University of Central Florida College of

Medicine / HCA Graduate Medical

Education Consortium
2020 Anesthesiology Residency
Program, Resident’s Manual

Version 6.4.2020 1
 Table of Contents
1. Introduction to the Anesthesiology Residency Program Page 4

2. General/Contact Information Page 5

3. Program Learning Goals and Objectives by CA year Page 6

 CA-1 Page 8
 CA-2 Page 17
 CA-3 Page 26

4. ACGME Goals and Objectives Page 35

5. Resident Mentorship Program Page 37

6. General Expectations-Basic Rules Page 38

 Instructions for calling attending and preparing for cases Page 39

7. Codes of Conduct Page 42

 Evaluation Requirements Page 48

 Conference Attendance Page 48
 Scholarly Activity Requirements Page 48
 ACGME Recommendations Page 49

8. Resident Evaluations Page 50

9. ACGME Core Competencies Page 54

10. ABA Certification Page 56

11. Examinations and Exam Preparation Page 59

12. CA-1 Tutorial Month Page 60

 Expectations Page 60
 Goals Page 60

13. CA-1 Sample Tutorial Didactic Schedule Page 65

14. Educational Tools Page 66

 Perioperative Planning Page 66
 Anesthesia Sequences Page 69
  Anesthesia Do’s and Do Not’s Page 71
 Time Out Page 72
 Leaving the OR Page 73
 Transport PACU to ICU Page 73
 Transport from ICU to OR Page 74

15. Policies
 Transition of Care Page 75
 Tempo Hand-off Tool Page 78
 Resident Documentation Requirements Page 81
 Protocol Requiring Faculty Involvement: Care of Complex Patients, ICU
Transfers and DNR Page 84
 Moonlighting Page 85
 Vacation- Absence Requests Page 86
 Resident Work Hour and Work Environment Policy Page 88
 Conference attendance and educational activity Policy Page 92
 Policy on Substance Abuse Page 94
 Supervision of Residents and Faculty Responsibilities Page 96
 Resident Travel Policy- HCA Page 103
 Resident and Faculty Well-Being Policy Page 108
 Unsatisfactory Training, ITE Testing Standards, and ABA Examination
Failure Supplemental Policy Page 112
 Access to UCF/Institutional Policies Page 114

16. ABA Resources

 Staged Timeline for Residents Page 115
 ITE Exam Blue Print Page 116
 ITE Gaps in knowledge report Page 121
 Basic Exam Blueprint Page 123

17. UCF-HCA Residency Resources

 McGraw Hill Access Anesthesiology,
The Anesthesia Toolbox, TrueLearn QB Page 127
 WebEx Remote Access to Lectures/Conferences Page 128
 MedHub Quick-start Guide Page 137
 HCA Systems Remote Access & Email Instructions Page 147
 List of E-Books
UCF Library Page 149
McGraw Hill Access Anesthesiology Page 155

18. Responsibilities and Authority of the Chief Residents Page 158

 Introduction to the Anesthesiology Residency Program

Welcome to the UCF/HCA Consortium Anesthesiology Residency Program.

This is the final and more exciting stage of your residency training (not including
fellowship) where you will apply your medical knowledge and learn the practice of safe
anesthesia.

Your enthusiasm and your eagerness to learn will match with a supportive environment
where trainees are welcomed, valued, emotionally supported and actively involved in the
design, implementation and success of this new residency program.

Excellence, collegiality, compassion, and integrity in patient care are the core tenets of
our Program Education. Our ultimate goal is to prepare you as skilled anesthesiologist,
ready to practice independently and able to manage any complex or challenging case.

The first few months as anesthesia residents can be frustrating and overwhelming. The
CA-1 tutorial will help you to overcome these exciting and stressful times. It includes
structured lectures, simulation sessions, clinical experience and OSCE assessment.
Independent study is necessary to build a foundation of knowledge. In addition to
lectures and independent study, take advantage of the expertise of your assigned staff
anesthesiologist as well as of the surrounding healthcare providers, including surgeons,
consultants, nurses and other OR personnel.

Our entire department is here to support you in the next three most challenging but
rewarding years yet!

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 General/Contact Information

Primary Site Address ORMC: 1431 SW 1st Ave, Ocala, FL 34471

Key Staff:

Program Director: Ettore, Crimi, MD

Cell: 617-697-2861
Email: [email protected]
[email protected]
Associate Program Director: Smith, William (Brit), MD
Office: 352-665-3329
Email: [email protected]

Chief of Anesthesia ORMC: Heinbockel, John, MD

Office: 352-361-7230
Email: [email protected]

Chief of Anesthesia NFRMC: Doyle, William, MD

Office: 352-318-1408
Email: [email protected]

Chief of Anesthesia Osceola: Pulaski, Jaime, MD

Office: 904-477-5353
Email: [email protected]

Chief of Anesthesia Nemours: Sadiq Shaik, MD

Office: 407-866-3614
Email: [email protected]

Program Coordinator: Matthew Guthrie

Cell: 706-505-9345
Office: 352-401-8312
Email: [email protected]

Other UCF/HCA Anesthesiology Residency Rotation Sites

West Marion Community Hospital - 4600 SW 46th Ct, Ocala, FL 34474

North Florida Regional Medical Center - 6500 W Newberry Rd, Gainesville, FL 32605

Osceola Regional Medical Center - 700 W Oak St, Kissimmee, FL 34741

Nemour’s Children Hospital - 13535 Nemours Pkwy, Orlando, FL 32827

5
UCF COM / HCA GME Consortium Anesthesiology Residency Curriculum

University of Central Florida College of

Medicine / HCA Graduate Medical
Education Consortium

Anesthesiology Residency Program

Goals and Objectives
Program Director: Ettore Crimi, MD

6
Program Goals
The UCF COM / HCA GME Consortium Anesthesiology Residency program at Ocala Regional Medical
Center follows closely the standards set forth by the ACGME and American Board of Anesthesiology
(ABA). It is our primary mission to assist our residents in becoming accomplished professional clinicians
and consultants in Anesthesiology who meet the requirements to become board-certified by the ABA
and who are proficient to practice in anesthesiology in either academic or private practice settings.

This mission will be achieved through both formal teaching via lectures, conferences, simulation and
small groups as well as daily clinical teaching and experience. Our residents will become valued
members of an interdisciplinary team to deliver anesthesia care to patients across all sites and will be
appreciated for our efforts. As such, UCF COM / HCA GME Consortium encourage and will strive to
foster collegiality, encourage discussion, presentation of ideas, and involvement in quality improvement
and patient safety hospital initiatives.

The three years of our program (CA-1, CA-2, CA-3) are intended for physicians who have successfully
completed their clinical base years. The CA-1 through CA-3 years will provide residents with supervised
training to progress to more complex and demanding cases with increasing independence in decision-
making and performance. Experience in such a wide variety of patient and case complexities is met by
incorporating rotations across multiple sites including West Marion Community Hospital, a more rural,
acute hospital within the Ocala Health Systems, Osceola Regional Medical Center with a high-volume
obstetric anesthesiology service, and Nemours Children’s Hospital of Orlando which will provide a
robust pediatric anesthesia experience for our learners.

Although the focus of the clinical anesthesia years is predominantly clinical anesthesia training, we
encourage an interest and participation in ongoing hospital- and university-based research and quality
improvement initiatives. Below details, first, CA-level specific overall educational objectives expected for
each learner to graduate to the next level of training. Then second, the overall goals and objectives as
provided by ACGME.

7
Goals and Objectives by CA Year

CA 1 Year

Structure of the CA 1 Year

The structure of the CA 1 year involves 13 four-week rotations. During the first six weeks (entire first
rotation and half of second rotation) residents will receive a structured orientation to both the hospital
and department, including policies and procedures. The orientation will also include formal lecture,
small group sessions, and simulation covering basic topics of anesthesia, such as the anesthesia
machine, common medications, pre-operative assessment, and technical skills such as intubation, mask
ventilation, and central line placement. During this six week period residents will initially be supervised
by faculty one on one and incrementally increase the time spent in the operating room and decrease the
amount of time the attending is with them during the maintenance of anesthesia. The resident’s
readiness to be alone, indirect supervision, for significant amounts of time during the maintenance of
anesthesia will be assessed by an OSCE assessment done between the fourth and sixth week of
orientation. CA 1 rotations will focus on learning the art and science of delivering anesthetics to
patients that do not have significantly complicated medical histories or scheduled for complicated
surgical procedures. Residents will also start some subspecialty rotations based on their progression
throughout the year.

The rotations are as follows:

1. General anesthesia
2. Obstetric anesthesia
3. PACU
4. Preoperative assessment
5. Pain (Chronic, Regional, or Acute pain)
6. ICU
7. Neuro Anesthesiology
8. Cardiac Anesthesiology

Goals of the CA 1 Year:

By the end of the CA 1 year, the anesthesia resident is expected to:

1. Demonstrate proficiency in pre-anesthetic assessment, preoperative preparation and

medication, intraoperative management and post-anesthetic care of patients with a variety of
medical conditions presenting for minor to moderately complex surgical procedures.

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 2. Develop a working knowledge of physiology, pharmacology, equipment, medicine and
surgery in order to provide safe and effective anesthesia for uncomplicated and minimally
complicated patients presenting for minor to moderately complex surgical procedures.
3. Demonstrate the ability to evaluate, clinically investigate and counsel a patient who is to
undergo anesthesia.
4. Demonstrate the ability to transfer the care of a patient in the immediate postoperative
period and understand and manage the common problems that may occur in this period,
such as postoperative nausea and vomiting.
5. Demonstrate an understanding of the management of patients in the surgical intensive care
unit (for those residents completing the ICU rotation).
6. Describe how to care for patients suffering from acute postoperative pain.
7. Perform the tasks described with either direct or indirect supervision.

Learning Objectives of the CA 1 Year:

Residents will be able to demonstrate competency in the following areas:

1. Patient Care
2. Medical Knowledge
3. Practice-Based Learning and Improvement
4. Interpersonal and Communication Skills
5. Professionalism
6. Systems-Based Practice

PATIENT CARE
Residents must be able to provide care that is compassionate, appropriate and effective for patients
undergoing anesthesia, for patients with postoperative pain, and for patients in the critical care units.
During the CA 1 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Identify and describe the functions and essential components of the preoperative encounter,
including the elements of an informed consent.
2. Describe the appropriate use of basic anesthesia equipment and monitors, including data
interpretation and appropriate clinical response.
3. Identify the appropriate preoperative testing for the uncomplicated surgical patient.
4. Describe the essential elements of uncomplicated general anesthesia care.

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 5. Identify common medical conditions and disease processes that impact anesthetic
management.
6. Explain the basics of pain management.
7. Develop basic strategies to manage complications such as failed or difficult intubation, failed
intravenous line placement, failed epidural placement, accidental dural puncture.
8. Describe concepts of patient care, interventions, and assessment in the PACU. Included in
patient assessment is determination of adequate recovery from anesthesia and appropriate
disposition.

Psychomotor (Skills/Performance) Objectives:

1. Develop a range of technical skills necessary to provide patient care including: placement of
intravenous, arterial and central venous catheters, airway management skills including
techniques for difficult airway management, neuraxial anesthetic techniques, preparation of
an anesthetic station, fluid and drug infusions systems, pre-anesthetic machine checks,
preparation of anesthetic monitoring equipment such as arterial and central venous lines.
2. Gather essential and accurate preoperative information about their patients.
3. Develop and carry out an appropriate anesthetic management plan, with consideration for
the entire perioperative period.
4. Demonstrate vigilance during intraoperative care of patients.
5. Develop skills necessary to care for a patient’s recovery from anesthesia including decision
making, multitasking and situational awareness.
6. Manage various intraoperative and post-anesthetic complications such as hypotension,
hypertension, arrhythmias, hypoxia, tachycardia, bradycardia, anaphylaxis, nausea and
vomiting.
7. Demonstrate the ability to respond rapidly to critical events and emergency situations using
fundamental crisis management skills.
8. Maintain a safe environment for patients.
9. Adequately document all aspects of care provided.
10. Demonstrate competence in providing uncomplicated general anesthesia care.
11. Diagnose, assess and manage common complications seen in the post anesthesia care unit
(PACU).
12. Perform postoperative evaluations.

Affective (Attitude) Objectives:

1. Develop an appreciation of their individual strengths and deficiencies.

2. Identify when and how to call for appropriate assistance.
3. Develop increasing independence in the course of the year.
4. Take responsibility for their patients with supervision.

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 5. Develop a better understanding of the patient’s concerns and demonstrate a dedication to
providing compassionate care.

MEDICAL KNOWLEDGE
Residents must demonstrate knowledge about established and evolving biomedical, clinical and
social-behavioral sciences as they apply to the practice of anesthesiology.

During the CA 1 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

Develop an in-depth knowledge of:

1. Anatomy relevant to anesthesia:

Airway, pulmonary system, cardiovascular system, nervous system, spinal cord, and
vertebral column

2. Physiology:
Basic introduction to respiratory physiology, cardiac physiology, neurophysiology,
renal, gastrointestinal and hepatic physiology, geriatric physiology, neuromuscular
transmission, fluid balance, blood and blood products, transfusion practices

3. Pharmacology:
Volatile anesthetic agents, intravenous anesthetic agents, narcotics, anticholinergics,
neuromuscular blockers, reversal agents, local anesthetics, drugs that act on the
cardiovascular and respiratory systems, anti-emetics, anxiolytics, non-narcotic
analgesics, antibiotics, and other agents used during the course of an anesthetic

4. Anesthetic equipment:
Anesthesia machine, gas delivery systems, basic breathing systems, vaporizers,
ventilators, scavenging systems, O2 , CO2 and agent analyzer systems, oscillometric
and invasive blood pressure monitoring, fluid and drug infusions

5. Medical conditions that impact on preanesthetic, intraoperative, and postoperative

management:
Cardiovascular, respiratory, endocrine, neurological, neuromuscular, coagulation,
renal, hepatic, gastrointestinal, psychiatric diseases and disorders
6. Conduct of Anesthesia:
Pre-anesthetic assessment, induction, maintenance, and emergence form general
anesthesia, regional anesthesia, care of the anesthetized patient, sedation and monitors
anesthesia care, basic monitoring principles, management of pain and other
postoperative problems
7. Surgical procedures:

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 General, orthopedic, genitourinary, gynecological, ophthalmic, plastic, spinal and
neurosurgery, including but not limited to estimated blood loss, associated
complications, positioning, and duration. Principles of trauma and resuscitation
8. Critical care:
Basic principles of intensive care, including strategies for mechanical ventilation,
sepsis management, sedation, vasopressor therapy, and delirium management
9. Pain Management:
Basic principles of postoperative pain management

Psychomotor (Skills/Performance) Objectives:

1. Apply anesthetic knowledge in daily practice of providing perioperative anesthesia care

2. Develop technical skills to successfully apply cognitive objectives as listed above
3. Attend and participate in all learning activities to develop anesthesia-specific knowledge
base, such as lectures, simulation sessions, and online exercises

Affective (Attitude) Objectives:

1. Express the concept of a consultant anesthesiologist as an expert in perioperative medicine,

pain management and critical care
2. Describe the importance of interacting with other members of the surgical and OR team to
fully understand the nature of the patient’s surgical condition and procedures being
undertaken
3. Demonstrate eagerness to learn during educational activities and clinical care
4. Recognize gaps in medical knowledge and actively seek out answers

PRACTICE-BASED LEARNING AND IMPROVEMENT

Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence and improve their patient care practices.
During the CA 1 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Identify the various modalities available for practice-based learning including didactic
lectures, conferences, grand rounds, morning report, Quality Assurance meetings and
conferences, journal clubs, local and national meetings, journals, web-based material,
resident portal and simulation
2. Describe the basics of quality assurance protocols
3. Define the basics of study design and statistics
4. Identify the contributory role of resident teaching to student education

12
 5. Explain the basic principles of evidence-based medicine
6. Describe the importance of life-long learning and learning from their experience

Psychomotor (Skills/ Affective) Objectives:

1. Attend and contribute to various educational conferences available in anesthesia, such as the
ASA, and in the anesthesia department
2. Use web resources to locate, appraise and incorporate evidence from scientific studies
related to the practice of anesthesiology, critical care and pain medicine
3. Analyze practice experience
4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies
5. Facilitate learning of students and other health care professionals
6. Perform postoperative follow-up evaluations and follow-ups on complications

7. Participate as resident member of QA committee

8. Obtain and use information technology to manage information and access on-line medical
information
9. Actively participate in simulation sessions and small group case based discussions
10. Recognize and correct deficiencies in their knowledge and expertise
11. Perform competency- based self-assessment about their own practice and performance

Affective (Attitude) Objectives

1. Demonstrate basic behaviors that exhibit a commitment to practice- based learning

2. Attend and actively participate in all of the educational activities organized by the anesthesia
department
3. Demonstrate basic behaviors that facilitate life-long learning

INTERPERSONAL SKILLS

Residents must be able to demonstrate interpersonal and communication skills that result in
effective informative exchange and teaming with patens, their families and professional associates.

During the CA 1 year, the resident is expected to:

Cognitive (Knowledge) Objectives

1. Describe the role of effective communication as it applies to the development of a

therapeutic relationship with the uncomplicated patient

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 2. Gain knowledge of means to ensure effective communication with members of the operating
room team including nurses, technicians and surgeons
3. Gain knowledge of means of effective communication with other hospital personnel such as
consulting physicians, nurses, social workers, and other administrative and support staff

Psychomotor (Skill/Performance) Objectives

1. Perform clear and accurate presentation of uncomplicated preoperative assessments

2. Create a therapeutic and ethical relationship with patients
3. Use effective listening skills
4. Demonstrate effective nonverbal, explanatory, questioning and writing skills
5. Maintain clear and concise preoperative, intraoperative and postoperative records
6. Work effectively with others as a member of a health care team
7. Maintain composure and effective communication in stressful situations
8. Provide therapeutic direction as appropriate to the clinical situation
9. Demonstrate effective communication during the education of students and other health
care professionals

Affective (Attitude) Objectives

1. Express and appreciate the importance of effective communication with patients, their
families and other health care professionals
2. Develop behaviors that contribute to effective communication
3. Project increasing levels of competence and confidence during communications with
patients, families, and other health care professionals

PROFESSIONALISM
Resident must demonstrate a commitment to carrying out professional responsibilities, and hence to
ethical principles and show sensitivity to a diverse patient population.
During the CA 1 year, the resident is expected to:

Cognitive (Knowledge) Objectives

1. Define the basic domains of medical professional behavior including altruism, honesty and
respect, caring and compassion, responsibility and accountability, excellence and scholarly
pursuit
2. Describe the ethical principles of informed constant and patient confidentiality

Psychomotor (Skills/ Performance) Objectives:

14
 1. Adhere to the domains of medical professional behavior as listed above
2. Show respect for their patients wishes
3. Interact with nursing and other staff in a polite and respectful way
4. Observe patient confidentiality practices at all times
5. Dress appropriately
6. Arrive to clinical and nonclinical activities on time
7. Answer pagers and other forms of communication in timely way
8. Attend and participate in departmental conferences and educational activities
9. Comply with hospital and departmental policies and procedures
10. Complete all preoperative, intraoperative and postoperative documentation according to
departmental requirements
11. Complete necessary residency management paperwork in a timely fashion (duty hours, case
logs, students evaluations, rotation evaluations and faculty evaluations)

Affective (Attitude) Objectives:

1. Show an appreciation of the importance of professional behavior and its impact on patient
care and the smooth functioning of the health care system
2. Demonstrate sensitivity and responsiveness to patient culture, beliefs, age, gender and
Disabilities
3. Express an attitude of commitment to excellence and on –going professional Development

SYSTEMS BASED PRACTICE

Resident must demonstrate an awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to provide care that is of optimal
value.

During the CA 1 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Develop a basic understanding of how their patent care and professional practices effect
other health care professionals, the health care organization, and the larger society and how
these elements of the system effect their own practice
2. Develop a basic understanding of quality improvement programs and control of health care
costs
3. Explain how types of medical practice and delivery systems differ from one another

15
 4. Identify methods to provide effective patient flow through the preoperative services clinic
and post-anesthesia care unit
5. Describe how to partner with other health care providers to access, coordinate and improve
health care

Psychomotor (Skills/Performance) Objectives:

1. Demonstrate basic operating room management and facilitate case turnover

2. Practice cost-effective care and resource allocation
3. Demonstrate anesthetic practices that include system issues such as reducing cost and
working as a member of an interdisciplinary team member (PACU, preoperative care team,
ICU)
4. Work effectively as a team member
5. Perform postoperative rounds
6. Manage patients with post anesthesia complications
7. Document preoperative, intraoperative and postoperative data in clear and concise fashion

Affective (Attitude) Objectives:

1. Show considerations for the broader aspects of the health care system when working in the
operating room
2. Show interest in improving the health care system and assisting their patients in navigating
the system
3. Describe and appreciate the importance of coordination of health care and teamwork

SUGGESTED READING FOR CA-1 YEAR:

1. Miller’s Anesthesia, 9th Ed, 2019

2. Clinical Anesthesia Procedures of Massachusetts General Hospital, 9th Ed, 2016
3. Manual of Clinical Anesthesiology, Larry F. Chu, Andrea Fuller, 2012
4. Clinical Anesthesiology, 6th Ed, Morgan and Mikhail’s, 2018
5. Pharmacology and Physiology in Anesthetic Practice, 5th Ed, Rober K. Stoelting, Simon C
Hillier, 2014
6. Anesthesia and Coexisting Disease, 7th Ed, Rober K Stoeling, 2017
7. Anesthesiologist’s Manual of Surgical Procedures, 5th Ed Richard A. Jaffe, 2014
8. Crisis Management in Anesthesiology, 2nd Ed, Gaba and Fish, 2014
9. Obstetric Anesthesia Principles and Practice , 6th Ed, Chestnut, 2019

IMPORTANT WEBSITES:

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1. University of Central Florida GME Homepage: https://med.ucf.edu/academics/graduate-medical-
program/
2. Ocala Regional Medical Center GME Homepage: https://ocalahealthsystem.com/gme/anesthesiology/
3. MedHub: https://ucfhca.medhub.com/
4. Federation of State Medical Boards: http://library.fsmb.org/m_usmlestep3.html
5. The ACGME: http://www.acgme.org/acWebsite/home/home.asp
6. The American Board of Anesthesiology: www.theaba.org
7. The American Society of Anesthesiologists: http://www.asahq.org/
8. Florida Society of Anesthesiologists: http://www.fsahq.org/
9. STARprep Homepage: www.startprep.org
10. NPI Registry: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

CA-2 Year:

Structure of the CA 2 Year

The structure of the CA 2 year involves 13 four-week rotations. The rotations focus on the various
subspecialties in anesthesia. Residents during this year are expected to develop their skills to operate
with indirect supervision.

The rotations are as follows:

1. Pediatric anesthesiology
2. Obstetric anesthesiology
3. Cardiac anesthesiology
4. Neuro Anesthesiology
5. Pain (Chronic, Acute, or Regional)
6. ICU
7. Advanced Clinical
8. Non-operating Room Anesthesiology (NORA)
9. Trauma

Goals of the CA2 year:

By the end of the CA 2 year, the anesthesia resident is expected to:

17
 1. Demonstrate competence in pre-anesthetic assessment, preoperative preparation and
medication, intraoperative management, and post-anesthetic care of patients in a number of
subspecialties:
Cardiothoracic anesthesia
Neuroanesthesia
Obstetric Anesthesia
Pediatric Anesthesia
Regional Anesthesia
2. Demonstrate advanced technical skills in areas such as airway management, venous and
arterial cannulation, and neuraxial techniques among others
3. Demonstrate competence in the anesthesia specialties of intensive care and chronic, as well
as acute and cancer related, pain management

Learning Objectives of the CA2 Year:

Resident will be able to demonstrate competency in the following areas:

1. Patient Care
2. Medical Knowledge
3. Practice-based Learning and Improvement
4. Interpersonal and Communication Skills
5. Professionalism
6. Systems Based Practice

Patient Care
Resident must be able to provide care that is compassionate, appropriate and effective for patients
undergoing anesthesia, for patients with acute and chronic pain, and for patients in the critical care
units. Residents will care for patients in the various anesthesiology subspecialties during the CA2 year.

