects related to the management of the operating room case load    (Daily OR/IPD)
• Managing all aspects of anesthetic patient care for procedures outside the operating suite, including the organizational aspects related to the provision of anesthesia and patient safety issues   (REMOTE)
• Managing all aspects of anesthetic patient care for obstetrical patients, including the organizational aspects related to the management of the obstetric ward   (OBS)
• Managing all aspects of care for a scheduled routine pediatric list, including the organizational aspects related to the management of the operating room case load  (CHEO)
• Providing and coordinating the care of patients with simple and complex acute pain conditions referred to and managed by the pain service (APS)
• Developing an ongoing personal career and learning plan
• Leading initiatives to enhance the system of patient care (QPS)
• Managing and coordinating the workday delivery of anesthesia services at a hospital level, ie fulfilling the role of operating room manager (Manager) (elective)
• Leading a post crisis debriefing and feedback session (elective) (SIM)

Academic Curriculum

• Learning Cases (Oral Exam Preparation)
• Monday afternoon half days
• Career Management Seminar Series

Assessment Tools

• Transition to Practice Plan (EPA 9)
• 12 EPAs Completed (EPA
  • 2 CCAT with separate assessors with Score 4 or greater in Pre-Intra-Post.
  • EPA 1-8
• Resident Independent Practice Evaluation (RIPE) Chart Audit
  • CPSO PIPO Framework
    • Pre-operative: Information Gathering, Plan, Consent
    • Intra-Procedure: Procedural Skills, Decision Making, Facilitating Teamwork
    • Post-Procedure: Transfer of Care, Plan & Follow-up
    • Other: Practice Management Plan & Administration
• Multi-Source Feedback

Summative Assessment

• Royal College Written Examination
• Royal College Oral Examination
• My Portfolio Review by Academic Coach
• Clinical Competency Committee Promotion
• Final Sign-off and Goals for Transition to Practice reviewed by PD

• Simulation
• Scholar
• CanMEDS
• QI/Patient Safety
• Ethics