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Appendix A
Sample Subject Curricula

NOTE:
THIS SAMPLE SUBJECT CURRICULUM WAS DEVELOPED FROM THE ANESTHESIA OBJECTIVES IN THE PREVIOUS EDITION OF HTIS MODEL CURRICULUM, AND IS PRESENTED HERE FOR ILLUSTRATION PURPOSES ONLY. THE UPDATED OBJECTIVES FOR ANESTHESIA APPEAR IN THE TABLE OF CATEGORIES.

ANESTHESIA
GOALS

Develop airway management skills

1. Develop familiarity with pharmacologic agents used in anesthesia
2. Learn standard monitoring techniques
3. Learn relevant pre-operative historical and physical exam considerations
4. Learn principles of pain management.

OBJECTIVES
Upon completion of the PGY I Anesthesia rotation the resident will be able to:

1. Demonstrate correct use of the bag-valve-mask device.
2. Demonstrate knowledge of the anatomy of the upper airway.
3. Demonstrate basic familiarity with nasotracheal and endotracheal intubation as well as the indications and complications
4. State the dosages, indications and contraindications for inhalation anesthetic agents, intravenous analgesic and anesthetics, and neuromuscular blocking agents.
5. Demonstrate ability to use standard monitoring techniques.
6. Demonstrate ability to manage a patient on a ventilator.

   Upon completion of the PGY I year the resident, in addition to achieving objectives A-F, will be able to:

7. Demonstrate knowledge of the principles of regional anesthesia and successfully perform metacarpal, digital, radial, median, ulnar, tibial and sural nerve blocks.
8. Demonstrate ability to administer local anesthetics and be familiar with agents, dosing, side effects, and techniques to monitor pain.

   Upon completion of the PGY II year the resident will be able to:

9. Recognize and manage an obstructed airway.
10. Demonstrate skill in all aspects of nasotracheal and endotracheal intubation.
11. Demonstrate ability to use standard emergency department monitoring techniques.
12. Perform conscious sedation under faculty supervision.
13. Perform facial nerve blocks to include supraorbital, infraorbital, mental and auricular nerves.

    Upon completion of the PGY III year the resident will be able to:

14. Demonstrate appropriate judgement regarding the need for airway intervention.
15. Demonstrate skill in the use of anesthetics and neuromuscular blocking agents including conscious sedation and rapid sequence intubation.
16. Demonstrate ability to obtain a surgical airway.
17. Perform dental blocks.

While the Anesthesia objectives should be relatively consistent from one program to another, the implementation methods may vary quite a bit. In the section above, the standard list of Anesthesia objectives was subdivided to indicate where and when they are taught in a hypothetical residency program. The next section describes one method by which these objectives may be achieved. It is presented only as an example, not as a recommended method.

IMPLEMENTATION METHODS
These objectives will be achieved through a one month rotation in the Anesthesia Department during the first year and through participation in the management of Emergency Department patients during the three years of the residency.
Anesthesia Rotation:
Clinical Activities - Residents are assigned to work under the supervision of an attending anesthesiologist who oversees their participation in 4-6 cases per day. Resident responsibilities include performance of a pre-operative history and physical examination, induction and maintenance of anesthesia, airway and ventilator management, intraoperative monitoring, and post-operative evaluation. Residents take in-house call every fourth night during which time supervision is provided by attending staff or senior level anesthesia residents.
Lectures - Residents attend Department of Anesthesia Grand Rounds every Wednesday from 3:00 to 4:00 PM.
Reading Assignments - Clinical Procedures in Emergency Medicine, Chapters 1, 2, 42. Emergency Medicine - Concepts and Clinical Practice, Chapters 4, 5. Emergency Department Rotations:
Clinical Activities - During the PGY I year the resident works one day per week in the Fast Track area of the emergency department under the direct supervision of a EM PGY III. During the PGY I ED experience the resident receives instruction in administration of local anesthesia for patients with lacerations and minor orthopedic injuries. The PGY I resident assists senior residents with intubation and during the second half of the year may perform intubation under close supervision. During the PGY II year the resident is the primary resident responsible for performing tracheal intubations in the ED. The resident is supervised and instructed in the proper technique as well as appropriate use of monitoring devices by the faculty physician. Critical decisions regarding airway intervention are generally made by the PGY III in consultation with the faculty physician. The PGY III is also responsible for administration of pharmacologic adjuncts to intubation and for performance of all cricothyrotomies in the ED.
Lectures- During the PGY I orientation the following lectures are provided: Upper Airway Anatomy, Local Anesthetic Agents, Administration of Regional Anesthesia, Parenteral Analgesic Agents. The orientation also includes an animal lab and ATLS and ACLS courses during which residents are exposed to the mechanics of orotracheal intubation and cricothyrotomy. The following lectures are provided once every 36 months: Neuromuscular Blocking Agents, Monitoring in the ED, Rapid Sequence Induction, Techniques of Regional Blocks.
Recommended Reading - Principles and Techniques of Minor Wound Care.

EVALUATION

Residents receive a written evaluation upon completion of the Anesthesia rotation, as well as after each month in the ED. Residents are evaluated specifically on their skills in airway management and monitoring. All evaluations are reviewed by the program director and placed in the residents' files. (A sample of the Anesthesia rotation evaluation is included at the end of this section.)
FEEDBACK
The program director is responsible for notifying residents of any problems noted as soon as possible. Written evaluations are available for review during normal working hours. They are reviewed formally with the residency director on a semi-annual basis.

EMERGENCY MEDICINE RESIDENT EVALUATION

MIDWESTERN UNIVERSITY SCHOOL OF MEDICINE
Division of Emergency Medicine

IV. Please provide a description of specific strengths/weaknesses.Evaluator's Signature ______________________

Key: O=Outstanding, G=Good, S=Satisfactory, D=Deficient, IC=Insufficient Contact

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