During the CA 2 year, the resident will be expected to:

Cognitive (Knowledge) Objectives:

1. Describe the appropriate use of all anesthesia equipment advanced invasive monitoring,
including data interpretation and appropriate clinical response
2. Develop strategies for preoperative testing of complex patients, as well as, the appropriate
use of consultants in the preoperative assessment

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 3. Describe concepts of evaluation and care of subspecialty patient populations such as
pediatric, obstetric, cardiac, neurosurgical, off-site, critical care and ambulatory patients
4. Describe advanced airway management strategies and preparation
5. Describe the components of the pain management evaluation and treatment alternatives in
acute and chronic settings
6. Describe principles of patient safety during care of the anesthesia subspecialty patient
7. Develop advanced management strategies for complications such as failed or difficult
placement of double lumen tube, problem with wedging a PAC, high spinal, total spinal,
aortocaval compression in obstetric patient

Psychomotor (Skill/Performance) Objectives:

1. Gather essential and accurate preoperative information via anesthesia directed history and
physical with interpretation and incorporation of all relevant data for any ASA level for any
operation
2. Evaluate and provide care of the subspecialty patient populations such as pediatric, obstetric,
cardiac, geriatric, neurosurgical, critical care, and ambulatory patients
3. Demonstrate vigilance to the intraoperative care of patients undergoing subspecialty
anesthesia
4. Demonstrate advanced invasive monitoring strategies and data synthesis
5. Manage complex introspective events relative to the particular subspecialty area
6. Develop a range of technical skills necessary to provide optimal care of the subspecialty
patient populations including: placement of pulmonary artery catheters, echocardiography,
central lines, double lumen endotracheal tubes, thoracic epidurals, neuraxial anesthetic
techniques for obstetric patients, peripheral nerve blocks, and advanced airway skills
7. Evaluate and treat acute and chronic pain
8. Learn to use equipment and techniques designed to minimize potential complications such as
ultrasound guided CVP insertion and nerve block techniques
9. Demonstrate competence in ACLS
10. Perform postoperative evaluations of the anesthesia subspecialty patient
11. Adequately document all aspects of subspecialty anesthesia care provided
12. Evaluate blood loss and resuscitate with fluids and transfuse appropriately
13. Maintain a safe environment during care of the subspecialty patient populations
14. Demonstrate superior multitasking skills, situational awareness and decision making 15.
Demonstrate sterile technique

Affective (Attitude) Objectives:

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 1. Develop an appreciation of their individual strengths and deficiencies
2. Learn when and how to call for appropriate assistance during care of anesthetic subspecialty
patients
3. Develop increasing confidence and independence in the course of the year
4. Learn to take increased levels of responsibility for their own patients with supervision

Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical and
social-behavioral sciences as they apply to the practice of anesthesiology.

During the CA2 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

Develop in-depth knowledge of all the anesthesia subspecialties – these are defined in the
subspecialty rotation goals and objectives and seminars. Particular areas of knowledge that residents
will study include:

1. Anatomy relevant to anesthesia:

Central nervous system, brachial plexus, lumbosacral plexus, sciatic, femoral nerves,
anatomy of complex cardiac lesions, pulmonary, obstetric and pediatric anatomy
2. Physiology:
Physiologic changes in pregnancy, physiology of acute and chronic pain, complex
cardiac lesions, interpretation of pulmonary artery pressure reading, physiology of the
pediatric patient
3. Pharmacology:
Vasoactive drugs and drugs used in cardiac anesthesia, drugs used in obstetrics, drug
dosing in pediatric anesthesia and geriatric anesthesia, and drugs commonly used as
infusions
4. Equipment:
Cardiac pacemakers, complex neurophysiologic monitors, pulmonary artery
catheters, fiberoptic endoscopy, jet ventilation, other advanced airway equipment,
ultrasound guided procedures, nerve stimulators
5. Medical Conditions:
Common and rare diseases and their impact on patient assessment and pre-
operative, intraoperative, and post-operative management
6. Conduct of Anesthesia:

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 Administration of anesthesia for complex surgical procedures and surgical procedures
related to anesthetic subspecialties that is safe, evidence-based, and consistent with
current practices
7. Critical Care:
Advanced principles in critically care, including evidence-based management of ARDS,
Embolic complications. Increased depth of knowledge for common conditions and the
current management strategies
8. Pain Management:
Knowledge of a wide variety of techniques and advances the in management of
chronic, acute, and cancer related pain

Psychomotor (Skill/Performance) Objectives:

1. Apply anesthetic subspecialty knowledge to daily practice

2. Develop technical skills to apply cognitive objectives as listed above

3. Attend and participate in all learning activities to develop anesthesia subspecialty knowledge
base

Affective (Attitude) Objectives:

1. Apply the concept of a consultant anesthesiologist as an expert in perioperative medicine of

the subspecialty patient, pain management and critical care
2. Describe the importance of interacting with other members of the surgical and OR team to
fully understand the nature of the subspecialty patients’ surgical condition and procedures
being undertaken
3. Demonstrate eagerness to learn during educational activities and clinical care

Practice Based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices.
During the CA 2 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Further develop their understanding of quality assurance protocols.

2. Identify the various modalities available for practice-based learning including: didactic
lectures, conferences, grand rounds, morning report, quality assurance meetings and
conferences, journal clubs, local and national meetings, journals, resident portal, electronic
and web-based resources, and simulation

21
 3. Describe types of study design and fundamentals of statistical analysis
4. Describe the importance of life-long learning and learning from their experience

Psychomotor (Skill/Performance) Objectives:

1. Attend and contribute to various educational conferences available to them

2. Use resident portal and web resources to locate, appraise and assimilate evidence from
scientific studies related to the practice of subspecialty anesthesiology, critical care and pain
medicine
3. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies
4. Obtain and use information technology to manage information and access on-line medical
information
5. Participate in simulation seminars
6. Perform self-assessment about their own practice and performance

7. Recognize and correct deficiencies in their knowledge and expertise

8. Perform post-op follow-ups of complications related to the care of the anesthesia
subspecialty patient
9. Facilitate teaching of students and other health care professionals
10. Participate as a resident member of QA or other practice improvement committee

Affective (Attitude) Objectives:

1. Demonstrate behaviors that exhibit a commitment to practice-based learning

2. Attend and actively participate in educational activities
3. Demonstrate behaviors that facilitate life-long learning

Interpersonal and Communication Skills

Residents must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and teaming with patients, their families and professional associates.
During the CA2 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Describe the role of effective communication as it applies to the development of a

therapeutic relationship with the anesthesia subspecialty patient
2. Gain knowledge of means to endure effective communication with members of the operating
room team (nurses, technicians, surgeons) during care of the anesthesia subspecialty patient

22
 Psychomotor (Skills/Performance) Objectives:

1. Perform clear and accurate presentations of the preoperative assessments of the anesthetic
subspecialty patients
2. Create a therapeutic and sound relationship with the anesthesia subspecialty patients
3. Use effective listening skills during care of the anesthesia subspecialty patient
4. Demonstrate effective nonverbal, explanatory, questioning and writing skills during care of
the anesthetic subspecialty patient
5. Maintain clear and concise preoperative, intra-operative and postoperative records during
anesthesia subspecialty practice
6. Work effectively with others as a member of a healthcare subspecialty team
7. Maintain composure in stressful situations related to the anesthesia subspecialty situations
8. Provide therapeutic direction as appropriate to anesthesia subspecialty situations
9. Demonstrate effective communication during education of students and other healthcare
professionals

Affective (Attitude) Objectives:

1. Express the importance of effective communication with patients, their families and other
healthcare professionals during anesthetic subspecialty practice
2. Develop behaviors that contribute to effective communication during anesthesia subspecialty
care
3. Project increasing levels of competence and confidence during communications with
anesthesia subspecialty patients and other health care professionals

Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adhere to
ethical principles and show sensitivity to a diverse patient population.
During the CA 2 year, the resident will be expected to:

Cognitive (Knowledge) Objectives:

1. Identify the domains of medical professional behavior including: altruism, honor, respect,
caring, empathy, compassion, responsibility, accountability, excellence and scholarship during
care of the anesthesia subspecialty patients
2. Describe the ethical principles of informed consent, surrogate decision making, do not
resuscitate orders, and patient confidentiality

Psychomotor (Skills/Performance) Objectives:

23
 1. Adhere to the domains of medical professionalism behavior as described above during care of
the anesthesia subspecialty patient
2. Show respect for their patient’s wishes
3. Interact with nursing and other staff in a polite and respectful way
4. Observe patient confidentiality practices at all times
5. Dress appropriately
6. Arrive to clinical and nonclinical activities on time
7. Answer pagers and other forms of communication in timely way
8. Attend and participate in departmental conferences and educational activities 9. Comply with
hospital and departmental policies and procedures

10. Complete all preoperative, intraoperative and postoperative documentation according to

departmental requirements
11. Complete necessary residency management paperwork in a timely fashion (duty hours, case
logs, students evaluations, rotation evaluations and faculty evaluations)

Affective (Attitude) Objectives:

1. Show an appreciation of the importance of professional behavior and how it impacts on

subspecialty patient care and the smooth functioning of the health care system
2. Demonstrate sensitivity and responsiveness to patient culture, age, gender, beliefs, and
disabilities
3. Express an attitude demonstrating a commitment to excellence and ongoing professional
development

SYSTEMS BASED PRACTICE

Resident must demonstrate an awareness of and responsiveness to the larger contest and system of
health care and the ability to effectively call on system resources to provide care that is of optimal
value.

During the CA 2 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

24
 1. Describe how their patent care and professional practices affect other health care
professionals, the health care organization, and the larger society, as well as, how these
elements of the system affect their own practice
2. Develop an understanding of quality improvement programs and control of health care costs
during care of the anesthesia subspecialty patient
3. Identify how types of medical practices and delivery systems differ from one another during
care of the anesthesia subspecialty patient
4. Discuss methods to provide effective patient flow through the operating room, ambulatory
surgical center, preoperative services and surgical intensive care unit
5. Describe how to partner with other health care providers to access, coordinate, and improve
health care during anesthesia subspecialty practice

Psychomotor (Skills/Performance) Objectives:

1. Demonstrate effective operating room management and facilitate case turnover

2. Practice cost-effective care and resource allocation during anesthesia subspecialty practice
3. Demonstrate anesthetic practices that include system issues such as reducing cost and
working as a member of an interdisciplinary team(operating room, pre-anesthesia clinic,
ambulatory surgery center, SICU)
4. Work effectively as a team member during care of the anesthesia subspecialty patient
5. Perform postoperative evaluations of the anesthesia subspecialty patient
6. Manage anesthesia subspecialty patients with post anesthesia complications
7. Document preoperative, intraoperative and postoperative data in clear and concise fashion
as related to anesthesia subspecialty practice

Affective (Attitude) Objectives:

1. Show considerations for the broader aspects of the health care system when providing
subspecialty anesthesia care
2. Show interest in improving the health care system and assisting subspecialty anesthesia
patients in navigation of the system
3. Describe the importance of coordination of health care and teamwork during care of the
anesthesia subspecialty patient

SUGGESTED READING FOR CA-2 YEAR:

1. Essentials of Trauma Anesthesia, 2nd Ed, Varon and Smith, 2018

2. Miller’s Anesthesia, 9th Ed, 2019
3. Clinical Anesthesia Procedures of Massachusetts General Hospital, 9th Ed, 2016

25
 4. Manual of Clinical Anesthesiology, Larry F. Chu, Andrea Fuller, 2012
5. Clinical Anesthesiology, 6th Ed, Morgan and Mikhail’s, 2018
6. Pharmacology and Physiology in Anesthetic Practice, 5th Ed, Rober K. Stoelting, Simon C Hillier,
2014
7. Anesthesia and Coexisting Disease, 7th Ed, Rober K Stoeling, 2017
8. Anesthesiologist’s Manual of Surgical Procedures, 5th Ed Richard A. Jaffe, 2014
9. Crisis Management in Anesthesiology, 2nd Ed, Gaba and Fish, 2014
10. Obstetric Anesthesia Principles and Practice , 6th Ed, Chestnut, 2019

IMPORTANT WEBSITES:

1. University of Central Florida GME Homepage: https://med.ucf.edu/academics/graduate-medical-

program/
2. Ocala Regional Medical Center GME Homepage: https://ocalahealthsystem.com/gme/anesthesiology/
3. MedHub: https://ucfhca.medhub.com/
4. Federation of State Medical Boards: http://library.fsmb.org/m_usmlestep3.html
5. The ACGME: http://www.acgme.org/acWebsite/home/home.asp
6. The American Board of Anesthesiology: www.theaba.org
7. The American Society of Anesthesiologists: http://www.asahq.org/
8. Florida Society of Anesthesiologists: http://www.fsahq.org/
9. STARprep Homepage: www.startprep.org
10. NPI Registry: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

CA-3 YEAR

Structure of the CA 3 Year

The structure of the CA 3 Advanced Clinical Track involves 13 four-week rotations. The specific rotation
assignments differ depending on the residents’ previous completion of required rotations and expressed
subspecialty interest. The CA 3 residents are assigned to the most difficult and challenging cases
available on each day. In addition, if the CA 3 residents identify cases from their case logs for which they
need additional numbers, they will be assigned to such cases.

The rotations are as follows:

1. Pediatric anesthesiology
2. ICU
3. Obstetric anesthesiology
4. Cardiac anesthesiology

26
 5. Neuro Anesthesiology
6. Pain (Chronic, Acute, or Regional)
7. Advanced Clinical
8. Transition to Practice
9. Transesphogeal Echocardiography/ Point of care Ultrasound (TEE/POCUS)

Goals of the CA 3 Year:

By the end of the CA 3 year, the anesthesia resident is expected to:

1. Develop a knowledge base of the physiologic manifestations of rare disease and their effects
on pharmacology and anesthesia management
2. Develop proficiency in the preoperative assessment, preoperative preparation and
medication, intraoperative management, and post-surgical care of patients with complicated
multi-system medical conditions and patients presenting for complex surgery
3. Become proficient in advanced anesthesia skills including use of complex monitoring systems
and invasive monitors
4. Become proficient in the management of uncontrolled anesthesia situations
5. Become proficient in the management of low frequency critical events, such as malignant
hyperthermia
6. Become proficient in the management and leadership of intraoperative resources including
nurses, anesthesia technicians, and hospital support staff
7. Describe the steps taken in search and selection of future employment
8. Develop understanding and skills of practice management
9. Understand economic considerations of anesthesia practice

Learning Objectives of the CA3 Year:

Resident will be able to demonstrate competency in the following areas:

1. Patient Care
2. Medical Knowledge
3. Practice-based Learning and Improvement
4. Interpersonal and Communication Skills
5. Professionalism
6. Systems Based Practice

27
 PATIENT CARE
Residents must be able to provide care that is compassionate, appropriate and effective for medically
complicated patients undergoing anesthesia for complex surgical procedure throughout the
perioperative period. As well as caring for patients with complicated postoperative courses including
difficult to control pain and disposition to critical care units.

By the end of the CA 3 year, the resident is expected to:

Cognitive Objectives:

1. Develop management strategies for a variety of complex situations such as: Vascular
patients; patients with rare and complicated diseases; uncontrolled situations;
management of anesthesia in ‘out-of-operating’ off-site locales such as MRI, CT,
interventional radiology, interventional neurology, endoscopy, cardiac catheterization lab,
ECT; moribund patients; transplant related surgery, such as multi-organ donors; complex
airway management in a variety of situations
2. Further develop management strategies for patients with complex, multi-system disease 3.
Develop the necessary problem solving techniques for intraoperative events such as:
anaphylaxis, myocardial ischemia, autonomic hyperreflexia, malignant hyperthermia, venous
embolism (air, amniotic, thrombotic) major equipment failures

Psychomotor (Skills/Performance) Objectives:

1. Further develop proficiency in a range of technical skills necessary to provide optimal patient
care such as: multiple techniques and approaches to vascular and arterial cannulation and
securing the airway
2. Evaluate patients and perform anesthesia safely with oversight supervision, including
performance of invasive procedures
3. Effectively evaluate and treat complex patients with acute and chronic pain

Affective (Attitude) Objectives:

1. Further develop an appreciation of their individual strengths and deficiencies with regards to
complex and specialized patient care
2. Demonstrate respectful interaction with physician and non-physician hospital staff, patients,
and family members when working as part of a team to care for complicated patients
3. Serve as positive role models and demonstrate patient care behaviors that serve as examples
to junior residents and other hospital personnel
4. Take responsibility for their patients with minimal supervision

28
 MEDICAL KNOWLEDGE
Residents must demonstrate knowledge about established and evolving biomedical, clinical and
social-behavioral sciences as they apply to the practice of anesthesiology.
By the end of the CA 3 year, the anesthesia resident is expected to:

Cognitive (Knowledge) Objectives:

1. Develop advanced knowledge in all of the anesthesia subspecialties which are defined
in the individual rotation goals and objectives.
2. Develop advanced concepts of patient care including multi-organ disease for complex
operations
3. Develop their knowledge base in the anesthetic management of complex and uncommon
conditions such as: Pheochromocytoma, Malignant Hyperthermia, Porphyria, Myasthenia
gravis, Thyrotoxicosis, Addison’s disease, Marfan’s syndrome, Muscular dystrophy, valvular
heart disease, severe ischemic heart disease, cardiomyopathy, vascular disease, aortic
aneurysms, major vascular bypass procedures, circulatory arrest and transplant related
procedures
4. Become familiar and skilled with the use of specialized equipment such as: transesophageal
echocardiography, cardiac pacemakers, complex neurophysiologic monitors, fiberoptic
bronchcoscopy, jet ventilation, ultrasound and nerve stimulators for nerve block placement,
and ultrasound for central venous access and arterial catheter placement
5. Develop in-depth knowledge of electrical grounding systems and electrical safety

Psychomotor (Skill/Performance) Objectives:

1. Further develop the technical skills learned during the CA 1 and CA 2 years including:
Placement of thoracic epidural catheters, placement of central venous catheters; advanced
management of the difficult airway; surgical airway procedures; placement of special
catheters used in monitoring techniques for cardiac and neurosurgery; ICP monitors; SSEP
monitors; TEE placement and data interpretation; difficult swan ganz catheter placement and
data interpretation; complex peripheral nerve blocks
2. Gain experience in research by participating in journal club, grand rounds and departmental
research
3. Apply advanced anesthesia knowledge in daily practice of providing perioperative anesthesia
care
4. Attend and participate in all learning activities to develop anesthesia-specific knowledge base

Affective (Attitude) Objectives:

1. Develop an active role as consultants in anesthesia

29
 2. Express their understanding of the importance of interacting with other members of the
surgical and OR team to fully understand the nature of the patient’s surgical condition and
procedures being undertaken
3. Demonstrate a dedication and desire to educate others in anesthesia related matters

PRACTICE BASED LEARNING AND IMPROVEMENT

Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence and improve their patient care practices.
By the end of the CA 3 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Describe the importance of lifelong learning and the various modalities available for practice
based learning such as:
Didactic lectures
Conferences and grand rounds
Quality Assurance meetings and conferences
Journal clubs
Local and national meetings
Journals and web-based educational material
Simulation in anesthesia education “real-time” and web-based

2. Identify advanced statistical methods for evaluating research and the principles of evidence
based medicine
3. Gain further depth of knowledge regarding methods, techniques, and tools for performance
self-evaluation and practice improvement
4. Further describe the importance of learning from their experience

Psychomotor (Skills/Performance) Objectives:

1. Attend and contribute to various educational conferences available to them in the anesthesia
department
2. Prepare and deliver departmental grand rounds
3. Teach medical students and other allied health professionals
4. Assist junior residents in clinical assignments, preoperative evaluations and case management
5. Completion of a practice improvement project from formulation of an idea to
implementation and evaluation
6. Attend and participate in Quality Assurance meetings and conferences

Affective (Attitude) Objectives:

30
 1. Demonstrate behaviors that show a commitment to practiced based learning
2. Actively participate in all the educational activities organized by the anesthesia department
3. Demonstrate an appreciation for the different resources and processes for practice based
learning
4. Demonstrate a desire to be a role model and teacher regarding the fundamentals and values
of practice based learning and improvement

INTERPERSONAL AND COMMUNICATION SKILLS

Residents must be able to demonstrate interpersonal and communication skills that result in effective
informative exchange and teaming with patens, their families and professional associates.
By the end of the CA 3 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Further develop an understanding of the role of effective communication as it applies to the

development of a therapeutic relationship with the patient and particularly with more
complicated patients
2. Further gain knowledge of strategies and techniques to ensure effective communication
members of the operating room team including nurses, technicians and surgeons
3. Further understand why different strategies and techniques of communication are effective
and differentiate when they may be more or less effective

Psychomotor (Skills/Performance) Objectives:

1. Demonstrate effective communication with their patients, particularly patients with complex
medical and surgical conditions, to ensure patient understanding
2. Further develop effective listening skills
3. Communicate effectively with all members of the health care team
4. Demonstrate accurate, legible, and timely documentation of pre-operative information,
intraoperative record keeping, and post-operative orders
5. Effectively communicate during student education
6. Demonstrate an increased level of comfort in communicating with others in the hospital as a
consultant physician

Affective (Attitude) Objectives:

1. Express the importance of effective communication with patients their families and other
health care providers
2. Demonstrate desire to further develop behaviors that contribute to effective communication

31
 3. Demonstrate desire to act as a positive role model and teacher of communication skills to
junior residents, medical students, and other hospital personnel

PROFESSIONALISM
Resident must demonstrate a commitment to carrying out professional responsibilities, and hence to
ethical principles and show sensitivity to a diverse patient population.
By the end of the CA 3 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Define the basic domains of medical professional behavior such as: altruism, honor
and respect, caring and compassion, responsibility and accountability, clinical and academic
excellence, and scholarship
2. Recognize the more complex ethical principles involved in taking care of patients with
differing cultural, religious, or personal beliefs
3. Recognize the more complex ethical principles involved in taking care of patients unable to
make medical decisions for themselves, such as moribund conditions
4. Recognize the more complex ethical principles involved in taking care of patients for
transplant related surgeries
5. Understand the various mechanisms in place to assist in managing difficult and complex
ethical issues

Psychomotor (Skills/Performance) Objectives:

1. Demonstrate a commitment to professionalism in their daily interactions with patients, family

members, and hospital personnel
2. Show respect for their patients’ wishes
3. Interact with nursing and other staff in a polite and respectful way
4. Observe patient confidentiality practices at all times
5. Dress appropriately
6. Arrive for work on time
7. Answer pagers and other forms of communication in a timely manner
8. Attend and participate in departmental conferences and educational activities
9. Comply with departmental policies and procedures
10. Demonstrate the ability to use hospital resources in place for assistance in managing difficult
or complex ethical issues

Affective (Attitude) Objectives:

32
 1. Show an appreciation of the importance of professional behavior and how it impacts on
patient care and the smooth functioning of the health care system
2. Demonstrate an understanding of the importance of completing all pre-operative,
intraoperative and post-operative documentation according to departmental requirements.
3. Demonstrate a desire to act as a role model and teacher to others in developing and
maintaining a high level of professionalism

SYSTEMS BASED PRACTICE

Resident must demonstrate an awareness of and responsiveness to the larger contest and system of
health care and the ability to effectively call on system resources to provide care that is of optimal
value for all patients, including those with difficult and challenging medical conditions and/or complex
surgeries and hospital stays.
By the end of the CA 3 year, the resident is expected to:

Cognitive (Knowledge) Objectives:

1. Gain a more in-depth understanding of the broader aspects of the health care system and
how the care they offer patients influences, and is influenced by and other parts of the health
care system
2. Further learn about quality improvement programs and control of health care costs
3. Further describe the importance of working as part of a team
4. Describe the importance of effective OR management and patient flow through the operating
room system in caring for all patients, with attention to patients that have extenuating
circumstances
5. Develop understanding of anesthesia billing, medical economic and medical legal issues
6. Gain a better understanding of the factors currently and historically that have shaped the
current systems of healthcare practice and delivery

Psychomotor (Skills/Performance) Objectives:

1. Demonstrate advanced anesthetic practices that include systems issues such as reducing
costs and maximizing efficiency
2. Effectively work as a leader or member of an interdisciplinary team in the operating room,
critical care areas, pre-operative evaluation process, obstetric unit, and pain service, among
others
3. Perform efficient and effective post-operative rounds
4. Manage patients with post anesthesia related complications, including proper follow up and
coordination of other medical specialists
5. Facilitate expedient case turn over
6. Act as a consultant to surgeons for anesthesia planning and care of a variety of patient types
and surgical settings

33
 7. Facilitate resolution of pre-operative concerns and issues to expedite and optimize patient
care

Affective (Attitude) Objectives:

1. Show considerations for the broader aspects of the health care system when working in the
operating room and off-site locations
2. Demonstrate a desire to improve the health care system and assist patients in navigating the
system, particularly in cases of extenuating circumstances and seek ways to develop
systematic approach to account for them
3. Demonstrate a desire to be leader and supervisor in directing others in the planning and
implementation of providing anesthesia
4. Demonstrate a desire to be a positive role model and teacher to junior residents, medical
students, and other hospital personnel in navigating the system to facilitate optimization of
patient care

SUGGESTED READING FOR CA-3 YEAR:

1. Miller’s Anesthesia, 9th Ed, 2019

2. Clinical Anesthesia Procedures of Massachusetts General Hospital, 9th Ed, 2016
3. Manual of Clinical Anesthesiology, Larry F. Chu, Andrea Fuller, 2012
4. Clinical Anesthesiology, 6th Ed, Morgan and Mikhail’s, 2018
5. Pharmacology and Physiology in Anesthetic Practice, 5th Ed, Rober K. Stoelting, Simon C Hillier,
2014
6. Anesthesia and Coexisting Disease, 7th Ed, Rober K Stoeling, 2017
7. Anesthesiologist’s Manual of Surgical Procedures, 5th Ed Richard A. Jaffe, 2014
8. Crisis Management in Anesthesiology, 2nd Ed, Gaba and Fish, 2014

IMPORTANT WEBSITES:

1. University of Central Florida GME Homepage: https://med.ucf.edu/academics/graduate-medical-

program/
2. Ocala Regional Medical Center GME Homepage: https://ocalahealthsystem.com/gme/anesthesiology/
3. MedHub: https://ucfhca.medhub.com/
4. Federation of State Medical Boards: http://library.fsmb.org/m_usmlestep3.html
5. The ACGME: http://www.acgme.org/acWebsite/home/home.asp
6. The American Board of Anesthesiology: www.theaba.org
7. The American Society of Anesthesiologists: http://www.asahq.org/
8. Florida Society of Anesthesiologists: http://www.fsahq.org/
9. STARprep Homepage: www.startprep.org
10. NPI Registry: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

34
ACGME Goals & Objectives
To successfully complete anesthesiology residency, each resident is expected to achieve knowledge,
skills and attitudes necessary for adequate performance in anesthesiology profession in all six ACGME
defined general competencies:

I. Medical Knowledge:

Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-
behavioral sciences, as well as the application of this knowledge to patient care; and as specified by
each RRC.

II. Patient Care:

Provide patient care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health and as specified by each RRC.

III. Interpersonal & Communication Skills:

Demonstrate interpersonal and communication skills that result in effective exchange of

information and collaboration with patients, their patients’ families, and health professionals.
Residents should be able to:

a. Communicate effectively with patients, families, and the public, as appropriate, across a
broad range of socioeconomic and cultural backgrounds
b. Communicate effectively with physicians, other health professionals, and health related
agencies
c. Act in a consultative role to other physicians and health professionals
d. Work effectively with others as a member or leader of a health care team or other
professional group
e. Maintain comprehensive, timely, and legible medical records, if applicable
IV. Professionalism

Demonstrate a commitment to carrying out professional responsibilities, and an adherence to ethical

principles. Residents should:

a. Demonstrate compassion, integrity and respect for others; responsiveness to patient

needs that supersedes self-interest
b. Demonstrate respect for patient privacy and autonomy
c. Demonstrate accountability to patients, society and the profession
d. Demonstrate sensitivity and responsiveness to a diverse patient population, including
but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation.
 Practice Based Learning and Improvement

Investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to
continuously improve patient care based on constant self-evaluation and life-long learning.
Residents should be able to: - Identify strengths, deficiencies, and limits in one’s knowledge and
expertise - Set learning and improvement goals - Identify and perform appropriate learning activities

35
 a. Incorporate formative evaluation feedback into daily practice
b. Systematically analyze practice using quality improvement methods, and implement
changes with the goal of practice improvement
c. Locate, appraise, and assimilate evidence from scientific studies related to their
patients’ health problems
d. Use information technology to optimize learning
e. Participate in the education of patients, families, students, residents and other
health professionals

 Systems Based Practice

Residents should be able to:

a. Work effectively in various health care delivery settings and systems relevant to
their clinical specialty
b. Coordinate patient care within the health care system relevant to their clinical
specialty
c. Incorporate considerations of cost awareness and risk-benefit analysis in patient
and/or population-based care as appropriate
d. Advocate for quality patient care and optimal patient care systems
e. Work in inter-professional teams to enhance patient safety and improve patient
care quality
f. Participate in identifying system errors and implementing potential systems
solutions

Evaluation Methods
Regardless of CA-level and rotation, residents will be assessed using the same protocol. This protocol is
as follows:

- At start of rotation, resident is to discuss with supervising attending personal goals for achieving
the CA-level and rotation-specific curriculum identified within the rotation’s goals and
objectives.
- Throughout the rotation, the supervising physician is to provide the resident with formative
feedback on communication with patients and families, peers, and members of the
interdisciplinary team; completeness of Electronic Medical Records, and overall patient care.
- At the end of rotation, the supervising physician will complete an end-of-rotation evaluation of
the resident in MedHub. See the program manual for an example.
- Once per preoperative, general anesthesia, and advanced clinical anesthesia rotation, the
resident will be observed conducting a preoperative assessment with the patient and family.
The supervising attending (or CA-3, if a CA-1 is being supervised) will provide immediate
feedback to the resident and submit the OSCE form to the resident educational portfolio in
MedHub
- Residents will receive quarterly feedback that includes an overall, summative view of
evaluations across all rotations through meeting with their faculty mentor.

36
 - Residents will be evaluated by the Clinical Competency Committee, in collaboration with the
program director, semi-annually. The CCC meeting outcomes will be de-briefed with the
resident directly by the program director within 2-weeks of CCC meeting date.
- Residents will receive simulation training at the UCF Simulation Center annually in mid-July.
Residents will participate in small group de-brief discussions and individual evaluations will be
made available in the resident educational portfolio in MedHub.

Resident Mentorship Program

The University of Central Florida College of Medicine / HCA GME Consortium at Ocala Regional Medical
has established an established Resident Research Mentorship Program. The goal of the Mentorship
program is to pair residents with a faculty mentor who’s educational, research, and career goals are
aligned. Residents will be paired by the end of the fourth block of CA-1 with the faculty mentor and will
meet with the faculty mentor for the duration of training to discuss progress in training, research, and
meeting career goals. The faculty mentor is to also provide a form of social support to the resident as
well.

After faculty members and residents are paired, they are placed within a “mentorship committee” that
consists of the mentee, the mentor, and a member of the Anesthesiology Program leadership team
(Program Director, Associate Program Director, or Site Director). Mentors meet with their mentees
quarterly to review their current and future goals. The meetings help the mentor keep the mentee on
track by developing short-term goals (six to twelve months), intermediate-term goals (one to three
years, such as a manuscript or program), and long-term goals for career development.

After six-months, the mentor creates a formal report that outlines the mentee’s goals, achievements,
and aspirations for the future, reviews it with the resident, and submits the report to the Clinical
Competency Committee as part of considerations for the semi-annual evaluation process. The mentor
works with the mentee to identify obstacles and determine the resources needed for success. The
mentorship committee then meets with the department chair to evaluate the success of the mentoring
relationship and discuss future plans. This initiative has also expanded to include residents and fellows,
who also benefit from this guidance much earlier in their careers. Residents and their mentors will be
strongly encouraged to combine their research interest with those of their faculty mentor. All residents
will be encouraged, as part of the research curriculum to submit applications to the American Society of
Anesthesiology Committee on Professional Diversity ‘s annual ASA Mentoring Program in the spring of
each year. For more information: https://www.asahq.org/sitecore/content/ASAHQ/about-asa/asa-
awards-and-programs/asa-mentoring-program

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 General Expectations
• Committed to Excellence in Patient Care and Learning
• Feel welcomed and Emotionally supported
• Respect your teachers and others in the patient care team
• Feel safe and comfortable expressing yourselves
• Provide critical appraisal of your learning environment and use feedback to
make changes
• Motivated to diagnose your own needs, your learning objectives, execute your
learning plans and self-reflect on your learning performances

Basic Rules
1. The Resident has to call the assigned Anesthesia Staff the night before the working day
to discuss the case, even if you had not chance to collect any information. This is a
requirement and not an option.

2. The Resident is expected to come to the Hospital as early as it is required to set up the
room and complete the preoperative evaluation of the first patient, without creating any
delay.

3. If you have been assigned to a room with a quick turnaround, you need to plan your set
up for all cases early in the morning so to not delay any case. "I am not ready. Do not
bring the patient to the room," when it's time to start IS NOT ACCEPTABLE!

4. Even you have been assigned to a room with a late start (8 – 8:30 or later), you are
EXPECTED TO BE at the Hospital NO LATER THAN 6:30 AM (unless otherwise
instructed at the time you receive your assignment)! Case assignment can always change,
and you could help to start other rooms.

5. Be always RESPECTFUL of your Staff. They are there to help you. Take advantage of
their expertise and knowledge. Passive-aggressive or confrontational behaviors are never
acceptable. If there is any disagreement, ask to discuss it at the end of the case or the day.
Please report to me of any issues you might have with any Staff.

6. Residents rotating at ORMC are expected to personally participate to

Lectures/Conferences even if they finish early. Residents at WM will join
lectures/conferences via Webex if still at the Hospital; otherwise, they are required to
come to ORMC.

7. Residents at any location unable to join lectures/conferences are required to report it

and explain the reason to Matt before lecture/conference starts.

8. Daily morning " Key Words" review session is MANDATORY and not a
forgettable option. Again, plan ahead your time to come to the hospital to complete all
the required tasks.

38
 Instructions for calling attending and preparing for cases

You will get an assignment for the next day with room number, surgeon and
anesthesia attending hopefully by 5pm (it may be later). At this point, you can
pull up the schedule for the next day and review your cases/patients. Try to
picture pre-op sheet or have a copy of one and make sure that everything is
covered (top to bottom). Jaffe’s Anesthesiologist’s Manual of Surgical
Procedures is a great source of relevant clinical information about variety of
procedures and will guide you with preop, intraop and postop plan. If you are
still at the hospital when the schedule comes out it would be wise and efficient
to see your inpatient patient; this would give you an opportunity to present
physical exam and go over airway with your attending. Otherwise, you will do
this portion the morning of surgery. After reviewing the case and all of the
pertinent information on Meditech/Patient Keeper you are ready to call the
attending and present your case.
ID: Give the age and sex of the patient, what procedure they are scheduled for, as
well the surgeon, and mention anticipated duration of the case if long, atypical, or
unpredictable. Consider mentioning the start time and room number, especially if
different than usual, i.e., late or early start, cath lab, biplane, endo, etc.
PSHX: Briefly review relevant prior surgeries, type of anesthesia used, and
complications or other relevant points regarding past anesthetic or surgical
experiences. Include the common (PONV) as well as complicated anesthesia issues
(failed intubation, anaphylaxis, etc).
PMHX: Discuss relevant past medical history, preferably in order of severity,
especially cardiovascular and pulmonary conditions. Each disease process or
condition should be discussed in terms of its severity, duration, treatment, and
relevant work up such as recent echo and the results. Anything pertinent in the
review of systems such as serious reflux or snoring try to mention if the PMHX. Also,
motion sickness often gets overlooked.
MEDS: Discuss relevant medications as well as allergies, over-the-counter
medications such as NSAIDS and herbal remedies. If you are unfamiliar with a
medication, look it up. This is how you will keep up to date on the continual roll out
of new medications. Check with interactions with other medications (especially with
any meds that you plan to administer). Knowing MOA is very helpful.
ET: If someone has significant cardiac or pulmonary disease, or risk factors you
are concerned about you should mention exercise tolerance/functional capacity in
the PMH. If they do not, then one can discuss it here. If they have a good or excellent
level of fitness if often simply state that the patient is “fit” or even “very fit” (what is
their MET?). You can get at ET many ways by asking about exercise, activities of
daily living and work they do at home and on the job.
EXAM:
VS: Anything abnormal you should report. Know weight, height and calculate BMI.
AIRWAY: Report Malampati class, as well as any other relevant features such as
thyromental distance, pro or micrognathia, oral opening, flexion/extension, chipped
teeth, caps/dentures, distorted anatomy (prior XRT, tumor, etc).

39
LUNGS: Report any abnormalities. You can simply state “Heart and lungs were
normal.”
HEART: Same as above.
EXTREMITIES: Check for edema, scars, bruising (make sure you have good IV access
and look for ideal alternate site.
NEURO: Any deficits, weakness, tingling, numbness, etc.
ANALYSIS AND PLAN:
This is where you will put all of your information together and come up with
the best, individualized plan that fits each patient. You will become more fluent and
confident as you get more practice. Practice with each other or your seniors if you
wish before calling your attending. Do not forget to assign an ASA status. Develop
and then discuss your anesthetic plan taking in to account the patient’s medical
conditions, past anesthetic experiences, and the surgical procedure including
possible complications. In the beginning of your residency your plan, at a minimum,
should include consideration of premedication, intraoperative monitoring, use of
regional techniques if appropriate, IV access and fluids, induction, maintenance,
emergence if GA is used, and postoperative issues such as destination (home, ICU,
etc,) and pain control.
Elements of Anesthetic Plan:
 Patient summary relevant to anesthesia and surgery
o Pre-existing medical conditions understood and “optimized” for anticipated
surgery and anesthetic
o History and physical examination completed and documented.
o Appropriate preoperative testing ordered and/or reviewed.
o Outside consults reviewed and integrated appropriately into your
plan.
o Appropriate medication and substance “adjustments” (alcohol, etc) made
o Plan understood and discussed with patient-****INFORMED CONSENT*****
 Preoperative planning:
o Monitoring
o Positioning
o Lines/IV access/blood products
o Postop destination and care transition issues
 Pre-induction
o Premedication for anxiolysis
o Control of blood pressure, blood sugar, etc
 Induction/Meds:
o Hypnotic/induction agents
o Narcotics
o Muscle relaxant
o Vasoactive agents
 Airway:
o Ventilation - mask, oral airway

40
 o Intubation - consider having a plan A and a plan B (sometimes even
and even C and D)
 Maintenance:
o Medications
o Fluids
o Temperature management
o Anticipate key surgical events: hypothermia, bleeding,
anticoagulation, tourniquet use, positioning, redosing antibiotics, etc.
o Muscle relaxation and when it will be needed and not needed.
o Use of monitoring: ABG’s, EEG, CVP, UOP, TEE, Clearsite
o Intra as well as planning for postop pain management
 Emergence:
o Timing
o Analgesia
o Hemodynamic management
o Destination and transitioning of care
o Airway
 Postoperative:
o Monitoring
o Analgesia
o PONV
o Hemodynamics
o Diagnostics
o Transfer of Care/communication
o Follow up
TIPS FOR GETTING MOST OUT OF PK/MEDITECH FOR YOUR CASE PREPARATION:
1. Lab Results: lab section will show results newest to oldest. Review all: CBC, BMP,
Coags, TEG, UA, Beta-hcg and make sure WNL.
2. Clinical Notes contain useful reports that have H&Ps and consults, prior operative
notes, EKGs, etc. Consider reading surgical note to understand surgical issues and
plan. Use preconfigured filters for H&P, consults.
3. Test results show imaging including CXR, US, CT etc.
4. You can also obtain prior anesthesia records which can be very useful in
managing your patient and it gives you some idea if there were any issues with
anesthesia.
Do not forget that the best way to take care of the patient is by discussing your plan
with your senior resident, attending and the patient and deciding as a team which
route to take. Our plan should be succinct to all and provide safe and pleasant
experience.
Good luck!

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 CODES OF CONDUCT
Dress
Residents will be neatly and professionally attired and groomed when interacting with
patients and their families. Identification badges with photographic ID must be worn
above the waist at all times.

Scrubs must NOT be worn outside the hospital. They must be changed every day, or
more often if necessary due to contamination. A white coat must be worn over scrubs
when not in the OR, such as when performing pre-operative evaluations in the hospital on
in-patients. Emergency intubations, codes and STAT calls are exceptions.

In the O.R., eye protection is required, either a mask with a face shield, goggles or
glasses and plastic side shields. Shoes or sneakers may be worn in the O.R., but not
sandals. If you do not have a dedicated pair of shoes for the O.R., then shoe covers must
be worn. Hair on head and beard must be covered in the O.R. Gloves must ALWAYS be
worn for direct patient contact

Patient Communication
Residents must introduce themselves to the patient (and family when appropriate).

Patients should be addressed by their surnames (Dr., Mrs., Mr., Ms.) unless the patient
specifically requests otherwise. Pediatric patients may, of course, be called by their first
name.

When transporting a patient through the hospital, please make sure the patient is properly
covered and the monitors are visible to you.

Reading
Texting or reading of ANYTHING (cellphone, iPad, anesthesia literature, textbooks,
board review books, journals, and newspapers) IS NOT PERMITTED DURING THE
ADMINISTRATION OF ANESTHESIA (GA, REGIONAL, MAC). One-page
summaries from any of the recommended reading texts, written notes regarding the
technique of anesthesia administration directly related to the present case, reference
materials of medications (PDR, package insert, MGH Handbook) is allowed. Brief
consultation from a technology aide is allowed. In certain cases, residents may be
allowed to read literature related to cardiac anesthesia, during cardiac cases when patients
are on cardiopulmonary bypass. This perquisite is granted to residents who have had
adequate experience on the cardiac service, show and demonstrate an understanding of
the preparations necessary to come-off bypass and discuss with his/her attending his/her
desire to "read" during bypass.

42
Confidentiality
When speaking to other residents, surgeons, attendings, nurses and ancillary staff,
professional conduct must be maintained, always. When disagreements, disputes or
misunderstandings arise, they must be discussed in private, away from patients' sight and
hearing ranges. Strict confidentiality of all patients must be guarded. Discussions of
patients and their medical conditions are never permitted in elevators, hallways, cafeteria,
etc. Never discuss one patient in the presence of other patients or visitors. Patient
confidentiality is a hospital-wide and federal legal issue (HIPAA) and part of the
Hippocratic Oath. Please refer to the medical staff/resident bylaws for additional
information.

Communication
Residents must be reachable throughout their clinical day, whether at the ORMC campus
or on away clinical rotations. Residents are provided pagers while taking trauma call.
Residents are also provided with iPhone cell phones. These phones and pagers must be
on and carried throughout the day while on campus, as they are the primary means of
communication within the Operating Room suite. We ask that all residents carry their
phones while on rotations at other institutions as well, as it allows for easier
communication between the program and the resident.

Residents will be assigned an HCA email address; this will be used to communicate vital
information about the academic program, including changes to schedules and other
information about general professional duties. Residents must check their email
regularly to avoid missing important information. Residents will be held
accountable for missing information sent out by the residency office if they do not
check their email!!

Residents are required to inform the program of any home address changes and telephone
numbers, which is used in part to formulate a departmental phone list. This information is
not released to any individuals external to the institution. Residents must inform the
Residency Coordinator immediately of any changes to this information.

Clinical
Residents are expected to set up their cases and prepare their patients in time for the
scheduled time. Residents should start preparation for the day by 0600-0630 at the latest,
and earlier for complex cases. Residents are responsible for checking their anesthesia
machine and monitors and setting up before each case. They should check the carts to
make sure the necessary equipment and drugs are available.

43
Appropriate orders must also be written and informed consent must also be obtained.
Each resident is expected to know the details of their patient, whether or not they
personally evaluated them. Each case must be discussed with the attending
anesthesiologist beforehand. Traditionally, this is done the evening before, in person or
by telephone. Resident and attending dialogue before the morning of surgery has many
advantages. Residents will have a solid "plan" to work with, which facilitates room set-up
and medication preparation in the morning. Cases, in general, proceed more smoothly
when anesthetics, techniques, preferences and special requirements are discussed. All
residents should contact their attendings the night/afternoon before surgery, unless
otherwise instructed. Being post-call or having a fellow resident perform the pre-
operative anesthesia evaluation is NOT an excuse for inadequate patient knowledge
or poor preparation.

Inpatient preoperative assessments are the responsibility of the resident assigned to the
case.

Residents will make post-operative rounds on all of their own patients. A post-operative
note must be written with date and time in the patient’s charts within 48 hours of the
anesthetic. Patients who have had an epidural or spinal anesthetic should be seen on the
first post-operative day. Follow-up visits should be made to any patient with an
anesthesia-related problem and appropriate notes written in the Progress notes.

To ensure the efficient running of the OR schedule, the Anesthesiologist in Charge must
know the whereabouts of each resident at all times. Therefore, before leaving the OR,
residents must check with the Anesthesiologist in Charge. Residents must have their
beepers on at all times while in the hospital.

Proper Documentation
The perioperative paperwork that is completed for each patient is important not only
because it becomes part of a patient's permanent medical record, but also because it
provides the necessary information for billing purposes. If this paperwork is not
completed accurately, completely, and in a timely fashion, the billing department cannot
collect fees for the services rendered. It is the dual responsibility of the resident and the
attending to correctly complete all required paperwork, so please ask if you have any
questions! The person in ORMC campus who follows documentation and billing
compliance is Valerie Fountain, Site Billing Coordinator (phone: 352 401-1414)
Emails: [email protected] or
[email protected]
She reviews all paperwork, and will find you if yours in incomplete or
missing.

44
All items of the Anesthesia Record need to be completed in a very neat and readable way.
The date and times must be crystal clear.
Example: Date: MONTH/DAY/YEAR
Time: 24 Hour Clock

The DATE is the date during which the case begins. The Start Time is the time
from which you are continually in attendance with the patient. The Stop Time is the time
immediately after you have given report to the receiving staff (PACU, ICU etc.) and
prepare physically to leave the presence of the patient. If you stay in the ICU/PACU to
stabilize, monitor, assess, or recover a patient, this time should be included in the
anesthesia time. This extended time must be monitored on the record. The time ends
when you physically leave the side of a patient to start another task. Please use a 24-hour
clock. Example: 1:00PM is 1300, 6:00PM is 1800, and 10:00PM is 2200. This way, if a
case is started at 2315 and ends at 0335, it is very clear to the billing processor that the
case extended from one day (24-hour cycle) into the next.

The Operative Diagnosis must match the surgeon's diagnosis exactly. The best way to get
this when it is not obvious is to ask the surgical attending and/or the circulating nurse,
who is responsible for entering the same information into the OR Information System.
Diagnoses are nouns: Cholelithiasis, crush injury to the hand, tibia fracture, ruptured
spleen, end stage renal disease, etc. NOT s/p MVA, s/p EXP LAP.

The Surgical Procedure, as well, must be identical to that indicated on the Operative
Record. When in doubt, ask your attending.

Antibiotics must be administered within the hour prior to incision. Please make sure you
record all antibiotics and times on the record. In addition, notify the circulating RN so
that she may enter the information in the OR data collection system.

Your signature must be legible. All documents requiring your signature must also include
your degree (M.D., D.O. etc.) and your pager number. All the documentation, including
Anesthesia Consent, REQUIRES co-signature of the Attending Anesthesiologist.

Anesthesia related complications reports must be written within 24 hours of the

anesthetic.

The Clinical Anesthesia Report of Events Form must be completed on all patients who
have had an anesthetics and placed in the appropriate billing box located in the PACU.
This sheet will be found attached to each Anesthesia Record.

45
The Clinical Anesthesia Report of Events Follow up Form must be completed on all
patients who have had an anesthesia related complications and placed in the box located
in the PACU. This sheet will be found at the inpatients preoperative desk. The reports are
reviewed for discussion at the Quality Improvement

Case Logs
Residents are required to keep an accurate record of their clinical experience and to log
the procedures they undertake during their residency. As case logs are required by most
hospitals for credentialing processes, it is advantageous that residents maintain accurate
case logs.

Case logs must be electronically entered on the ACGME website at

https://www.acgme.org/residentdatacollection on a regular basis. It is extremely
important that case log data be entered as soon as possible – do not wait until the last
minute to add your cases. It becomes overwhelming. Case logs are reviewed by the
Program Director quarterly and reviewed by the Clinical Competency Committee
annually. The accuracy of these case logs is essential to ensure that residents successfully
complete their training. Minimum numbers of cases are required in many areas (see
below).

If a resident finds he/she is falling behind in his/her requirements in a particular area,

every effort will be made to assign them to particular operating rooms to make up the
deficit. Any concerns about case numbers should be addressed to the Program Director.

ABA Case Requirements for the Anesthesia Resident During the 3-year
Residency:

• 40 anesthetics for vaginal delivery, with evidence of direct resident involvement

in cases involving high-risk obstetrics

• 20 cesarean sections.

• Anesthesia for 100 children <12yrs. Within the group, 20 must be less than three
yrs., including 5 less than 3 months of age

• 20 patients undergoing cardiac surgery; the majority must involve use of

cardiopulmonary bypass

• 20 patients undergoing open or endovascular procedures on major vessels

(excludes vascular access or repair of vascular access)

• 20 patients undergoing non-cardiac intrathoracic surgery (pulmonary, surgery of

great vessels, esophagus, mediastinum and its structures)

• 20 patients undergoing intracerebral procedures, including intracerebral

endovascular procedures. Majority of procedures must involve an open cranium

46
• 40 patients undergoing surgical procedures, including c-sections, in whom
epidural anesthetics are used. Use of a combined spinal/epidural technique may be
counted as both

20 patients undergoing procedures for complex, life-threatening injuries (trauma,

penetrating wounds, burns > 20% of body surface area).

• 40 patients undergoing surgical procedures, including c-sections, with spinal

anesthetics

• 40 patients undergoing surgical procedures in whom peripheral nerve blocks are

used as part of the anesthetic technique or perioperative analgesic management

• 20 new patients who are evaluated for management of acute, chronic or cancer
pain

• Documented involvement with acute pain management, including familiarity

with patient-controlled intravenous techniques, neuraxial blockade or other pain-
control modalities

• Documented involvement with preoperative evaluation for at least 4 weeks

• Significant experience with a broad spectrum of airway management techniques

(performance of FOI, LMA, DLT, endobronchial blockers); significant
experience with central line and pulmonary artery catheter placement, and the use
of TEE and evoked potentials. The resident must either participate in cases in
which EEG or processed EEG monitoring is used (not BIS), or have adequate
didactic instruction to ensure familiarity with EEG use and interpretation.

• 2 weeks continuous post anesthetic care experience

• Critical care training. (4 months distributed throughout the curriculum in order

to provide progressive responsibility)

• Experience in providing anesthesia for patients undergoing diagnostic or

therapeutic procedures outside of the surgical suites.

For further details see the ACGME website http://www.acgme.org, follow the
drop down menu to Anesthesiology Review Committee and follow the link to the
Program Requirements.

47
Evaluations
Residents are responsible for reviewing their evaluations quarterly in meetings with their
mentors

Residents are responsible for completing the yearly Program Evaluation, as well as the
end-of-month rotation and site evaluations.

Residents are responsible for completing the confidential Faculty Evaluation form each
year, as well as the confidential monthly rotation faculty evaluation.

Residents are responsible for developing an individualized study plan with the assistance
of their mentor.

All evaluations are done through the web-based MedHub system. Residents will
receive reminder emails with a link to the system

Attendance
Residents must sign in for each conference. Residents are expected to attend regularly
within the confines of the Duty Hours requirements, regardless of which site or rotation
they are on. Exceptions to attendance include vacation, illness, post-call, ICU rotations. A
minimum attendance of 70% of all lectures which an individual resident is allowed to
attend (given work hours regulations) is expected. If the expected minimum of 70% is not
met, then a remediation period may be required for that particular resident. Residents
rotating in the ICU will be expected to attend ICU conferences preferentially.
Conferences and Grand Rounds are telecast by Webex Meeting system.

Scholarly activity requirements

By the end of the CA-3, the resident should have completed a major academic project
that can include: a paper published on an anesthesiology/critical care journal; a chapter in
an anesthesiology/critical care book; a Quality Improvement project.

Each training year, the resident should submit an abstract to either national or local
anesthesiology/critical care conference

48
ACGME recommendations
The ACGME (Accreditation Council for Graduate Medical Education) recommends the
following Resident Responsibilities:

• Develop a personal program of self-study and professional growth with

guidance from the teaching staff.

• Participate in safe, effective and compassionate patient care under supervision,

commensurate with their level of advancement and responsibility.

• Participate fully in the educational activities of their program and, as required,

assume responsibilities for teaching and supervising other residents and students.

• Participate in institutional programs and activities involving the medical staff

and adhere to established practices, policies and procedures of the institutions.

• Participate in institutional committees and councils; especially those which refer

to patient care review.

49
 RESIDENT EVALUATIONS

It is expected that all residents will demonstrate a steady maturation in clinical skills and
competence throughout their training. It is important that residents receive timely
feedback on their performance from the faculty. Residents who are not making
satisfactory progress will be informed of the situation promptly by their mentor and/or
program director, with discussion and implementation of remediation efforts. Residents
who demonstrate exceptional ability will be recognized and encouraged to continue such
exemplary behavior. In order to maintain the standards of the Anesthesiology Residency
Program, a process for evaluating the resident’s performance and Department teaching
has been established. All evaluations are done via a web-based evaluation tool referred to
as MedHub, with monthly reminders to both faculty and residents re: pending
evaluations.

The purpose of these evaluations is to:

• Assess
• Monitor the progress of the resident’s knowledge, judgment and skills.
• Assess the resident’s ability to effectively communicate both clinical and
didactic material, whether oral or written.
• Recommend promotion.
• Provide remedial work when necessary.
• Recommend remediation/dismissal
• Use as a basis for appropriate changes in the curriculum and clinical teaching.

The evaluation process is based on a resident’s performance in all of the

following measures;
• ACGME general competencies
• Essential Attributes as defined by the American Board of Anesthesiology

Mechanisms for evaluation

Daily Feedback/Evaluation
All attendings are asked to provide residents with feedback and commentary about their
performance on a daily basis. Ideally this should take the form of a brief conversation at
the end of the day (formative evaluation). Residents should then remind/ask the faculty to
complete a written daily evaluation. Residents are expected to ask their attending to
provide feedback at the end of each day

Faculty are strongly encouraged to report any concerns (verbally or in writing), however
minor, to the program director or chair of the CCC so that patterns of behavior can be
recognized promptly. The program director will make a written notation of any verbally

50
reported concerns, and will confer with the resident advisor. If the situation is deemed
significant, the PD and/or advisor will speak with the resident.

Clinical Rotations
Supervising faculty are encouraged to perform daily or per/case written or verbal resident
feedback and evaluation. In addition a monthly evaluation is required from either the
general faculty, or those involved in a particular resident’s specialty rotation. These
evaluations are directly accessible to the resident. The MedHub data is collated every
three months and distributed to each resident and the resident’s advisor as part of the
quarterly mentor-mentee meetings. Written summary evaluations are available on
MedHub website to residents at the end of each rotation. These are also used in the
Milestone assessments

Mentors
Each resident will be paired with a Mentor who is a member of the clinical faculty, and
who meets with the resident formally at least quarterly. The assignment of a Mentor is
made by Program Director. The Mentor for the resident usually remains the same for the
three years of Residency, but may readily be changed by request of either the resident or
faculty member. The Mentor assists the resident in formulating a study plan and
recommends texts and other reading. The Mentor is also available for problems the
resident may encounter during residency, in addition to reviewing the quarterly
evaluations with their advisee.

Topics for discussion at the quarterly meetings include review of the resident portfolio;
the evaluations for the individual rotations; scores on standardized tests such as the In-
Training Exam; progress at satisfying the ABA case-log requirements; reading materials.
At these meetings the resident’s future plans may be discussed, as well as a plan for
independent study. This meeting will provide the residents with the opportunity to give
direct feedback on how the program is meeting the resident’s needs. A written summary
of each meeting will be submitted to the resident’s portfolio.

Learning Portfolio
Residents are required to maintain an experience and learning portfolio vis MedHub.
These portfolios are not only of benefit during training, but also serve as documentation
of experience when applying for employment, medical licenses, and medical staff
credentials following residency. There are a number of sections, which the residents are
asked to keep up to date with the assistance of the Residency Coordinator. These sections
include evaluations, case logs, records of academic assignments, presentations, self-
assessments from Mock Oral Exams and QIC presentations. As portfolios are developed,
residents will be asked to bring their up-to-date portfolio to each mentor-mentee meeting

51
and review of this will form the basis for that meeting, together with the written form
completed by the advisor.

Clinical Competence Evaluation

All new residents have their first general evaluation by the Clinical Competence
Committee at the end of August to assess readiness to complete Tutorial and enter the
regular resident work schedule. Subsequent evaluations are at three-month intervals.
If a resident has an unsatisfactory evaluation or problems are anticipated, the resident is
evaluated formally on a monthly basis for at least three months. After this time, the
Clinical Competence Committee will decide the frequency of evaluation.
The evaluations are discussed by the Department Clinical Competence Committee, which
is currently chaired by Dr. Brit Smith. On the basis of discussion, the Committee decides
whether a resident may continue in training, requires a remediation program, or must be
dismissed from the program.
The Clinical Competence Committee meets every 6 months to review all evaluations.
Every 6 months, a CCC report must be filed with the ABA (January 31st and July 31st)
certifying that each resident displays the ABA Essential Attributes. The Milestone data
must be reported to the ACGME every 6 months as well. .
The resident’s mentor discusses individual evaluations with the resident during the
quarterly advisor/advisee meetings. When issues exist, the Residency Program Director
will also discuss the evaluations with the resident. A summary of the discussion is written
and signed by both resident and faculty advisor. The signed summary is kept in the
resident’s portfolio.
Residents experiencing problems must understand that faculty members will be notified
of the nature of the problems if appropriate, so that proper supervision can be maintained
at all times. This must be done to ensure patient safety.

American Board of Anesthesiology essential attributes

Clinical Competence Report
Every 6 months the residency program submits a clinical competency report to the ABA.
This may be satisfactory or unsatisfactory. The attributes reported to the ABA in this
report are described below. If a resident receives an unsatisfactory report for the last 6
months of training, or 2 consecutive unsatisfactory reports, the ABA requires that the
resident completes additional training before a satisfactory certificate of clinical
competence is awarded.

Essential Attributes (Must all be satisfactory for an overall satisfactory report)

1. Demonstrates high standards of ethical and moral behavior
2. Demonstrates honesty, integrity, reliability, and responsibility.
3. Learns from experience; knows limits.

52
4. Reacts to stressful situations in an appropriate manner
5. Has no documented abuse of alcohol or illegal use of drugs during this report period
6. Has no cognitive, physical, sensory or motor impairment that precludes acquiring and
processing information in an independent and timely manner.
7. Demonstrates respect for the dignity of patients and colleagues, and sensitivity to a
diverse patient population.

Examples of problems that result in actions by the CCC are outlined below:
Problems that have frequently been a cause for concern as indicated in faculty
evaluations:
• Failure to pass the USMLE step 3/COMLEX 3 prior to December of the CA-1 year

• Failure to pass the BASIC exam prior to starting your CA-3 year

• An unsatisfactory or marginal report at the conclusion of a rotation

• Inability to provide appropriate clinical care such as poor judgment; lack of vigilance

• Inability to multitask and/or lack of situational awareness

• Failure to call for help in an appropriate and timely manner

• Failure to respond to constructive criticism and feedback in an appropriate manner

• Poor attendance at lectures, conferences and didactic teaching

• Failure to complete required training exercises and comply with hospital and program
requirements (licensing, mandatory curriculum, etc)

• Failure to report duty hours and follow other departmental or hospital policies and
procedures
• Complaints either verbal or written from patients, other physicians or members of staff.
The minimum level of response to any substantiated written complaint by a patient,
member of staff or any risk management issue will be Focus of Concern status.

53
 ACGME CORE COMPETENCIES
These encompass six broad areas: patient care; medical knowledge; practice-based
learning and improvement; interpersonal and communication skills; professionalism and
systems-based practice. Broad examples of expected performance include, but are not
limited to the following:
Patient Care
• Provides complete and thorough preoperative evaluation and optimization of all patients
• Develops an appropriate anesthetic plan including selection of monitors, anesthetic
agents and plan for postoperative analgesia for every patient;
• Pays attention to intraoperative course and adjusts care appropriately (e.g. fluid balance,
level of anesthesia and analgesia)
• Responds appropriately and in a timely manner to critical events (e.g. unexpected
difficult airway / hypotension / hypertension / arrhythmias / decreased O2 sats / high
airway pressures / failed block / anaphylaxis / hypovolemia etc, etc)
• Demonstrates good judgment and calls attending appropriately
• Maintains a safe environment (proper labeling of syringes / ordered lay out of
anesthesia cart)
• Evaluates patients postoperatively
• Adequately documents all aspects of care provided

Medical Knowledge
• Understands physiology, pathophysiology and pharmacology as it applies to anesthesia
• Understands the basics of evaluation and treatment of common medical and surgical
diseases
• Is able to interpret laboratory and diagnostic tests.
• Is capable of appropriately modifying anesthetic care based on the status of the patient's
medical conditions.
• Properly utilizes and interprets monitoring and other medical equipment.

Technical Skills
• Performs technical procedures with dexterity (e.g. intubation, line placement, and
regional anesthetic techniques)
• Always well prepared for technical procedures, (cart set up, appropriate pt monitoring
etc)
• Performs technical skills with regard for patient safety and comfort
• Demonstrates ability to explain procedures and possible complications to patients using
appropriate language
• Asks for assistance appropriately
• Understands complications of procedures and proper management of complications
• Demonstrates organizational skills such as efficient case turnover and case starts.

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Practice-based Learning and Improvement
• Reads about unfamiliar patient care situations
• Formulates questions when unclear how to integrate knowledge into clinical practice
• Learns from clinical experiences and direct teaching
• Recognizes and corrects gaps in knowledge & expertise
• Locates, appraises & applies scientific evidence to patient care
• Actively teaches and mentors other learners
• Regularly attends conferences, didactic teaching and grand rounds

Interpersonal and Communication Skills

• Develops a therapeutic relationship with patients and families
Considers cultural and language differences in interpersonal interactions
• Keeps clear and concise preoperative, intraoperative & postoperative records (writes
legibly)
• Communicates and establishes good relationships with peers; attendings; surgeons;
nurses; and other health professionals
• Maintains composure in stressful situations
• Projects competence and confidence
• Provides therapeutic direction and leadership, where appropriate
Professionalism
• Demonstrates appropriate concern for patients
• Shows a commitment to excellence
• Behaves in an ethical manner
• Shows honesty and integrity
• Is reliable and conscientious
• Demonstrates respect for coworkers
• Is punctual
• Is diligent in completion of documentation
• Functions appropriately in a team
Systems Based Practice
• Demonstrates effective operating room management
• Understands cost-effective practice
• Provides efficient and safe turnover of cases.
• Consults and delegates effectively
• Appreciates the role of other Units in providing patient care (pre-anesthesia clinic,
PACU, ICU)
• Functions as a team member with health care providers from other disciplines
(surgeons, nurses)
• Participates fully in quality improvement (CQI) activities

55
 AMERICAN BOARD OF ANESTHESIOLOGY CERTIFICATION
Definition of ABA Diplomate
A board-certified anesthesiologist is a physician who provides medical management and
consultation during the perioperative period in pain medicine and in critical care
medicine. A diplomate of the Board must possess knowledge, judgment, adaptability,
clinical skills, technical facility and personal characteristics sufficient to carry out the
entire scope of anesthesiology practice independently, without accommodation or with
reasonable accommodation.

An ABA diplomate must logically organize and effectively present rational diagnoses
and appropriate treatment protocols to peers, patients, their families and others involved
in the medical community. A diplomate can serve as an expert in matters related to
anesthesiology, deliberate with others, and provide advice and defend opinions in all
aspects of the specialty of anesthesiology. A board-certified anesthesiologist is able to
function as the leader of the anesthesiology care team.

Because of the nature of anesthesiology, the ABA diplomate must be able to manage
emergent life- threatening situations in an independent and timely fashion. The ability to
independently acquire and process information in a timely manner is central to ensure
individual responsibility for all aspects of anesthesiology care. Adequate physical and
sensory faculties, such as eyesight, hearing, speech and coordinated function of the
extremities, are essential to the independent performance of the board-certified
anesthesiologist. Freedom from the influence of or dependency on chemical substances
that impair cognitive, physical, sensory or motor function is also an essential
characteristic of the Board- certified anesthesiologist.

Certification Requirements
At the time of certification by the ABA, the candidate must:
A. Hold an unexpired license to practice medicine or osteopathy in at least one state or
jurisdiction of the United States or province of Canada that is permanent, unconditional
and unrestricted.
B. Have fulfilled all the requirements of the continuum of education in anesthesiology (a
clinical base year and 36 months of approved training in anesthesia).
C. Have on file with the ABA a Certificate of Clinical Competence with an overall
satisfactory rating covering the final six-month period of clinical anesthesia training in
each anesthesiology residency program.
D. Have satisfied all examination requirements of the Board.
E. Have a professional standing satisfactory to the ABA
F. Be capable of performing independently the entire scope of anesthesiology practice
without accommodation or with reasonable accommodation

56
Absence from Training
The total of any and all absences may not exceed 60 working days (12 weeks) during the
CA 1-3 years of training. Attendance at scientific meetings, not to exceed five working
days per year, shall be considered a part of the training program. Absences in excess of
those specified will require lengthening of the total training time to the extent of the
additional absence. A lengthy interruption in training may have a deleterious effect upon
the resident’s knowledge or clinical competence. Therefore, when there is an absence for
a period in excess of six months, the Credentials Committee of the ABA shall determine
the number of months of training the resident will have to complete subsequent to
resumption of the residency program to satisfy the training required for admission to the
ABA examination system.

Overview Staged Examinations

The staged examinations of the Primary Certification Examination System were designed
to better support the movement toward competency-based training in graduate medical
education. The staged examinations consist of three distinct parts: the BASIC
Examination, the ADVANCED Examination and the APPLIED Examination.

A. The BASIC Examination, which will be administered at the end of a resident’s

CA-1 year, focuses on the scientific basis of clinical anesthetic practice including
content areas such as pharmacology, physiology, anatomy, anesthesia equipment
and monitoring. The content outline available at www.theABA.org provides a
detailed description of the covered topics. The examination is offered twice each
year. Residents must pass the BASIC Examination to qualify for the
ADVANCED Examination. The Board strongly encourages residents to register
and take the BASIC Examination as soon as they meet the eligibility
requirements.

B. The ADVANCED Examination, which will be administered after graduation

from residency training, focuses on clinical aspects of anesthetic practice
including subspecialty-based practice and advanced clinical issues. The content
outline provides a detailed description of the topics covered, which is inclusive of
the topics covered in the BASIC Examination. Candidates must pass the
ADVANCED Examination to qualify for the APPLIED Examination

C. The APPLIED Examination is designed to assess the candidate’s ability to

demonstrate the attributes of an ABA diplomate when managing patients
presented in clinical scenarios, with an emphasis on the rationale underlying
clinical management decisions. These attributes include sound judgment in
making decisions, proper management of surgical and anesthetic complications,

57
appropriate application of scientific principles to clinical problems, adaptability to
unexpected changes in the clinical situations, and logical organization and
effective presentation of information. The APPLIED Examination includes two
components: a Standardized Oral Examination (SOE) and an Objective Structured
Clinical Examination (OSCE).

1. The SOE is an oral assessment using realistic patient cases with two
Board-certified anesthesiologist examiners questioning an examinee in
a standardized manner. These examinations assess clinical decision-
making and the application or use of medical knowledge with realistic
patient scenarios.
2. The OSCE is a series of short, simulated clinical situations in which a
candidate is evaluated on skills such as history taking, physical exam,
procedural skills, clinical decision-making, counseling,
professionalism and interpersonal skills. Both components are
administered by directors of the Board and other ABA diplomates who
assist as associate examiners. For the OSCE component, candidates
will participate in a seven-station circuit to evaluate their proficiency
in seven of the nine skills listed in the OSCE Content Outline, which is
available on the ABA website. Each OSCE encounter will be eight
minutes long, and candidates will have four minutes between stations
to review the next scenario. The OSCE portion of the APPLIED Exam
will take 84 minutes from start to finish.

Candidates will receive a separate score for each component of the APPLIED
Examination - the SOE and the OSCE. If one component is failed, the candidate
will retake only the failed component. Candidates must pass both components of
the APPLIED Examination to become Board certified.

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 EXAMINATIONS AND EXAM PREPARATION
In-Training Examination
All CA-1, CA-2 and CA-3 residents are expected to take the ABA/ASA In-Training
Exam given every year. Currently the exam is given over several days in February.
Residents on call will be relieved of their duties. The Program will assist the resident with
the application and will be responsible for the fee. The exam is only given once per
year. All residents are expected to take the exam.

ABA Basic and Advanced Board Examination

Residents are reminded that they are WHOLLY RESPONSIBLE for their application to
the Basic and Advanced Board Examinations. Requests for applications should be made
early in the CA-1 and CA-3 years. The ABA requires a full medical license in any US
state or at least the passing of the USMLE Step III in order to be eligible to take the
Advanced written examination. The resident is responsible for meeting the deadline and
for the examination fee.

Anesthesia Knowledge Test (AKT)

CA-1 residents will take the AKT Pre-Test during orientation lecture time, the Post-Test
after 30 days of training and the AKT-6 test after their first six months of training. In
addition, they will be required to take the AKT-24 exam after 24 months of training. The
results of these exams are for the resident’s self-evaluation, and are not used to make any
advancement decisions.

Department Mock Oral Examinations

Mock oral exams are given during a time protected session on a Tuesday afternoon. Each
resident in the program is examined at least twice per academic year. At the end of each
session, the resident is asked to complete a self-assessment of his performance, including
areas of strength, weakness, and knowledge deficits.

Written Board Review

Once a week, there is a written Board Review using questions already compiled or from a
Board Review Course. Key words are also reviewed using an Anesthesia Review Book.

USMLE Exam
It is necessary to pass USMLE 3 before registering for the Anesthesiology Basic Exam
that occurs in June of the CA-1 year.

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 CA-1 TUTORIAL

 Duration: 8 weeks

 Sites: WM/NFRMC/ORMC General OR’s

 First two weeks: lectures and simulation

 Last 6 weeks: Clinical Experience

 OSCE assessment: at the end of Tutorial residents will complete a simulation

based OSCE assessment

 Evaluation: at the end of the Tutorial the Clinical Competency Committee will
recommend the resident ready for two to one supervision or remediation and
continued one on one supervision. This will be based on attending evaluations and
OSCE performance.

 Faculty will provide one-on-one mentoring

 CA-1s will receive verbal feedback from their Tutors throughout the week, as
appropriate, as well as at the end of each week.

Expectations of CA-1 Residents:

• Attend the CA-1 Introduction to Anesthesia Lecture Series.

• Participate in goal-directed learning by completing the CA-1 Tutorial Intra-operative

Didactics with your Tutor.

• Discuss cases with your Tutor the night before.

Goals of the CA-1 tutorial month

The goal of the CA-1 Tutorial is to acquire the fundamental knowledge, as well as
cognitive and technical skills necessary to provide safe anesthesia. The following are
essential cognitive and technical skills that each CA-1 resident should acquire by the end
of their first month.

• Preoperative Preparation:

Perform a complete safety check of the anesthesia machine.

60
 Understand the basics of the anesthesia machine including the gas delivery
systems, vaporizers, and CO2 absorbers.

Set up appropriate equipment and medications necessary for administration of

anesthesia.

Conduct a focused history with emphasis on co-existing diseases that are of

importance to anesthesia.

Perform a physical examination with special attention to the airway and

cardiopulmonary systems.

Understand the proper use of laboratory testing and how abnormalities could
impact overall anesthetic management.

Discuss appropriate anesthetic plan with patient and obtain an informed

consent.

Write a pre-operative History & Physical with Assessment & Plan in the chart.

• Anesthetic Management

Placement of intravenous cannulae. Central venous catheter and arterial

catheter placement are optional.

Understanding and proper use of appropriate monitoring systems (BP, EKG,

capnography, temperature, and pulse oximeter).

Demonstrate the knowledge and proper use of the following medications: i.

Pre-medication: Midazolam ii. Induction agents: Propofol, Etomidate iii.
Neuromuscular blocking agents: Succinylcholine and at least one non-
depolarizing agent iv. Anticholinesterase and Anticholinergic reversal
agents: Neostigmine and Glycopyrrolate v. Local anesthetics: Lidocaine
vi. Opioids: Fentanyl and at least one other opioid vii. Inhalational
anesthetics: Nitrous oxide and one other volatile anesthetic viii.
Vasoactive agents: Ephedrine and Phenylephrine

Position the patient properly on the operating table.

Perform successful mask ventilation, endotracheal intubation, and LMA

placement.

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 Recognize and manage cardiopulmonary instability.

Spinal and epidural anesthesia are optional.

Record intra-operative note and anesthetic data accurately, punctually, and

honestly.

• Post-operative Evaluation

Transport a stable patient to the Post Anesthesia Care Unit (PACU)

Provide a succinct anesthesia report to the PACU resident and nurse.

Complete the anesthesia record with proper note.

Leave the patient in a stable condition.

Make a prompt post-operative visit and leave a note in the chart (optional but
strongly encouraged).

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 Suggested checklist for CA-1 tutorial intraoperative didactics

Week One ___________ Discuss GOR Goals and Objectives for CA-1

___________ Discuss etiquette in the OR

___________ Discuss Proper Documentation

___________ Discuss Proper Sign-out

___________ Discuss Postop-orders

___________ Machine Check

Week Two ___________ Standard Monitors

___________ Inhalational Agents

___________ MAC & Awareness

___________ IV Anesthetic Agents

___________ Opioids

___________ Intraoperative Hypertension & Hypotension

___________ Neuromuscolar Blocking Agents

Week Three ___________ Difficult Airway Algorithm

___________ Fluid Management

___________ Transfusion Therapy

___________ Hypoxemia

___________ Electrolyte Abnormalities

___________ PONV

___________ Extubation Criteria & Delayed Emergence

63
Week Four ___________ Laryngospasm & Aspiration

___________ Oxygen Failure in the OR

___________ Anaphylaxis

___________ Local Anesthetics

___________ ACLS

___________ Malignant Hyperthermia

___________ Perioperative Antibiotics

64
 CA-1 SAMPLE TUTORIAL DIDACTIC SCHEDULE
Date Lecture Time Lecturer
7/1/2019 Substance Abuse 8:00-8:50a Dr. Crimi
7/1/2019 OR Set up 9:00-9:50a Dr. Crimi
7/1/2019 Anesthesia Billing/Charting 10:00-10:50a Dr. Doyle
7/1/2019
Introduction to Research 11:00-11:50a Dr. Toklu
7/1/2019
Preop Assessment 1:00-3:00p Dr. Crimi
Dan Hatlestad -
7/2/2019
GE Anesthesia Machine Course 8-3p GE
Basic Airway and Central Line:
7/3/2019
Lecture and Skill Lab 8-3p Dr. Crimi
7/4/2019 Informed Consent 8:00-8:50a Dr. Crimi
7/4/2019 MAC/Sedation 9:00-9:50a Dr. Pretto
7/4/2019 MAC/Sedation 10:00-10:50a Dr. Pretto
7/4/2019 ASA Monitoring 11:00-11:50a Dr. Crimi
7/5/2019 Meds: Pre-Induction 8:00-8:50a Dr. Heinbockel
7/5/2019 Meds: IV Induction 9:00-9:50a Dr. Heinbockel
7/5/2019 Meds: Inhaled agents 10:00-10:50a Dr. Heinbockel
7/5/2019 Safety in Anesthesia 11:00-11:50a Dr. Heinbockel
7/08/2019 Meds: Opioids 8:00-8:50a Dr. Crimi
7/08/2019 Meds: NMBDs & Rev. 9:00-9:50a Dr. Crimi
7/08/2019 Monitoring NMBD 10:00-10:50a Dr. Crimi
7/08/2019 Patient Positioning 11:00-11:50a Dr. Crimi
7/09/2019 Anaphylaxis 8:00-8:50a Dr. Turner
7/09/2019 Fluid & Blood Mgmt 9:00-9:50a Dr. Turner
7/09/2019 Intraoperative Hypotension
and Hypertension 10:00-10:50a Dr. Turner
7/09/2019 Hypoxemia 11:00-11:50a Dr. Turner
7/10/2019 Emergence & Delay 8:00-8:50a Dr. Crimi
7/10/2019 Electrolyte Abnormalities 9:00-9:50a Dr. Crimi
7/10/2019 PONV 10:00-10:50a Dr. Crimi
7/10/2019 MH/ Hypotermia and
Shivering 11:00-11:50a Dr. Crimi
Administration of General
7/11/2019
Anesthesia 8:00-8:50a Dr. Crimi
7/11/2019 Local Anesthetics 9:00-9:50a Dr. Crimi
7/11/2019 Spinal/Epidural Anesthesia 10:00-10:50a Dr. Crimi
7/11/2019 Ethics and Professionalism 11:00-11:50a Dr. Crimi

65
 EDUCATIONAL TOOLS

Recommended Books
1. Basics of Anesthesia 7th Edition RD Miller (also known as baby Miller)
2. Morgan and Mikhail’s Anesthesiology 6th Edition
3. Stoelting’s Anesthesia and Co-exisiting Disease 7th Edition
4. Anesthesiologist’s Manual of Surgical Procedures RC Jaffe 5th Edition
5. Clinical Anesthesia Procedures of the Massachusetts General Hospital, 9th Edition

CLINICAL TIPS

PERIOPERATIVE PLANNING

Procedure:
• Surgical Considerations
• estimated blood loss, CM, T&S
• patient position
• special considerations (e.g., pneumoperitoneum)
Anesthetic Considerations:
• cardiovascular
• respiratory
• neurologic
• renal
• hematologic
• other
Vascular access
• size of IV cannula
• type of fluid
Pre-medication
Monitoring
• EKG
• SpO2
• BP
• capnography
• temperature
• urine output
Equipment
• machine
• laryngoscopes
• oral airway
• ETT with stylet

66
 • esophageal stethoscope
• NGT
• Suction
• mask
• nerve stimulator
• LMA for backup
Induction
• induction checklist (equipment, drugs, monitors)
• narcotic
• lidocaine
• sedative hypnotic
• neuromuscular blockade
• laryngoscopy, ETT
• confirmation of ETT location - ETCO2, auscultation
• secure tube
Maintenance
• gas mixture - air, N2O, oxygen
• inhaled agent
• paralytics
• narcotics
• fluid management (crystalloid, colloid, blood products)
Emergence
• discontinuation of anesthetic
• narcotics for pain control
• reversal of NMB
• testing of neuromuscular function
• evaluation of recovery of consciousness
• extubation
• assessment of adequacy of respiration
• mask oxygenation
Transport to PACU
• oxygen mask
• monitoring (respiration, BP, EKG, SpO2)
• PACU
• narcotics for pain control
• anti-nausea medication
• fluid management
• hemodynamic management

67
68
ANESTHESIA SEQUENCES
PREOP HOLDING
• Complete precise H&P
• Check preop labs/tests/prior anesthetics
• Complete optimization
• Verify Consent Laterality
• Get OK from Circulator to go to OR
• Check IV line: Dripping freely
• Mark Anesthesia Start Time: Signifies start of billing and you cannot leave
• patient once you start billing
• Premed
• Transport to OR
• Verify OR table locked
• Transfer to OR Table
• Do your best to keep patient warm. Ideally, BAIR hugger should be started before
induction for most patients.

PREINDUCTION
• MOM SAID: Quickly r/o sabotage
• Place SpO2 on PIV side: Want to know RA baseline
• Verify open APL: Hard to breathe w APL closed
• Start PreO2: Turn O2 flow 10L/min. Verify EtCO2 w each breath and exh Vt on
ventilator. PreO2 takes a while, start early, the more the better. Consider black
strap.
• Place NIBP on opposite arm from PIV and SpO2: We don't want cuff interfering
w IV or with plethysmography Cycle cuff Cycle cuff q1min during periods of
potential instability like induction, otw q2.5-5m
• Place ECG White on the Right. Smoke over Fire. Snow on the Grass.
• Place Nerve Stim Opponens pollicis (ulnar n.) easy to block, hard to
• reverse. Need preblock baseline. Do not monitor direct musc. stim of flexors.
Monitor opposition of thumb.
• Assess PreO2: EtO2>80% w good CO2 tracing and registered Vt. If mask seal
inadequate, you will be sampling delivered gas rather than exhaled.
• Assess pt position Optimize bed height, sniff position, RAMP if
• necessary.
• Review VS Verify SpO2, BP, HR, Rhythm is appropriate. Print rhythm strip if
any abnormalities.

PREINDUCTION CHECKLIST
• Machine 30cmH2O x 10s and release, ventilate bag @ low flow, absorbent,
volatile supply
• O2: O2 backup tank >1000psi w Mapleson
• Monitors What do I need? Is it avail and working? SpO2, BP cuff, ECG, Temp
probe, Nrv Stim, art line etc.
• Suction Yankauer, Tubing, Canister, Neg pressure. OGT.

69
 • Airway Airway - Mask, tube, stylette, blades, oral airways, bite block, steth,
backup LMA, bougie. Think about plan B, C.
• IV IV - extra IV start kit, bag w primed tubing. Fluid warmer? Pumps? Infusions?
• Drugs Drugs - Lido, midaz, fentanyl, Roc/Vec, Sux, Prop x 2, Phenylephrine,
Ephedrine, Abx

INDUCTION
• Fentanyl : Consider starting w opiates so that they have time to work.
• Lidocaine: Watch your IV as you give drugs to ensure it isn't infiltrating
• Propofol: Don't need to give it all at once unless RSI Consider test ventilation
Controversial. Always omitted in RSI.
• Check baseline: TOF It's painful so wait until your pt is anesthetized
• Paralyze: Any contraindications to Sux. No paralysis for LMA.
• Mask Ventilate Optimize via oral AW and sniff position: Adjust APL to keep PIP
< 20cm H20, verify EtCO2, exhaled Vt
• Check VS and TOF: Verify SpO2, BP, HR, Rhythm and depth of anesthesia
• is appropriate. IF BP or HR high, consider additional IV or inhaled agent. If BP
low consider pressors vs laryngoscopy.
• DL when paralyzed: Consider LTA if avoiding tachycardia. Describe view
• to others (epiglottis, Gr 2 view etc), practice improving view w external laryngeal
manipulation with every intubation.
• Place ETT cuff just past cords: Keep view after intubation and verify the ETT
cuff is through cords.
• Confirm placement Chest rise, fog, EtCO2, R then L breath sounds in axilla
• Secure ETT
• Connect circuit
• Turn on vent and volatile: Verify settings (reasonable default 7cc/kg, RR10,
• PEEP 5)
• Review VS: Don't forget to look again at ECG, Twaves, ST segments, rhythm.
• Give antibiotics Could also give decadron if using for PONV
• Place temp probe, OGT Also place Bair Hugger
• Set flows
• Move TOF to ulnar nerve: Ensure you are assessing thumb opposition not direct
• muscle stimulation of hand flexors
• Check pressure points
• If arms are tucked, check that IVs and a-line still functions well. Double check
that all connections are tight (IV, art line, circuit)

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PRE-EXTUBATION CHECKLIST
• Airway Reintubation equipment and rx, Absence of edema or bleeding in or
around airway, Suctioned and bite block or oral airway in place.
• Breathing Oxygenation: SpO2 appropriate to FiO2, Ventilation: EtCO2 < ~55
mmHg, Mechanics: Vt > 5cc/kg, RR < 30
• Circulation BP HR controlled
• Depth Awake or Deep not in between, Awake=following commands,
Deep=Unresponsive to ETT manipulation with a steady, regular ventilation
pattern.
• Exchange Exchange catheter needed?
• Force TOF (opponens pollicis) >1/4 prior to reversal, TOF 4/4 w 5 sec ST after
reversal, 5 sec head lift

ANESTHESIA DO'S
 Do assume vital sign changes are REAL until proven otherwise. Don't just assume
artifact!
 Do call your attending if someone from the surgical team asks you to do
something you are uncomfortable with.
 Example - Pulling an endotracheal tube when you have +ETCO2 and the patient
is pink despite the O2 sat not picking up and the surgical attending telling you the
tube is not in.
 Do read your medication vials carefully (and double-check), including drug name,
dosage, and expiration date. Medication errors happen all the time!
 Do not do anything else while drawing up your medications.
 If someone is trying to talk to you while you are drawing up your drugs either
tell them to wait, or stop drawing up the drugs.
 Do make sure the laryngoscope light is working before you use it to intubate.
Always check all of your airway equipment prior to inducing anesthesia.
 Do check (and double-check) your infusion settings when using drips in the OR.
Example - Programming phenylephrine infusion to mcg/kg/min instead of
mcg/min will lead to gross overdosage.
 Do make sure your patient is adequately reversed and spontaneously ventilating
before extubation.
 Do use caution when inserting a nasal trumpet into a patient who is on Asa,
Plavix, or anticoagulant agents. The nose can bleed extensively!
 Do know that insulin vials contain 100 units/ml and MUST be diluted. Always re-
check the patient's blood glucose shortly after administering insulin.
 Do know that epinephrine and vasopressin vials contain MUST be diluted before
administering to a non-coding patient.
 Do provide or obtain a thorough sign-out before the transfer of care of a patient to
another provider. Errors due to transfer of care occur all the time!

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ANESTHESIA DON’TS
 Don't try to pre-oxygenate your spontaneously breathing patient with the pop-off
valve closed.
 Don't forget to turn on the ventilator after intubating a patient.
 Don't forget to provide anesthesia after paralyzing/ intubating a patient.
 Don't try to manage the airway alone with the bed turned away: Example: Trying
to convert a nasal rae to an oral endotracheal tube with the bed turned 90 degrees
away - when the nasal rae is pulled, the oral/nasal cavities fill with blood, no
suction ready or within reach, unable to obtain a good laryngoscopic view due to
blood, difficult mask ventilation due to blood in upper airway.
 Don't give hemabate or methergine IV (always IM) -this applies to OB anesthesia.
 Don't push anything through an arterial line – especially drugs. It is also wise to
avoid re-administering the "wasted" blood back through the arterial line to avoid
inadvertent injection of air. You can give this blood back through a venous line.
 Don’t let yourself get behind when a patient is bleeding. Check Hgb/ABG q30
min during any ongoing blood loss and keep in mind your patient’s estimated
allowable blood loss.
 Don’t hook up hotline tubing to a patient without priming/flushing it first.

TIME OUT
Regional anesthesia/analgesia
A HARD STOP TIME OUT with the preop nurse is mandatory prior to placing a
block/epidural.
Epidurals and regional blocks are often placed in the holding area.
Communication with the surgical team with regards to the anesthetic plan is important
especially if a block or epidural is not previously indicated in the schedule. This can also
be discussed with the surgeon the day prior to the surgery especially for the first case to
avoid unnecessary confusion and delays. If the surgeon initiates a request for a block this
will be indicated on the OR schedule – either on the printed/online schedule or written on
the white board.
All consents must be completed before sedating. The family SHOULD be asked to wait
in the waiting room for procedures. Anesthesiologists are responsible for all sedatives
and narcotics for blocks and a-lines in the Preop holding.

Operating room
1. Room Entry: Check In by the circulating nurse (name, date of birth, MR number
and surgical procedure is reconfirmed).

72
 The patient can be moved to the OR bed and monitors applied if a surgical team
member is not present but do not induce until they are present and have
confirmed the procedure.

2. Hard Stop Time Out: A final time out is initiated by the circulating nurse just
prior to incision. All personnel are required to stop what they are doing and
participate in the time out.

LEAVING THE OR
Post-Anesthesia Care Unit (PACU)
At the end of the case the circulating nurse calls the recovery room for a spot. Once the
recovery room confirms a spot, the patient is transported to the PACU. A complete sign
out is given to the PACU nurse and the PACU anesthesia resident, if present. The
Anesthesiologist assigned to the case in the OR is also responsible for the patient in
PACU and can be paged for complex issues.
The first pages of the Anesthesia Record is included in the patient’s chart. The second
pages (yellow) go in the dedicated box in PACU, and the third pages in the dedicated box
at the front desk.. PACU orders are entered in POE on the computer.

ICU
If the patient needs ICU care post op, the circulating nurse in the OR calls the bed
facilitator who then assigns an ICU room. If beds are temporarily not available the patient
is transferred to the PACU with appropriate monitors (EKG, pulse ox, blood pressure).
Please call as soon as you know that the patient needs an ICU bed to give the bed
facilitator time to secure a bed.

Preparation for the following case starts during the first case. This helps to minimize turn
over delays. Approximately half hour prior to end of surgery the next patient is put on
call by the circulator. The expectation is to get the next patient ready as efficiently as
possible.

TRANSPORT PACU TO ICU

Critically ill patients are transported from PACU to Critical Care Units using transport
monitoring equipment.

73
The ultimate goal is to minimize transport time and achieve the safe passage of the
patient

Prior to transport, critically ill patients require the following:

A. Transport Monitor
B. Functioning intravenous line
C. Supplemental O2 based on patient’s airway status
D. Mask and Ambu Bag
E. Airway Bag
F. Assessment with appropriate monitoring to evaluate hemodynamic parameters
G. Emergency drugs
H. Defibrillator if medically indicated

TRANSPORT FROM ICU

If the patient is in the ICU as indicated on the OR board the anesthesia team is required to
transport the patient from the ICU with a surgical team member.

Equipment needed for transport

 IV bag with Anesthesia tubing
 Transport monitor from the work room.
 Emergency medications.
 If the patient is on multiple pressors some staff find it is easier to transport them
with the ICU infusion pumps instead of changing them over to the anesthesia
infusion pumps..
 If the patient is ventilator dependent on high levels of PEEP the respiratory
therapist will assist in the transport with an ICU vent. All other patients who do
not require special vent settings are transported by the anesthesiologist.
 Please inform the floor manager if additional help is required in transport.
 Check the consent.
 Finally call the OR for readiness before leaving the ICU.

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 University of Central Florida College of Medicine/HCA Graduate Medical
Education Consortium Ocala Regional Medical Center
Anesthesiology Residency Program

Resident Transition of Care Policy

Policy
The Anesthesiology Residency Program in accordance with Envision Anesthesiology transfer of care
policy and procedures will utilize the TEMPO handoff tool to ensure adequate transfer of care.

Transitions of care are necessary in the hospital setting for various reasons. The transition/hand-off
process is an interactive communication process of passing specific, essential patient information from
one caregiver to another.
Transition of care occurs regularly under the following conditions:
• Change in level of patient care, including inpatient admission from an outpatient procedure or
diagnostic area or ER, transfer to or from a critical care unit, transfer to the nursing staff in the post
anesthesia care unit (PACU).
• Temporary transfer of care to other healthcare professionals when provided with relief during an
anesthetic for a surgical or diagnostic procedure, including shift changes, meal breaks, or changes in on-
call status
• Discharge, including discharge to home from the PACU
• Change in provider or service change, including rotation changes for residents.

The transition/hand-off process must involve face-to-face interaction with both verbal and written
communication. The transition process between anesthesia providers in the O.R. should include, at a
minimum, the following information in a standardized format that is universal across all services:

• Identification of patient, including name and date of birth

• Identification of attending surgeon or primary physician
• Diagnosis and current status/condition of patient
• Recent events, including changes in condition or treatment, current medication status, recent lab
tests, allergies, anticipated procedures and actions to be taken.
• Review of patient history and physical exam
• Review of written anesthetic record to include:

SITUATION
Patient’s diagnosis, procedure, notable past history, allergies, abnormal lab values, CXR, EKG, Anesthesia
technique

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STATUS
Anesthetic course, antibiotic doses
Progress of surgical procedure
Fluids and blood products given; estimated blood loss, urine output, IV lines, a. lines, ports, etc.
Present level of anesthesia – stable or requiring more or less
Labeling of drugs and concentrations on administration apparatus and syringes
Controlled substances status; availability and accurate recording for administration thus far
Current gas flows, anesthetic concentration, reading of oxygen analyzer, cylinder and pipeline supply
pressures
Clinical signs and vital signs before original anesthesia provider exits

FUTURE
Need for anesthetics, fluids, other medications
Availability of blood products
Plan for post-operative respiratory and medication support
Time when the relieved anesthesia provider will return
Pending tests and studies which require follow up
Changes in patient condition that may occur requiring interventions or contingency plans

RECORD
Time of relief exchange and reliever’s name on anesthetic record
If the transition is for permanent relief, the “patient status board” and all other OR personnel should be
updated to the personnel change

The transition process which occurs outside of the OR should include, as applicable, the following
information presented in an organized fashion:

Identification of patient, including name, medical record number, date of birth, allergies
Identification of attending surgeon or primary physician
Diagnosis and current status/condition of patient
Important prior medical history, DNR status and advanced directives
Recent events, including changes in condition or treatment, current medication/fluid/diet status, recent
lab tests and results, anticipated procedures and actions to be taken
Specific protocols/resources/treatments in place (DVT prophylaxis, insulin, anticoagulation, restraints,
etc.)
Pending tests and studies which require follow up
Important items planned between now and discharge

CA-1 residents during their orientation in July and August are instructed in proper handoff procedures
for transferring a patient to the nurse’s care in the PACU and for accepting relief from other anesthesia
providers in the operating room.

76
The CA-1 residents specifically receive instruction and the opportunity to model proper handoff
procedures for transferring a patient to the nurse’s care in the PACU and for accepting relief from
another anesthesia provider in the operating room during their first several weeks of experience in the
ORs.

Each CA-1 resident will be evaluated in the simulation lab for his/her ability to complete a proper
patient transfer of care (hand-off) and/or will be observed individually by their faculty supervisor to
assess their hand-off skills. Each resident will receive feedback regarding the proper technique to ensure
that necessary information is transferred and understood by the team member who is receiving the
patient. Intrinsic to the on-going faculty supervision of patient care during anesthesiology resident
training, feedback, albeit frequently completed informally, about patient care, including hand-off skills,
will be on-going.

Transfer of care report forms are utilized in the transfer of cardiac surgery patients to CVICU. Every
anesthesiology resident involved in a transfer of care in the above situations will be observed
individually by their faculty supervisor to assess their hand-over skills. The Anesthesia Report Form must
be completed accurately, and reviewed with the receiving nurse in the ICU. The resident will receive
feedback regarding the proper technique to assure that necessary information is transferred to the
team member who is receiving the patient

77
Transition and action
x OR to PACU/ICU
x Immediate actions that are pending (i.e. blood transfusion, drips, pending consults, etc.)

Evaluation and significant history

x Medical co-morbidities and status (PM/AICD)
x Recent acid-base analysis
x Assessment of the adequacy of oxygenation and ventilation
x Review of the most current laboratory values
x Intravenous and arterial access
x Airway management plan
x Code Status

Medications:
x Drips and medications that have been administered and are currently being administered
x Sedation, analgesia, and PONV plans

Procedure and condition

x Diagnosis and procedure
x Condition (hemodynamically stable, acidotic, coagulopathies, intraop labs, etc)
x Surgical pathology and performed procedures
x Hemodynamic status and stability

Overall plan
x Special recovery orders/ Disposition (ICU, Tele, Floor)
x Post-op pain management plan, include dosing and effect
x Post-op orders related to our care/anesthetic plan
x Other CONCERNS

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 Tempo Handoff Tool
Background

“More than 40 million patients undergo surgery in the United States annually and are
subsequently transferred to a PACU or ICU for recovery.

These transfers are [often] characterized by poor teamwork and communication, patients
arriving in a compromised state, unclear procedures, technical errors, unstructured processes,
interruptions and distractions, lack of central information repositories, and nurse inattention
because of multitasking” [1]. Though causality remains unproven, poor-quality, nonstandardized
handovers and perioperative adverse events are associated. [2]

An analysis of 3548 sentinel events occurring between 1995 and 2005 performed by the tJC
demonstrated that “inadequate communication between care providers is consistently the main
root cause of sentinel events”. Indeed, failures in communication represented greater than 60%
of all root causes [3]. Given these results, in 2006, the tJC initiated National Patient Safety Goal
#2 with the purpose of encouraging accredited institutions to create standardized hand-off
procedures in an effort to enhance healthcare provider-to-provider communication.

A repeat analysis of sentinel event root causes in 2010 demonstrated that failures in
communication were still the number one cause. Taken together, these data prompted tJC to
publish a Sentinel Event Alert regarding the import of communication failure [4] and now
required institutions seeking tJC accreditation to implement standardized hand-off procedures.
Post Anesthesia Care Unit/ICU Handoff:

When patients are brought to the recovery room (PACU)/ICU, the Anesthesia Professional will
provide a comprehensive, structured, and standardized report to the PACU/ICU RN including all
of the details contained within the handoff checklist. While all of the listed details are of import,
detailing any specific concerns is critical. Please be sure to ask your PACU/ICU RN if he or she
has any questions regarding the procedure, anesthetic, patient condition, or the orders.
Furthermore, please be sure the PACU/ICU RN has your direct contact information.

The anesthesia record must detail that a formal patient handoff occurred following arrival in the
PACU/ICU.

References:

79
Background by Josh Bloomstone, M.D.

1. Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D, et al. (2012) Can we make
postoperative patient handovers safer? A systematic review of the literature. Anesth Analg
115:
102-115.

2. Bloomstone, J. Human’s Fail: Checklists Don’t. 19:Dec 2015

https://www.sciforschenonline.org/journals/clinical.../JCAM-1-104.php

3. (2007) The Joint Commission Improving America’s Hospitals: The Joint Commission’s Annual
Report on Quality and Safety. The Joint Commission 29: 3.

4. The Joint Commission (2010) Delays in treatment. Sentinel Event Alert 26: 1-2.

5. Sectish TC, Starmer AJ, Landrigan CP, Spector ND; I-PASS Study Group. Establishing a
multisite education and research project requires leadership, expertise, collaboration, and an
important aim. Pediatrics. 2010;126(4):619–622.

80
 UCF/HCA Resident Documentation Requirements:

You are responsible for all aspects of electronic charting on your patients, including
reviewing all clinical information and notes of other physicians and ancillary staff regarding
your patient. Although copying prior notes may help to save time and track changes, it is
unacceptable to leave unedited or outdated information. Remember the medico-legal adage
"If it's not in the chart, you didn't do it". Charting is the evidence that you are seeing your
patients and managing their care. Every single chart entry must be signed, and correctly
time-stamped! All your documentation must be signed by the supervising attending.

History and Physicals

The intern completes an H&P using the appropriate template. The Attending thoroughly
reviews the intern note to assure accuracy notifies the intern of any corrections that may be
needed. The attending writes a separate short note, documenting a brief HPl, pertinent exam
and correction of potential deficiencies in the findings of the intern, assessment, and plan.
The attending must also document the level of supervision "Patient seen and examined and
chart reviewed plan discussed with resident and agree with Assessment and plan". The
Attending is expected to review and make changes to orders as needed, and supervise the
intern appropriately to advance the intern's education and ensure the highest quality patient
care. These need to be finalized within 12 hours of admission.

Daily Progress Notes

These are the primary responsibility of the intern unless the intern is off. The Attending
() should read and give feedback about the intern notes each day. If significant information is
left out of the intern note, it is expected that the Attending will write an addendum to make it
more complete.

Follow up notes
If you return to check on a patient or there is a change in the plan of care based on your
discussion with the attending or consultant, then a follow up note or addendum to the prior
note, needs to be entered.

Cross Cover
If you are called to assess a patient, a note must be entered describing the current subjective
and objective information and your assessment and plan.

Orders
You are responsible for placing your own orders into the computer. Verbal orders (that is, an
order told to a nurse in person without being input into CPOE) should only be used during
an emergency. If verbal orders are given to a nurse, those orders will be sent to your inbox
and must be signed within 24 hours. Extended delays can result in notices from medical
records and the loss of your privileges.

Consults
If you are requesting a consult, you must call the consulting physician personally to discuss
the patient. If you are on a consulting team, including general IM or subspecialty service, you
19
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83
 Protocol Requiring Faculty Involvement:
Care of Complex Patients, ICU Transfers and DNR
UCF College of Medicine/HCA Anesthesiology Residency Program

I. Patients with complex issues

Complex patients require a team approach. There is an attending surgeon and back-up
attending physician on call every day of the year. The attending rounds daily and will
oftentimes round at least twice per day. During in-house call, all attendings are
expected to be available for the entire call period to either evaluate the patient or to
answer any questions concerning patient care. When at home, the attending will have
electronic access to the patient charts, radiographic imaging, and other pertinent clinical
information such as laboratory values. All attendings will come into the hospital
whenever the residents need assistance. Regardless of time of day, all complex patients
are to be evaluated by both the resident and attending.

II. ICU and PACU Patients

All patients who are critically ill or requires transfer to the intensive care unit (ICU) will
be immediately presented to the attending. The attending is expected to formally
evaluate the patient with the resident regardless of post graduate year. All patients in
the post-operative anesthesia care unit (PACU) will be evaluated by the resident
involved with the surgical procedure. If there is an unexpected clinical episode such as
refractory tachycardia, hypotension, or hypoxia the resident will present this
immediately to the attending. The attending will evaluate the patient at bedside for the
definitive plan and final disposition.

III. Invasive Procedures and Operations

The need for any invasive procedures will be made with the attending. All invasive
bedside procedures will have a senior resident or attending supervising. All decisions to
operate will require attending approval. All interventions will be supervised and
attended by the attending physician.

IV. Do Not Resuscitate

The do not resuscitate order (DNR), do not intubate (DNI), or withdrawal order are to be
made under the direction of the attending after thorough discussion with the patient or
the patient’s health care proxy if they (the patient) is unable to render their own
medical decisions. Residents may enter the order on behalf of the attending, but the
attending must sign the order in order for it to be activated.

84
 University of Central Florida College of Medicine/HCA Graduate Medical
Education Consortium Ocala Regional Medical Center
Anesthesiology Residency Program

Moonlighting policy

Policy
Moonlighting, defined as work of any nature, with or without compensation, performed by a
resident outside the residency program, is strictly prohibited for Anesthesiology (CA-1, CA-2, CA-3)
residents.

85
 VACATION

American Board of Anesthesiology allows:

• 20 days off per academic year as a CA-1, CA-2 and CA-3

• 5 days for educational meetings per academic year, whether presenting or not

Unused vacation will not transfer into the next academic year. If you go over your allotted days off
per academic year, for any reason, it will be deducted from your next year’s allotment of time or
you must make it up at the end of your residency.

Rules/Regulations for requesting time off:

• Please submit all vacation/meeting/personal time-off requests within MedHub by April 15th prior to the
academic year starting in July. Preference for time off is honored in the order in which it is received.
Incoming CA-1 residents must submit vacation using the form sent by the Program Coordinator and
returned via email to the Program Coordinator.

• Please note that if you were approved for vacation time around a major holiday, you will not receive that
same vacation around that holiday the following year.

• Vacation changes or request made within the academic year must be made 45 days prior to planned
vacation

Educational absences for specialty conferences will follow the HCA Travel Policy.
• All conferences must be in the US.
Sick days:
• Any sick calls must be called in to the Attending Anesthesiologist in charge at the site you were to
be working. You must also let Program Coordinator know that you have taken a sick day.

• Any exceptions to these rules must come in writing through Program Coordinator to the
education/administrative team for review. You will receive written confirmation that your exception has
been approved or denied.
Vacations and meetings are not allowed during:

• July- September for CA-1 residents

• October during the week of the ASA conference
• ICU rotations
• Cardiac
• Chronic Pain
• Pediatric
• Obstetric
• Trauma

86
Extended leaves of absence must be approved by the Program Director, Department Chair, the GME
Office and the American Board of Anesthesia in writing.
MedHub is our primary source for submitting vacation, sick time, away conference, and administrative
day requests. Residents are required to submit all requests for time off through MedHub. Residents are
also required to contact their assigned attending/ site director, and program coordinator when
submitting sick days. The service must know when you are calling out sick.

Log into MedHub at https://ucfhca.medhub.com/ and look for the absence request form within the left-
hand column.

Once you are in the absence request form, please select the appropriate type of absence.

Special circumstances=

Sick Days still require you to call the attending/Site Director and program coordinator.

Travelling for interviews, board review, or requesting special accommodations such as “please no call on
x date due to family plans”, should be requested as Conference (away) and these will not count toward
your vacation dates. Please indicate in the ‘purpose’ or ‘other information section’ what you are
requesting.

87
 University of Central Florida College of Medicine/HCA Graduate Medical
Education Consortium Ocala Regional Medical Center
Anesthesiology Residency Program

Resident Work Hour and Work Environment Policy

Policy

The Anesthesiology Residency Program will schedule resident assignments in compliance with
all applicable ACGME requirements. Faculty members know, honor, and assist in implementing
the applicable work hour limitations. Residents comply with those limitations, accurately report
duty hours, and cooperate with duty hour monitoring procedures. All involved identify and
report sources of potential work hour violations, and collaborate to devise appropriate
corrective action. This policy is to be communicated to the residents and faculty annually and
applies to all participating sites where residents are trained. All residents must log their duty
hours no later than 7 days after the completion of each shift. At the beginning of each academic
year, the program director will review this policy, and update for any new changes with all the
residents and faculty.

This policy will be an extension of the “UCF Policies for Resident Supervision and Duty Hours", as
formulated by the Graduate Medical Education Committee (GMEC).

Work hours are limited by the following restrictions:

A. Maximum Hours of Work per Week

 Anesthesiology residents may not work more than 80 hours per week, when averaged
over any four-week period.
 This includes all in-house call activities and academic activities, clinical work done from
home, and moonlighting.
 Clinical work done at home: residents are to track time per week for work done at home
(such as completing EMR work, phone calls, excludes study and reading).

B. Mandatory Time Free of Work

 Residents must have one day (24-hour period) every week free of all duty when
averaged over the four weeks of the rotation.
 At-home call cannot be assigned on these free days.

C. Minimum Time Off between Schedules Work Periods

 All residents (CA-1, 2, or 3) should have 10 hours, and must have at least 8 hours free
from all clinical duties between schedules duty periods.
 Any CA-2 or CA-3 finishing a 24-hour shift must have at least 14-hours free of duty
immediately thereafter.

D. Maximum Duty Period Length

 No CA-1 may work more than 16 hours of continuous duty

88
  CA-2 resident and above may work no more than a 24-hours continuous duty. Strategic
napping is encouraged.
 Alertness management strategies are encouraged in the context of patient care, for
example strategic napping at night or after 16 hours of duty.
 A limited amount of extra time (<4 hours) may occasionally be allowed for safe effective
transitions in care and/or resident education (no new patients can be assigned).
 This 24-hour period may be extended in unusual circumstances to care for a single
patient by the resident’s own volition.
o Circumstances which may call for this voluntary extension includes, but is not
limited to, (a) continuity for a severely ill or unstable patient, (b) academic
importance of an event transpiring, or (c) the humanistic attention to the need
of a patient or family.
 A CA-2 or CA-3 may extend the eight-hour work-free period when called
upon to provide continuity of clinical care after one of the above
circumstances. Such exception must be determined in consultation with
the resident’s assigned attending physician.
o No resident may admit new patients or assigned new clinical responsibilities
after 24 hours of consecutive work.
o The care of all other patients must be handed over during this extension and
the reason for this extension documented using the resident work hour
violation justification form. The Program director will monitor these additional
service periods by individual resident and program-wide.

E. Maximum Frequency of In-House Night Float

 In-House Night Float must satisfy the requirement for one-day-in-seven free of work and
also satisfy the maximum 80 hour work week when averaged over four weeks.

F. Maximum In-House On-Call Frequency

 CA-1 residents will not take overnight in-house call.
 Overnight in-house call may not be more frequent than every third night, when
averaged over a four-week period for CA-2 residents and above.

G. At Home Call
 At-Home Call must satisfy the requirement for one-day-in-seven free of work.
 Time spent in the hospital by a resident on at-home call must be reported in, and count
toward, the 80-hours

Monitoring
 Residents are required to log their hours on-line, no later than 7-days after the completion
of each week.
 Work Hour reports will be generated and sent to Program Directors for monitoring and
corrective actions, if needed.
 Program Director, faculty, and residents will be educated to recognize the signs of fatigue
and instructed in the effects of sleep loss and fatigue

Work Environment:
Residents are not expected to provide support services such as intravenous access, phlebotomy,
laboratory and electrocardiogram testing and patient transport on a routine basis. Under

89
circumstances when these services are required on an urgent or emergent basis, residents may
provide these services to ensure patient safety. Call Rooms are maintained by the participating
sites for residents on call. These rooms are monitored for cleanliness and safety by the Hospital
and the Residency Program. Residents will be provided adequate working space and computers
at all the participating sites.

Fatigue Mitigation:

• Residents and faculty are educated on the professional responsibilities of physicians to

be appropriately rested when providing patient care.
• Residents and faculty will complete an online or in-person module on alertness
management, sleep deprivation and fatigue. They will also participate in an educational program
related to physician impairment and substance abuse.
• Residents are expected to take responsibility for determining if they are fit for patient
care duties and to recognize signs of impairment, including illness and fatigue.
• The program has an early and late stay accountability system to cover for residents who
are unable to provide safe patient care.
• In addition, the program has fatigue mitigation processes, including an option for
napping.
• Participating hospitals provide sleep facilities and transportation options for those too
fatigued to safely return home.
• Residents and faculty must demonstrate responsiveness to patient need that
supersedes self-interest and must recognize that patient interests are best served by
transitioning care to another qualified provider. They must be prepared to transition patient
care to other qualified and rested clinical providers in order to promote safe medical care.

90
 Work Hour Extension/Early Return to Duty Form

(IMPORTANT: This form must be completed during the duty hour period
in which the extension/early return was taken.)

Name of Resident: ________________________________________

Date of extension/early return: ____________________

Check one: ___ Length of Work Hour Extension: ______ hours

___ Early Return to hospital with fewer than 8 hours away

The above named resident on the above noted date remained on clinical service
for ______ hours beyond work hour standards.

Reason (check one and then give explanation):

___ Continuity of care for severely ill/unstable patient
___ Academic importance of events
___ Humanistic attention to patient/family

Explanation:

Were other patients handed off to other providers? ____ Yes ____ No

Resident Signature: _________________________________ Date Submitted: _____________

Administrative use only below:

Total duty hours during respective time period ______

Number of times this has occurred in past 6 months ______

Comments:

Program Director signature: __________________________________________

Date: __________________

91
 University of Central Florida College Of Medicine/HCA Graduate Medical
Education Consortium Ocala Regional Medical Center
Anesthesiology Residency Program

Conference and Educational Activity Attendance Policy

Policy

Resident Attendance

Daily Morning Keywords:

CA-1 residents and those retaking the ABA Basic Exam are required to have a
minimum of 75% attendance for daily morning keywords. This takes into account,
and is inclusive of, missed time due to clinical responsibilities, call scheduling, and
vacation time.

Attendance will be evaluated every May and November as part of the six month
review.

Residents failing to meet the 75% minimum for a six month period will:
1. Meet with the program director.

2. Receive a written warning regarding poor attendance.

Failure to meet the 75% minimum for a second consecutive six month period will:

1. Meet with the program director and department chair.

2. Result in an UNSATISFACTORY score in Essential Attributes on the Clinical

Competency Committee report.

Thursday morning conferences and lectures:

Residents are required to have a minimum of 60% attendance for all Thursday
morning conferences and assigned lectures. This takes into account, and is inclusive
of, missed time due to clinical responsibilities, call scheduling, and vacation time.

Attendance sheets will be available at all conferences for documentation.

Attendance will be evaluated every May and November as part of the six month
review.

Residents failing to meet the 60% minimum for a six month period will:

1. Meet with the program director.

2. Receive a written warning regarding poor attendance.

Failure to meet the 60% minimum for a second consecutive six month period will:

92
1. Meet with the program director and department chair.

2. Result in an UNSATISFACTORY score in Essential Attributes on the Clinical

Competency Committee report.

Mock orals, simulation sessions, and mock OSCEs:

Residents are required to have 100% attendance for assigned mock orals,
simulation sessions, and mock OSCEs. These activities are scheduled with clinical
responsibilities, call scheduling, and vacation taken into consideration as to not
create a schedule conflict. If any session is missed the resident is responsible for
rescheduling the activity with the organizing faculty member within six months to
avoid any further action.

Faculty Attendance:
Faculty are required to have a minimum of 60% attendance for all Thursday
morning conferences. This takes into account, and is inclusive of, missed time due to
clinical responsibilities, call scheduling, and vacation time. Faculty failing to meet
the 60% minimum for a six month period will meet with the department chair.

93
 University of Central Florida College Of Medicine/HCA Graduate Medical
Education Consortium Ocala Regional Medical Center
Anesthesiology Residency Program

Substance Abuse Policy

Policy

The Anesthesiology Residency Program acknowledges that chemical dependence is a medical

disease and untreated or relapsing chemical dependence is incompatible with safe clinical
performance in anesthesia. It shall be the duty of all members of the Department of
Anesthesiology and Perioperative Medicine to share their concerns about chemical dependence,
in themselves or other members of the department, in confidence, with the designated resource
person. The Program Director, or his/her designee (individual or group), shall act as a
confidential resource person on chemical dependence. The Program Director and his/her
resource group which may include all members of the Clinical Competency Committee, with
appropriate consultation, reasonably believe that any member of the department is suffering
from untreated or relapsing chemical dependence.

All residents in the department of anesthesia, as a condition of staff privileges, agree to accept
the Program Director’s decision with concurrence of his/her resource group on the diagnosis of
chemical dependence. Should the Program Director judge that a resident is suffering from active
chemical dependence, the member shall immediately be placed on medical leave of absence.

Should it be determined that the departmental member is not suffering from chemical
dependence, this diagnosis shall be expunged from his/her record and he/she shall be allowed
to return to work without prejudice. Resident medical insurance policies shall cover treatment
of chemical dependence. Return from medical leave from chemical dependence shall be
governed by departmental Chemical Dependence Re-Entry Policy (see below). The
Departmental policy on chemical dependence in NO WAY supersedes hospital or institutional
policy governing intoxication on duty or conviction of a felony.

Substance Abuse Re-Entry Policy

- Medical leave for treatment of chemical dependence shall become part of the resident’s
personnel file and shall be released only upon the written permission of that person,
except under the rare possibility that a court order be received to produce the
physician’s file.
- Should the Program Director, in consultation with a recognized specialist in chemical
dependence, determine that the performance of clinical anesthesia is incompatible with
the recovery from the disease of chemical dependence; the resident agrees to resign
from the department.
- Should the Program Director, in consultation with a recognized specialist in chemical
dependence, determine that the performance of clinical anesthesia is compatible with
recovery from the disease of chemical dependence; the resident shall sign a re-entry
contract before returning to practice.

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 - New members of the department of anesthesia, including residents, with a medical
history of chemical dependence shall sign the same re-entry contract before being
granted medical privileges.
- Residents returning after medical leave of absence for the treatment of chemical
dependence shall be required to function (work) only on day shifts (no on-call
responsibilities including nights, weekends, or holidays) until such time as the Program
Director determines the resident is suitable to assume full responsibilities within the
department.
- Relapse of chemical dependence will result in immediate termination of staff privileges
in the Department of Anesthesiology and Perioperative Medicine.

Substance Abuse / Re-Entry Contract

An actual re-entry contract should be drafted by legal counsel. The following points should be
considered. A re-entry contract must be signed with both UCF COM / HCA GME Consortium
Anesthesiology Residency Program and Sheridan HealthCorp.

- The member provides the department with the name of the physician treating him/her
for the disease of chemical dependence. The department must agree that the physician
is qualified in chemical dependence; if the department does not find the treating
physician acceptable, another qualified addiction specialist will be sought. The member
must give the physician permission to share all the information about recovery from
chemical dependence with the department on a confidential basis.
- He/she agrees to follow the recommendations of the primary physician including “after
care” programs, and continued abstinence from substance of abuse.
- The member pays all costs connected with his/her continuing medical treatment for
chemical dependence.
- He/she agrees to random blood and/or urine screens.
- All medical supervision and drug screening is done by a physician outside the
department of anesthesia. The outside physician must agree to perform appropriate
random screens and provide the results to the departmental chairman.
- Violation of the contract (e.g., evidence of self-medication of any type, positive drug
screen) will result in termination of medical privileges. The department still has the
option of reinstating privileges after further treatment. Relapse commonly occurs after
treatment and is not necessarily a grave prognostic sign. However, strong evidence that
the practice of anesthesia may not be compatible with recovery from this lifelong
disease.

In accordance with the aforementioned substance abuse policy, impaired residents will be
removed from clinical duties, enrolled in appropriate therapeutic programs, evaluated closely
for re-entry, and contracted upon re-entry with clearly delineated actions to be taken for
contract violations. For cases of re-entry, the Program Director will serve as the workplace
monitor. Note that although all efforts will be made to protect privacy and confidentiality, at
times situations may arise wherein other residents (if not the entire department) are aware of a
particular resident’s level of impairment. If this situation arises, if deemed appropriate by the PD
and/or DIO, and if the impaired physician is willing, this may be discussed in closed-session with
the department (residents and faculty) so as to address departmental concerns and to reinforce
knowledge and statistics of substance abuse and dependency amongst anesthesia personnel.

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 University of Central Florida College of Medicine/HCA Graduate Medical
Education Consortium Ocala Regional Medical Center
Anesthesiology Residency Program
Supervision of Residents and Faculty Responsibilities Policy
Purpose
The goal of this supervision policy is to provide an organized and integrated educational program
providing guidance and supervision of the residents, facilitate the residents’ professional and personal
development, and ensure safe and appropriate care for patients.

The anesthesiology residency training program will utilize standards and criteria for supervision of
residents as put forth by the Residency Review Committee for Anesthesiology of the Accreditation Council
for Graduate Medical Education.

This policy is an extension of the "UCF/HCA GME Consortium Policies for Resident Supervision and
Clinical/Educational Work Hours", as formulated by the Graduate Medical Education Committee (GMEC).

Supervision Policy

Residents are to be supervised by teaching staff in such a way that the residents assume progressively
increasing responsibility according to their level of education, ability, and experience.

The attending physician has the ability to enhance the knowledge of the resident and to ensure the quality
of care delivered to each patient by any resident. This responsibility is exercised by observation,
consultation, and direction.͘ Responsibility includes the imparting of the practitioner’s knowledge, skills,
and attitudes by the practitioner to the resident and assuring that the care is delivered in an appropriate,
timely, safe, and effective manner. Attending physicians are responsible for the care provided to each
patient and they must be familiar with each patient for whom they are responsible. Fulfillment of such
responsibility requires personal involvement with each patient and each resident who is providing care as
part of the training experience.

Each patient will be assigned an attending physician whose name will be clearly identified in the patient’s
health record.͘ It is recognized that other attending physicians may, at times, be delegated responsibility
for the care of a patient and provide supervision instead of or in addition to the assigned practitioner.

 Assignment and Availability of Attending Physicians: Within the scope of the training
program, all residents, without exception, will function under the supervision of an
attending physician. It is expected that an appropriately privileged attending will be
available for supervision at all times.
 The Residency Program Director will define the levels of responsibility for each year of
training by preparing a description of the types of clinical activities resident may perform
and those for which residents may act in a teaching capacity. The documentation will be
made available to other staff as appropriate.

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Levels of Supervision

Appropriate supervision of residents must be available at all times. Levels of supervision may vary
depending on circumstances or skill and experience of the resident.

Definitions relative to levels of supervision are:

1. Direct Supervision – the supervising physician is physically present with the resident and
patient
2. Indirect Supervision:
a. With direct supervision immediately available – the supervising physician is physically
within the hospital or other site of patient care, and is immediately available to
provide Direct Supervision.
b. With direct supervision available – the supervising physician is not physically present
within the hospital or other site of patient care, but is immediately available by means
of telephonic and/or electronic modalities, and is available to provide Direct
Supervision.
3. Oversight - The supervising physician is available to provide review of procedures/encounters
with feedback provided the care has been delivered

 All patient care must be supervised by qualified attending anesthesiologists. An attending

anesthesiologist is assigned to supervise a resident in all facets of patient care, including
preoperative assessment, intraoperative management, and immediate postoperative care.
 The responsible attending anesthesiologist must be present and immediately available
throughout all anesthetics, whether general anesthesia, regional anesthesia or monitored
anesthesia care. The responsible anesthesiologist must be present at, and document in the
anesthesia record, his/her presence at induction, key portions of the case, and emergence, as well
as periodic monitoring.
 Residents may not perform any procedure in a non-emergent situation, either during provision of
anesthesia in the Operating Room or consult within the hospital, unless supervised by an
anesthesiology attending
 Non-physician personnel do not participate in the clinical instruction or supervision of anesthesia
residents. Residents do not supervise other anesthesia personnel.
 Daily case management: Each resident must discuss the preoperative evaluation of the patient
and the anesthetic plan for the patient with the faculty member who is assigned to supervise the
resident. If the resident knows the assignment on the evening before the day of surgery, the
resident is required to contact the faculty member that evening to discuss the case

Supervision of Procedures

Diagnostic or therapeutic procedures require a high level of expertise in their performance and
interpretation. Although gaining experience in performing such procedures is an integral part of the
education for each resident, such procedures may be performed only by residents with the required
knowledge, skill, and judgement levels while under the direct supervision of an attending physician.
Examples include, but not limited to, pain procedures performed in the operating suites, fluoroscopy,
regional anesthesia techniques, and others. Excluded from the requirements of this section are

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procedures that, although invasive by nature, are considered elements of routine and standards of patient
care. Examples are the placing of intravenous and arterial lines.

Attending physicians are responsible for authorizing the performance of such procedures and such
procedures should are to only be performed with the explicit approval of the attending physician.
Attending physicians will provide appropriate supervision for the patients’ evaluations, management
decisions, and procedures. For elective or scheduled procedures, the attending physician evaluates the
patient and writes a pre-procedural note describing the finding, diagnosis, plan of treatment and/or
choice of specific procedure to be performed.

During the performance of such procedures, an attending physician provides an appropriate level of
supervision. Determination of this level of supervision is generally left to the discretion of the attending
physician within the context of the previously described levels of responsibility assigned to the individual
resident involved. This determination is a function of the experience and competence of the resident and
the complexity of the specific case.

Direct Supervision implies that the attending is physically present and assisting the resident through the
anesthetic plan.

Indirect Supervision implies that the attending physician has left the immediate anesthetic location,
operating room, but may be physically present within 5 minutes.

We require all residents to notify their attending of the following:

 Hemodynamic and/or cardiopulmonary changes

 Any adverse reaction to medication
 Requirement of additional intravenous access peripheral or central
 Requirement of additional hemodynamic monitors
 Changes in surgical plan
 Patient safety concerns and/or issues

All Supervisory faculty will give feedback at the termination of each procedure.

Emergency Situation

An “emergency” is defined as a situation where immediate care is necessary to preserve life or to prevent
serious impairment of the patient’s health.͘ In such situations, any resident, assisted by other clinical
personal as available, shall be permitted to do everything possible to save the life of a patient or to save
a patient from serious harm. The appropriate attending physician will be contacted and apprised of the
situation as soon as possible. The resident will document the nature of that discussion in the patient’s
record.͘

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Progressive responsibilities for patient care:

During the three-year training period the residents will assume progressively greater responsibility for
patient care and develop independence in patient management.

CA-1: Residents are expected to function in the role of a team member requiring direct supervision from
attending physicians and senior trainees. CA-1 residents are expected to evaluate patients and develop
and execute their management plan under close supervision from the supervising attending physician.
Residents should be assigned to cases in the operating room appropriate to their level of experience. In
the first few months of CA-1 residents will care for healthier, ASA1 and 2 patients and patients undergoing
minor to moderately complex surgical procedures. Towards the end of the CA-1 year residents may care
for sicker (ASA3) patients and patients undergoing more complex surgery. Upon occasion, CA-1 residents
may care for ASA 4 patients with direct (hands on) support provided by their attending.

CA-2: Residents participate in rotations caring for patients in the various subspecialty anesthesia areas.
Towards the end of the subspecialty rotation a greater autonomy for patient care is expected, and
residents should be the first point of contact for questions regarding patient care. Supervision by
attending physicians is required and consulted for any questions that residents can not immediately
answer. In the general operating rooms CA-2 residents care for complex patients undergoing surgery in
the general operating rooms. Non-operating room anesthesiology (NORA) areas include the CT & MRI
scanners, cardiac cath lab, electrophysiology suite, GI endoscopy suite, and interventional radiology
department.

CA-3: As senior residents, CA-3s are expected to assume of a leadership role, coordinating the actions of
the team, and interacting with nursing and other administrative staff. Senior residents are expected to
develop more autonomy for patient care in the development and execution of their management or
treatment plan, although ultimate responsibility for patient care lies with the supervising attending
physician. CA-3 residents care for the most complex patients in the operating rooms and care for patients
having off-site interventional procedures.

Along with the attending physician, senior residents provide for the educational needs of any junior
residents and students.

Supervision of Medical Students: Medical students are an integral part of the learning environment of
the residency program. Residents are expected to provide supervision, guidance and teaching to medical
students on clinical service. Anesthesiology residents may be assigned no more than one third year
medical student. Medical students must be supervised by residents through direct supervision at all times.
They are expected to take history and perform physical examination daily on their patients, as well as
review all relevant labs and imaging data. The resident supervising a medical student is expected to
provide regular feedback and teaching to their student, as well as evaluate their performance. Attending
physicians should be notified with any concern about medical student performance.

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Attending (Supervising) Faculty:

All Anesthesiologists serving as faculty members within the department of Anesthesia MUST be board
certified by the ABA or board eligible actively pursuing certification and within three years of graduation
from residency or fellowship.

Anyone not meeting this criteria is not considered for a faculty position and will not be involved in the
supervision or instruction of anesthesiology residents.

Responsibility of the Supervising Attending Faculty

1. Ultimately responsible for care of the patient and supervises all anesthesiology resident care.
2. Responsible for co-signatures of patient medical records as required by hospital policy.
3. Must require the resident to present the progress of each inpatient daily, including discharge
planning.
4. Must delegate portions of care to residents, based on the needs of the patient and the skills of
the residents.
5. The proximity and timing of the supervision, as well as the specific tasks delegated to the resident
physician depend on a number of factors, including:

a. The level of training (i.e., year in residency) of the resident

b. The skill and experience of the resident with the particular care situation

c. The familiarity of the supervising physician with the resident’s abilities

d. The acuity of the situation and the degree of risk to the patient

6. Must provide intraoperative teaching.

7. Breaks for residents: Short breaks (15 minutes) each in the morning and afternoon. Lunch break
is 30 minutes. During resident interview season, or for special events, please try to relieve the
resident at the announced time
8. Provide constructive Feedback at the end of day
9. Promptly complete Med Hub evaluation at the mid-point and end of rotation.
10. Lectures: ensure residents are relieved from clinical duties on assigned academic day.
11. Faculty members are expected to attend clinical discussions, rounds, journal clubs, and
conferences.
12. Faculty members are expected to attend faculty development scheduled for the first Thursday of
each month.
13. Faculty will be expected to develop scholarly activity (publication of original research or review
paper, presentation or publications of case reports at local, regional, or national professional and
scientific society meetings; participation in national committees or educational organizations;
peer-reviewed funding).
14. Faculty should encourage and support residents in scholarly activities.
15. Faculty will be expected to actively participate in the Mentorship Program.

Note: Senior residents should serve in a supervisory role of junior residents in recognition of their progress
toward independence, based on the needs of each patient and the skills of the individual resident

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Faculty Assignment

 Tutorial Assignment: 1 room with two residents

 Regular Rotation Assignment: 2 rooms with one resident per room
 Resident Coverage Time: 7:00 am – 5:00 pm subject to variability based on case needs and
scheduled call.
 Residents MUST attend program academic day on alternating Thursdays

Lines of Communication

Purpose

The purpose of this policy is to ensure consistent communication process in order to effectively manage
difficult or time dependent clinical or administrative process issues and to provide for timely and effective
patient care.

Policy

Circumstances and Events in Which Residents Must Communicate with Appropriate Supervising Faculty

In addition to the general circumstances encountered below, residents may at any time request direct
faculty supervision if uncertainty exists or if felt to be required by the resident. Residents are encouraged
to communicate with supervising faculty any time they feel the need to discuss any matter relating to
patient care.

Listed below are circumstances and events where residents must communicate with supervising faculty:

a. ICU and Critical Care transfers (both to and from unit)

b. Substantial change in the patient’s condition
c. Issues regarding code status (including DNR) and end of life decisions
d. If the resident is uncomfortable with carrying out any aspect of patient care for any
reason (for example, a complex patient)
e. If specifically requested to do so by patients or family
f. Prior to accepting transfers from other hospitals
g. To determine discharge timing
h. Prior to performing any invasive procedure requiring written consent
i. To discuss consultations rendered
j. If any error or unexpected serious adverse event is encountered.
k. When, after directly triaging a patient, they question appropriateness of an admission
or transfer.

In addition, to provide direction for anesthesiology residents in acute patient care situations when
immediate (or semi-immediate) clinical interventions (or administrative) are required.

 During normal working hours (6 am to 5 pm Monday through Friday) resident will communicate
directly with their assigned faculty regarding all clinical and administrative issues. Administrative

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 issues might include when or how to place a patient of DNR, transferring a patient (i.e. to an ICU)
or issues of compliance
 During the evening hours and on all weekends, junior residents (CA-1 or CA-2) may elect to
communicate to either the Chief resident or senior resident (CA-3) before communicating to the
on-call faculty. If the Chief resident or senior resident cannot resolve the issue, then the faculty
must be notified.
 For all educational academic or non-healthcare related issues, the resident should first
communicate the situation/problem with the chief resident. If the Chief Resident is not able to
solve the problem/issue then the resident should communicate to either the Associate Program
Directors or the Program Director.

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HCA Healthcare
N. FL Division 2019
2019-2020 GME Resident Travel Budget Directives
Cristin Hart, M.Ed.
GME Div. Director

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Table of contents
Types of Meetings and Terms and Approvals ............................................................................. 3
Eligibility and Reimbursed Expenses .......................................................................................... 4
Resident Travel Management ..................................................................................................... 5

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Resident/Fellow Travel Process
Resident/Fellow travel will be managed at the facility level and follow HCA/UCF Consortium guidelines.

Types of Meetings

 Educational Conferences: Trainees attending educational conferences through their program,

attendance decided by their program director, and are paid through program budget funds.

 Research/Scholarly Activity Conferences: Trainees attending educational conferences to

present a poster, podium presentation or other scholarly work. Approved by division research
director and funds paid through research budget.

Terms

 Local Meeting (within 5O miles): Registration provided. No lodging provided. $65.00 daily
educational stipend provided.

 Meetings over 5O miles from GME site: Lodging, mileage/flight and registration provided.
$65.00 daily educational stipend provided.

 International Meeting: International travel requires Division approval and provided expenses
are assessed based on location and cost.

Approvals

 Educational Conferences:
1) Known annual conference travel are to be submitted at the beginning of the academic year
(July 1) to the ADME for division pre-approval.

2) Educational conferences are managed through the program and follow the program
hospital’s travel request process.

3) Once CFO approval is obtained, Program Coordinators will book travel arrangements.

 Research/Scholarly Activity Conferences:

1) Scholarly activity to be presented at conferences must follow corporate approval processes,
to include obtaining a project ID and PubCLEAR submission number.

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 2) Once submission to conference is accepted, research travel form is to be completed and
sent to division research director for review and approval.
a. Note- request must include your projects PubCLEAR & project ID number.
3) Once approved by Division research director, approvals will be sent to coordinator, program
director, hospital CFO, and site ADME. Program Coordinators will book travel arrangements.

Eligibility

Consortium resident must be in good standing within their program and all conference travel must be
approved by the Program Director, ADME, Research Director and CFO prior to commitment.
• Consortium residents who have scholarly travel must follow the additional step of division research
approval.

Expenses
Travel

Airline tickets (round trip) to an approved conference will be covered up to $500. Air Fare must be
coach or economy. Airfare over $500, will require ADME approval.
Mileage - Residents driving to a conference should, whenever possible, carpool. Only the resident who
incurs driving expenses will be reimbursed at the mileage rate of $.445 per mile when a personal
vehicle is driven in lieu of flight.
Rental cars are to be booked by coordinator prior to approved travel. Only compact cars are reserved.

Lodging

Program Travel- Hotel expenses of standard rooms will be paid for at the program director discretion
and must be covered under the program budget. When two or more residents attend the same meeting,
sharing a room should be considered.

Scholarly Travel - Hotel expenses of standard rooms will be covered up to 300.00 per night, up to
three days. Max lodging 600.00 total. When two or more residents attend the same meeting, sharing a
room should be considered.

*If programs or residents would like for a trainee to stay at a conference longer than the 3 days covered
by the Research/Scholarly travel budget, the program will need to obtain the proper travel approvals
and cover the additional days through the program budget.

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Reimbursements
Reimbursements will be rare due to the daily $65.00 educational stipend. If the occasion arises, the
paid for item(s) require 1) written approval from PD, 2) Itemized receipts. Credit card statement will not
suffice.
Note: Educational stipends will be deposited by UCF directly into resident/fellow paychecks at the end
of each quarter.
Q1: Jan – March
Q2: April – June
Q3: July – September
Q4: October - December

Conference Registration
Program Travel- Conference registration will be paid for at the program director discretion and must be
covered under the program budget. Approved registration will be booked by coordinator.

Research/Scholarly Travel – Conference registration will be paid for up to $800.00. Request over
$800.00, require additional division research director approval. Approved registration will be booked by
coordinator.

Examples of expenses NOT COVERED, for which the traveler will be personally responsible:

Short-term rentals through AirBnB and other similar sites (per corporate policy)
Room service
Hotel rooms other than standard single rooms
Alcohol
Travel other than coach class
Personal travel insurance
Hotel amenities (Spa, mini bar, bottled water, exc.)
Taxi or rideshare, gas for personal vehicles.

107
 University of Central Florida College of Medicine/HCA Graduate Medical Education
Consortium Ocala Regional Medical Center
Anesthesiology Residency Program

Resident and Faculty Well-Being Policy

Purpose and Intent:
The Anesthesiology Residency Program is committed to complying with the ACGME the common program
requirements and any specialty requirements regarding well-being.
Policy Summary:
The program is aware that in the current health care environment, residents and faculty members are at
increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical in the
development of the competent, caring, and resilient physician. Self-care is an important component of
professionalism; it is also a skill that must be learned and nurtured in the context of other aspects of residency
training. The Anesthesiology Residency Program, in partnership with the Sponsoring Institution, have the same
responsibility to address well-being as they do to evaluate other aspects of resident competence.
Resident and Faculty Well-being Policy:
1. Psychological, emotional, and physical well-being are critical in the development of the competent, caring,
and resilient physician and require proactive attention to life inside and outside of medicine. Well-being
requires that physicians retain the joy in medicine while managing their own real-life stresses. Self-care and
responsibility to support other members of the health care team are important components of
professionalism; they are also skills that must be modeled, learned, and nurtured in the context of other
aspects of residency training.
2. Residents and faculty members are at risk for burnout and depression. Both residency programs and the
sponsoring Institution have the responsibility to address well-being as other aspects of resident competence.
Physicians and all members of the health care team share responsibility for the well-being of each other. For
example, a culture, which encourages covering for colleagues after an illness without the expectation of
reciprocity, reflects the ideal of professionalism. A positive culture in a clinical learning environment models
constructive behaviors, and prepares residents with the skills and attitudes needed to thrive throughout
their careers.
3. The responsibility of the UCF/HCA Healthcare Anesthesiology Program, in partnership with their Sponsoring
Institution, to address well-being includes:
a. Efforts to enhance the meaning that each resident finds in the experience of being a physician,
including protecting time with patients, minimizing non-physician obligations, providing
administrative support, promoting progressive autonomy and flexibility, and enhancing professional
relationships.
b. Attention to scheduling, work intensity, and work compression that influences resident well-being.
c. Evaluating workplace safety data and addressing the safety of residents and faculty members.
d. Policies and programs that encourage optimal resident and faculty well-being; These opportunities
include, but are not limited to:
i. Developing a basic understanding of the principles of balanced nutrition

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 ii. Developing a basic understanding of the impact environment has on health
iii. Developing a basic understanding of the principles of exercise and relaxation techniques iv.
Having a basic understanding of the principles of stress response management techniques
e. Opportunities to schedule and attend medical, mental health, and dental appointments.
f. Attention to resident and faculty member burnout, depression, and substance abuse.
4. There are circumstances in which residents may be unable to attend work and these circumstances include
but are not limited to family emergencies, parental leave, illness, or burnout/fatigue. The residency program
allows an appropriate length of absence for resident unable to perform their patient care responsibilities.
When a resident is unable to attending work due to these circumstances or they are unable to perform their
patient care responsibilities, the resident’s patient care responsibilities are covered by the program faculty
and/or peer or senior residents. Training time may be extended as appropriate.
a. This is implemented without fear of negative consequences for the resident.
5. The Anesthesiology Program, in partnership with its Sponsoring Institution, educates faculty members and
residents regarding resident well-being. Topics for education include:
a. Fatigue, sleep deprivation, burnout, depression, and substance abuse, including identification and
recognition of symptoms and means to assist those who experience these conditions.
b. How to alert the program director or other GME leaders of any concerns, including suicidal ideation
or potential for violence.
i. Residents and faculty members are encouraged to alert the program director or other
designated personnel of the program when they are concerned that another resident,
fellow, or faculty member may be displaying signs of burnout, depression, substance abuse,
suicidal ideation, or potential for violence.
c. Recognize those symptoms in themselves and how to seek appropriate care.
d. Resources and tools available through the residency program
6. Residents and faculty members are provided access to tools for self-screening.
7. Residents are provided 24/7 access to UCF Employee Assistance Program (EAP) regarding behavioral health,
including mental health assessment, counseling, and treatment (see below). The UCF EAP is strictly
confidential. Faculty have access to EAP programs through their employer.

Wellness Resources:
1. Trainee Orientation: Our health and wellness philosophy begins at trainee orientation. During trainee
orientation, our health and wellness philosophy is discussed with the incoming trainees. We also provide the
following presentations during trainee orientation:
a. Physician Burnout, Depression and Suicide
b. Physician Self-Care
2. Residents and fellows (Trainees) who desire counseling services may consult with faculty, program director,
the local GME office or the Consortium GME office. Confidentiality will be observed.
a. Counseling is provided through the UCF Employee Assistance Program. The purpose of this program
is to provide and maintain a positive work environment. This program provides short-term
counseling to trainees about the following concerns that may impact on their training performance:
stress, relationship difficulties, parenting issues, family illness, anger, burnout, anxiety, depression,
gambling, and substance abuse. Financial wellness, medical bill saver assistance, and referrals for
childcare and the elderly may also be available. Counseling discussions and records are confidential
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109
 and not included in the residency training files. Up to six sessions through the UCF employee
assistance program are provided as part of the benefits package. Additional needed sessions may be
coordinated through health care coverage as applicable. Trainees may self-refer or be referred by
the GME program. If performance in residency is affected by any problems, the program director or
faculty advisor may recommend referral.
b. UCF Employee Assistance Program: Health Advocate
To access services call 1-877-240-6863 or log onto
https://members.healthadvocate.com/Account/OrganizationSearch Login:
UCF
Password: UCF
3. Trainees have access to numerous online tools and resources via
https://med.ucf.edu/academics/graduatemedical-program/trainee-wellness-program/ This includes:
a. Assessment to evaluate how well the trainee is taking care of their overall wellness
b. Resources for various wellness related topics (e.g. alcohol screening tests, anxiety, burnout,
depression, self-compassion, stress, work life balance, and more information on alcohol disorders)
c. Suicide Prevention Lifeline number: 800-273-8255
d. UCF Employee Assistance Program Information
e. Additional Trainee Well-being Resources
i. Useful and relevant links, crisis resources, books and articles, GME Offices and Directors
ii. UCF Health and Wellness Resources for Faculty and Staff, UCF Financial Wellness Series
iii. Resident Forum iv. ACGME Resources

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 Second Victims Support Protocol

Purpose: During an adverse event within the clinical environment there are typically multiple victims. The
traditional victim is usually the patient, but often overlooked is the healthcare providers delivering care. This
protocol was developed to provide structured guidance to support our healthcare providers experiencing an
adverse event.

Scope: The support group will be limited to residents for the initial implementation. Peers will cover all facilities
(Nemours, ORMC, WMCH, NFRMC, and Osceola). Later, with proper backing, we could expand to attendings and
CRNAs.
Steps:
1. Identification: support group can be activated by an attending, co resident, chief, or any other personnel
who is concerned about an anesthesia resident following an OR event. Concerned personnel may
call/text chief residents. We can also respond to identified incidents proactively.
2. Once a request is received, the chief residents will share a group text message and decide mutually who
is able to reach out to the affected resident.
3. The group will decide who will be in charge of contacting the affected resident that day. Ideally, as
multiple locations will have to be covered, this initial contact will likely occur via phone/or text.
4. The role of the contactor will be to approach the affected resident in a calm, very non-judgmental
manner (Monday morning quarterbacking is not acceptable). They will listen and empathize with the
affected resident. In the contact, the support person will try to gauge how affected the person is by the
event. There will be no immediate pressure to return to the OR.
5. If there is concern that the affected resident should not be returned to the OR immediately, the
recommendation from the counselor (with only "need to know" background information) should be
discussed with covering attending, PD, APD, or the local site director.
6. The contactor will follow-up with the affected resident either later that evening or the next day. If the
contactor or affected resident feels that additional time off service is necessary, this can be discussed
with PD or APD.
7. The contactor will determine at this point if additional intervention may be necessary. The affected
resident can be referred to EAP or other program through GME (with the affected resident’s
permission).
8. There will be ongoing follow-up with the affected resident as time progresses.
9. There will be minimal written note taking during this process.

UCF/HCA Anesthesiology Program – Well Being Policy

Version 2 January 2020
111
 University of Central Florida College of Medicine/HCA Graduate Medical
Education Consortium Ocala Regional Medical Center
Anesthesiology Residency Program

Unsatisfactory Training, ITE Testing Standards, and ABA Examination

Failure Supplemental Policy to:
UCF COM/HCA GME Consortium Policy regarding Resident Performance,
Renewal, Promotion, and Discipline (IV.C)

Policy Summary: This policy supplements the institutional UCF COM/HCA GME Consortium
Policy regarding Resident Performance found at:
https://med.ucf.edu/academics/graduate-medical-program/gme-policies-2/
The department of Anesthesiology for the University of Central Florida College of
Medicine/HCA Graduate Medical Education Consortium at Ocala Regional Medical Center
requires passing of the ABA BASIC Examination within two attempts. Failure to obtain a
passing score by the second attempt may result in non-renewal, or termination.

First test failure:

The Anesthesiology Resident will be placed on a formal individual performance plan focused on
medical knowledge and guidance for improvement. Additionally, he/she will receive an
unsatisfactory training period reported to the American Board of Anesthesiology (ABA).

Second test failure:

The Anesthesiology Resident will be place on temporary suspension pending CCC and
Consortium review. Additionally, he/she will receive a second unsatisfactory training period
reported to the American Board of Anesthesiology (ABA).

Consecutive reporting of unsatisfactory training to the ABA or consecutive failure of the ABA
Basic Examination may result in non-renewal or termination.

In-Training Exam:

Residents are required to score above the 20th percentile on ITE examination.

Residents failing to score at or above the 20th percentile will:

1. Individually meet with the program director and their faculty mentor.

2. Receive a written letter of concern to identify opportunities of improvement.

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3. Develop an intensive and focused education plan with their faculty mentor based on their
individual areas of need.

a. This plan will be reviewed and approved by the program director.

b. The resident’s faculty mentor will be the supervisor of study progress.

Residents failing to score at or above the 20th percentile on two consecutive exams will:

1. Individually meet with the program director and department chair.

2. Be required to participate in the supplemental academic program.

3. Can result in an UNSATISFACTORY score in the Essential Attributes section of the Clinical
Competence Committee report for the corresponding 6 months reportable to the ABA.

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 Access to University of Central Florida GME and Institutional GME Policies

All UCF policies are accessible online at:

https://med.ucf.edu/academics/graduate-medical-program/gme-policies-2/

Accommodations for Disabilities in GME Programs Policy

Benefits Policy

Best Practices Regarding Counseling and Behavioral Health Policy

Disaster Planning for GME Programs and Trainee Transfers Policy

Familial and Amorous Relationships Policy

Grievance Policy

Health Clearance Policy

Impaired Physicians Policy

Internet and Social Networking Sites Policy

Leave and Injury Policy

Moonlighting Policy

Performance, Renewal, Promotion, and Discipline

Professionalism Policy

Professional Liability Insurance Policy

Program or Institutional Closure and Reduction Policy

Recruitment, Selection and Appointment Policy

Remediation and Discipline Policy

Resident Forums, Trainee Complaints, Concerns and Harassment Policy

Restrictive Covenants and Non-Competition Policy

Trainee Qualifications and Eligibility Policy

Trainee Supervision and Clinical Education Hours Policy

Transitions of Care Policy

Vendor Policy

Well-Being Policy

Work Environment Policy (Safety Quality Well-Being and Vendor Relations)

114
115
 ABA

In-Training
Examination

BLUEPRINT 116
THE AMERICAN BOARD OF ANESTHESIOLOGY,
INC.
In-Training Examination (ITE) Blueprint

Purpose of the In-Training Examination

The ABA’s In-training Examination (ITE) is a formative examination designed to
evaluate a resident’s progress toward meeting the educational objectives of the
continuum of education in anesthesiology. The continuum of education in
anesthesiology consists of four years of full-time training subsequent to the date
that the medical or osteopathic degree has been conferred. The continuum consists
of a clinical base year and 36 months of approved training in anesthesia (CA-1, CA-
2 and CA-3 years).

Exam Content
The ITE covers both basic and advanced topics in the following four content
categories:
• Basic Sciences
• Clinical Sciences
• Organ-based Basic & Clinical Sciences
• Special Problems or Issues in Anesthesiology

Each ITE form is built to the same content specifications, known as an exam
blueprint. The examination blueprint is used to ensure that every form of the ITE
examination measures the same depth and breadth of content knowledge. Table 1
below shows the number and relative percentage of questions from each of the
four content categories shown above that will appear on each form of the ITE.

TABLE 1. In-Training Examination (ITE) Blueprint

I. Basic Topics in Anesthesiology (50%)
Number of
Content Category (Relative Percentage)
Questions
Basic Sciences (12%) 21 – 29
Clinical Sciences (17%) 29 – 43
Organ-Based Basic & Clinical Sciences (19%) 30 – 46
Special Problems Or Issues In Anesthesiology (2%) 2–6

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II. Advanced Topics in Anesthesiology (50%)

Number of
Content Category (Relative Percentage)
Questions
Basic Sciences (4%) 6 – 10
Clinical Sciences (4%) 6 – 10
Organ-Based Basic & Clinical Sciences (15%) 22 – 38
Clinical Subspecialties (24%) 36 – 60
Special Problems or Issues in Anesthesiology (3%) 6 – 14

To view the full ITE Content Outline, please click here.

Exam Specifications
The ITE consists of 200 questions and residents have up to 4 hours to complete the
examination. The
ITE includes A-type items only. A-type questions are single-best-answer multiple-
choice questions that require the application of knowledge rather than simple
recall of factual information. These questions often include a brief clinical vignette
followed by a lead-in question and four response options.

The ITE includes questions that reference static images.

Exam Administration
The ITE is administered annually to any physician enrolled in an ACGME-
accredited anesthesiology residency training program. The ITE is an online
examination that is administered through the residency program sites. The ITE is
available to be administered anytime during a five day window each February.
Please check the ABA’s website (www.theABA.org) for the specific exam
administration dates each year.

Residency program staff may schedule residents to take the ITE any time during
the administration window. Residency program staff may wish to administer the
examination to successive groups of residents on a single day or across multiple
days depending on what is most convenient for their site.

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 I. BASIC TOPICS IN ANESTHESIOLOGY (50%)
Number of
Content Category (Relative Percentage)
Questions
BASIC SCIENCES (12%) 21 – 29
Anatomy 5–7
Physics, Monitoring & Anesthesia Delivery Devices 5–7
Mathematics 2–4
Pharmacology 9 – 11
CLINICAL SCIENCES (17%) 29 – 43
Evaluation of the Patient & Preoperative Preparation 5–7
Regional Anesthesia 4–6
General Anesthesia 7–9
Monitored Anesthesia Care & Sedation 1–3
Intravenous Fluid Therapy During Anesthesia 4–6
Complications: Etiology, Prevention & Treatment 4–6
Postoperative Period 4–6
ORGAN-BASED BASIC & CLINICAL SCIENCES (19%) 30 – 46
Central & Peripheral Nervous System 4–6
Respiratory System 5–7
Cardiovascular System 6–8
Gastrointestinal/Hepatic Systems 3–5
Renal & Urinary Systems/Electrolyte Balance 3–5
Hematologic System 3–5
Endocrine & Metabolic Systems 3–5
Neuromuscular Diseases & Disorders 3–5
SPECIAL PROBLEMS OR ISSUES IN ANESTHESIOLOGY (2%) 2–6
Physician Impairment or Disability 1–3
Ethics, Practice Management, & Medicolegal Issues 1–3

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 II. ADVANCED TOPICS IN ANESTHESIOLOGY (50%)
Number of
Content Category (Relative Percentage)
Questions
BASIC SCIENCES (4%) 6 – 10
Physics, Monitoring & Anesthesia Delivery Devices 3–5
Pharmacology 3–5
CLINICAL SCIENCES (4%) 6 – 10
Regional Anesthesia 4–6
Special Techniques 2–4
ORGAN-BASED BASIC & CLINICAL SCIENCES (15%) 22 – 38
Central & Peripheral Nervous System 3–5
Respiratory System 3–5
Cardiovascular System 3–5
Gastrointestinal/Hepatic Systems 1–3
Renal & Urinary Systems/Electrolyte Balance 3–5
Hematologic System 3–5
Endocrine & Metabolic Systems 3–5
Neuromuscular Diseases & Disorders 3–5
CLINICAL SUBSPECIALTIES (23%) 36 – 60
Painful Disease States 4–6
Pediatric Anesthesia 4–6
Obstetric Anesthesia 4–6
Otorhinolaryngology (ENT) Anesthesia 2–4
Anesthesia for Plastic Surgery, Liposuction 1–3
Anesthesia for Laparoscopic Surgery 4–6
Ophthalmologic Anesthesia 1–3
Orthopedic Anesthesia 4–6
Trauma, Burn Management, Mass Casualty, Biological Warfare 1–3
Anesthesia for Ambulatory Surgery 4–6
Geriatric Anesthesia/Aging 3–5
Critical Care 4–6
SPECIAL PROBLEMS OR ISSUES IN ANESTHESIOLOGY (3%) 6-14
Electroconvulsive Therapy 1–3
Organ Donors 1–3
Radiologic Procedures 3–5
Ethics, Practice Management, & Medicolegal Issues 1–3

120
 THE AMERICAN BOARD OF ANESTHESIOLOGY
® 4208 Six Forks Road, Suite 1500 | Raleigh, NC 27609-5765 | Phone: (866) 999-7501

In-Training Examination Gaps in Knowledge Reports

The following reports describe concepts from the In-Training Examination that
were most misunderstood by examinees or proved to be especially difficult. Each
question was reviewed by the ITE Committee as part of key validation and the
correct answer was determined to be accurate. The reports are arranged by year.

2019 Gaps in Knowledge Report

• Pyridostigmine is an appropriate medication for prophylaxis against possible
nerve agent exposure, whereas atropine and pralidoxime chloride would be
appropriate for treatment after exposure
• Benzodiazepines are indicated for initial treatment of an acutely cocaine
intoxicated patient presenting for emergency surgery
• Application of charcoal filters to both inspiratory and expiratory limbs of the
anesthesia machine’s breathing circuit is an effective method of reducing
further exposure to volatile agent during an intraoperative episode of
malignant hyperthermia
• In healthy patients, serum creatinine is unlikely to change significantly between
the ages of 40 and 70
• The use of ginseng and garlic as herbal supplements does not represent a
contraindication to spinal anesthesia

2018 Gaps in Knowledge Report

• Increased temperature seen as the immediate result of a platelet transfusion is
most likely due to the presence of cytokines in the platelet transfusion
• Facial and airway edema complicating airway management can result from ACE
inhibitor associated angioedema
• Prolongation of the duration of action of succinylcholine can occur in patients
who are taking donepezil
• According to NIOSH, the recommended maximum level for volatile anesthetics
in the ambient air of an OR is 2 parts per million
• An elevated ipsilateral hemidiaphragm is commonly encountered after deep
cervical plexus block
• Inhalational general anesthetics exert their effects by binding directly to
amphiphilic cavities in proteins

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2017 Gaps in Knowledge Report
• Successful placement of an adductor canal block will result in weakness of the
vastus medialis muscle
• Daily palpation of the dressing site for tenderness is recommended by the CDC
as a method of preventing catheter-related bloodstream infections with central
venous catheters
• Hypoalbuminemia is a potential cause of metabolic alkalosis
• The posterior cricoarytenoid muscles are solely responsible for abduction of
the vocal cords, and are attached between the posterior cricoid cartilage and
the arytenoid cartilages bilaterally

122
 ABA

BASIC
Examination

BLUEPRINT 123
THE AMERICAN BOARD OF ANESTHESIOLOGY,
INC.
BASIC Examination Blueprint
Purpose of the BASIC Examination
The ABA’s BASIC Examination is a summative examination designed to assess a
resident’s mastery of the educational objectives for the clinical base and CA-1 years
of the continuum of education in anesthesiology. The continuum of education in
anesthesiology consists of four years of full-time training subsequent to the date
that the medical or osteopathic degree has been conferred. The continuum consists
of a clinical base year and 36 months of approved training in anesthesia (CA-1, CA-2
and CA-3 years).

Exam Content
The BASIC Exam covers basic topics in the following four content categories:
• Basic Sciences
• Clinical Sciences
• Organ-based Basic & Clinical Sciences
• Special Problems or Issues in Anesthesiology

Each BASIC Exam form is built to the same content specifications, known as an exam
blueprint. The examination blueprint is used to ensure that every form of the BASIC
Exam measures the same depth and breadth of content knowledge. Table 1 below
shows the number and relative percentage of questions from each of the four
content categories shown above that will appear on each form of the BASIC Exam.
TABLE 1.
BASIC Examination Blueprint
Number of
Content Category (Relative Percentage) Questions
Basic Sciences (24%) 44 – 52

Clinical Sciences (36%) 65 – 79

Organ-Based Basic & Clinical Sciences (37%) 66 – 82

Special Problems Or Issues In Anesthesiology (3%) 4–8

To view the full BASIC Exam Content Outline, please click here.

124
Exam Specifications
The BASIC Examination consists of 200 questions and examinees have 4 hours to
complete the examination. The BASIC includes A-type items only.

A-type questions are single-best-answer multiple-choice questions that require the

application of knowledge rather than simple recall of factual information. These
questions often include a brief clinical vignette followed by a lead-in question and
four response options.

The BASIC Exam includes questions that reference static images.

Exam Administration
All residents that have completed 18 months of satisfactory training in an ACGME-
accredited anesthesiology residency training program are eligible to take the BASIC
Exam. The BASIC is a computer-based examination that is administered annually
through Pearson VUE centers nationwide. The BASIC is administered over two days
each July. Please check the ABA’s website (www.theABA.org) for the specific BASIC
Exam administration dates each year.
Number of
Content Category (Relative Percentage) Questions
BASIC SCIENCES (24%) 44 – 52

Anatomy 10 – 12

Physics, Monitoring & Anesthesia Delivery Devices 12 – 14

Mathematics 3–5

Pharmacology 19 – 21

CLINICAL SCIENCES (36%) 65 – 79

Evaluation of the Patient & Preoperative Preparation 13 – 15

Regional Anesthesia 9 – 11

General Anesthesia 14 – 16

Monitored Anesthesia Care & Sedation 5–7

Intravenous Fluid Therapy During Anesthesia 8 – 10

Complications: Etiology, Prevention & Treatment 8 – 10

Postoperative Period 8 – 10

ORGAN-BASED BASIC & CLINICAL SCIENCES (37%) 66 – 82

Central & Peripheral Nervous System 10 – 12

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 Respiratory System 12 –14

Cardiovascular System 13 – 15

Gastrointestinal/Hepatic Systems 6–8

Renal & Urinary Systems/Electrolyte Balance 7–9

Hematologic System 6–8

Endocrine & Metabolic Systems 6–8

Neuromuscular Diseases & Disorders 6–8

SPECIAL PROBLEMS OR ISSUES IN ANESTHESIOLOGY (3%) 4–8

Physician Impairment or Disability 2–4

Ethics, Practice Management, & Medicolegal Issues 2–4

126
 UCF-HCA Residency Resources
The national GME office purchases AccessMedicine, AccessAnesthesiology and the McGraw-
Hill’s First Aid test prep eBooks for use in the Anesthesiology Residency Programs. NOTE: These
resources are licensed only for Anesthesiology Residents and Faculty. Sharing the access
information outside of the Anesthesiology program jeopardizes the license agreement between
the vendor and HCA GME.
Access information is below:
 Anesthesia Toolbox- Mandatory curriculum assignments
o Contains various specific presentations, curriculum guides, PBDLs, and many
other valuable resources
o https://www.anesthesiatoolbox.com/
o Login Username= First-name.Last-name
o Email request will be sent to reset password
o Works best in Chrome Browser, Mozilla Firefox, Safari. Do not use Internet
Explorer or Microsoft Edge due to severe incompatibilities.

 TrueLearn question bank and mandatory quiz assignments

o https://www.truelearn.net/Index.html
o Will receive email with account information from TrueLearn once subscription is
active.

 MH AccessAnesthesiology
o https://accessanesthesiology.mhmedical.com/
o You Must Log Into HCA Account First, Then Create A MyAccess Account
o User Name: HCA1
o Password: Medicine2017
o QBanks are available within the ‘Study Tools’ tab, select ‘Review Questions’ and
any of the available QBanks.

 MH AccessMedicine
o https://accessmedicine.mhmedical.com/
o You Must Log Into HCA Account First, Then Create A MyAccess Account
o User Name: HCA1
o Password: Medicine2017

 McGraw-Hill’s First Aid test prep eBooks

o https://mhebooklibrary.com/topic/fircol
o User Name: HCA1
o Password: Medicine2017

 HCA Library- Multiple journal articles and publications

o This interactive site is browser-based, mobile compliant, and open to anyone
with a 3-4 ID. The library site operates via single sign-on (SSO), so it is extremely
simple to access. While on the HCA network, simply navigate to the link below.
For off-network access, simply use the same link below and enter your 3-4 ID
and network password.
o : https://hcahealthcare.ovidds.com

127
 The WebEx platform is a meeting tool that we will utilize for many meetings, conferences, and lectures
for the residency program. The system is accessible on many devices to include mobile smart phones,
laptops, and desktop computers. In order to access meetings on your mobile device you must install the
Cisco WebEx Meetings application on your phone and have the meeting number to enter into the
prompt.
Make sure your computer has the Cisco WebEx Meetings app on it. It looks like ->
You can install it on your HCA computer using the software center:

3
1
WebEx Client for mobile apps:
 Installer for Apple iOS: https://itunes.apple.com/us/app/cisco-webex-
meetings/id298844386?mt=8
 Installer for Android:
https://play.google.com/store/apps/details?id=com.cisco.webex.meetings&hl=en

128
Creating a host account for WebEx to start meetings
In order to initiate WebEx meetings, you must first generate a host account. Account hosts can be given
the authority to start meetings in other hosts’ WebEx rooms if allowed.

Using an internet browser on a hospital computer open:

https://hcaconnect.webex.com

You will see the following website and you will want to click Log In on the right:

Enter your 3-4ID and HCA password and this will generate your host account. Your personal room site
will usually be designated as https://hcaconnect.webex.com/meet/firstname.lastname , the
firstname.lastname portion will mirror your name used in your HCA email. I recommend going into your
settings shown below and checking “Allow anyone with a host account on this site… to be an alternate
host” as this will allow other residents to start the lecture in the designated room.

3
129
To join a Residency Conference or lecture for Anesthesia:

The residency program will always use the same URL/hyperlink to access program events such as
lectures and conferences. To join please use the link below:

https://hcaconnect.webex.com/meet/Matthew.Guthrie

Or you can open the WebEx app on your phone or computer and join the room named
Matthew.Guthrie.

The Webex link is also available on MedHub under announcements and on the conference/lecture
details:

130
Applicable instructions to all meetings if you don’t use the apps:
After clicking the link you may receive a prompt to install a temporary application to see the meeting or
join by browser. Either option is fine, but I recommend installing a temporary application after clicking
“Go Here”.

131
You will then be prompted to connect audio as seen below: This is important to communicate with the
presenters and hear the event. Please mute your phone or device unless you are providing input or
asking a question because background noise will carrying into the host’s event and distract everyone on
the conference line.

You can either select use computer for audio, Call Me which requires you to enter a phone number that
will be called to join the conference, or select I Will Call In which will provide you a number and access
code to dial. Some devices will allow you to connect audio through itself, but in order to engage in
discussion you must have a microphone enabled or use the conference line via phone. You can stream
the presentation and call in using the same smart phone. Pease be aware that you must mute your line
unless engaging in discussion because background noise will interfere with the presentation!

132
After making the audio selection you will see the meeting screen where the host can deliver a
presentation.

Hosting a presentation:
Once you have completed all previous steps you will see the screen below with Matthew Guthrie in the
right column as the host and a green ball on the icon. Scroll over to the green ball, click, hold and drag
the ball to your name. This will change the host to whomever wishes to present or share a screen.

133
Once you are the presenter, your options will allow you to share your screen.

134
Once you click share screen, the program will prompt you to choose a screen. If you are connected to a
projector of have multiple screens, I recommend sharing screen 2 that way you can read notes from
screen 1 and present the slideshow/video on screen 2. Once your screen is chosen, you will see the
following toolbar on the screen selected for sharing:

You can drag this toolbox onto your screen if desired and it will not change which screen is shared. You
will use this toolbox menus to change which screen is shared and to stop the screen sharing.

On your home screen you will see a participant box that can obstruct your view of notes or materials:

135
Place your pointer into the left hand corner of the box and a little downward arrow will appear. Click
that arrow to hide the box and your view will remain unobstructed.

Once you have completed your presentation you can select stop sharing and then leave the meeting.

Additional links for help:

Joining a meeting: https://collaborationhelp.cisco.com/article/en-us/njmhfgbb

Downloading software: https://collaborationhelp.cisco.com/article/en-us/WBX21270

Important Tips

There are two ways to host meetings in WebEx, you can start one in a host’s personal room
(recommended if you want to use the same link for every meeting), or you can schedule meetings which
will generate a new link for every meeting and that link will need to be sent to all invited members.
Using the scheduling feature in your HCA outlook calendar is useful, you can create a meeting and chose
to add your WebEx personal room or generate a unique WebEx meeting, invite your attendees and or
cancel all from Microsoft outlook.

136
 HCA GME
Resident & Fellow
Quick Start Guide
MedHub is a web-based application designed to house, document, track and monitor
residency requirements and educational experiences. This system will allow you to
review your rotation, clinic and call schedule, submit work hours, complete
evaluations, log procedures, review your conference schedule and set up your
learning portfolio.

Getting Started
To log-in, use the following website address in your web browser <add Specific
MedHub URL>. You will log-in using the yellow Single Sign-On button found on the
left hand-side of the log-in page. You will use your HCA network log-in information
to get into MedHub if you are not on the HCA network.

Residents and fellows all have a user type of RESIDENT to indicate that the user is a
trainee. Residents and fellows are identified as either a resident or fellow from their
“review records” link on the portal page as part of their training history.

Home
The Home page is the central or portal page for each user. This page is essentially a
communication channel where the GME Office or the residency or fellowship
program may post pertinent information.

This page is also where you can navigate between functionality components (i.e.
schedules, evaluations, etc.) or view particular tasks that may need to be completed.
The portal page is also a location where specific resources or documents are
provided for your viewing.

137
Tasks
Under the Tasks section, this is where you’ll have the ability to log the current
week’s work hours, review your own records, and update your contact information,
among other potential tasks pertinent for your training program.

Reviewing your records allows you to see your basic demographic information as
well as see any files that have been shared with you by the GME Office or your
training program.

You may have the ability to update your contact information as needed as well as
record your work hours.

Urgent Tasks
Adjacent to the Tasks section are urgent tasks. This box will appear in red if you
have any particular items that need to be completed (i.e. evaluations, incomplete
work hours, etc).

Personal Calendar
You have the ability to keep a personal calendar in MedHub and sync it to either an
Outlook or Google e-mail account or through an iPhone or Android. By selecting the
“View myCalendar” button, it will allow you to add any appointments, meetings, etc
for each day within each month. If your training program has created a conference
schedule, these conferences will also appear on your personal calendar
automatically.

Rotation Schedule
The rotation schedule lists the rotations you are scheduled for the academic year.

Curriculum Objectives
The Curriculum Objectives provides you the ability to review the list of objectives
specific to rotations or services for which you are scheduled. These objectives will
only appear IF your training program has uploaded them to the system.

138
Messaging
Messaging allows you to send and receive messages through the MedHub system.
When sending a message through MedHub, this does not go to the recipient’s e-mail
unless you designate that the message you are sending should go to their e-mail as
well. If you have been sent a message, it will appear in this Messaging section where
you can select the message to review the content.

Residents/fellows also have the capability to send anonymous messages to their

DIO or Program Director if this has been enabled by your institution.

Announcements
Any announcements posted by either the GME Office or your training program may
be visible here.

Resources/Documents
There are various directory links that are available to you in case you need to find a
particular individual’s contact information. The GME Office or your training
program may also add other information to this section that you will have access
and can review.

Add New Channel

You have the ability to customize your home page when it comes to various news
feeds you may want to appear automatically when you log-in. The “Add New
Channel” button allows you to add various feeds from a variety of news sources.
Functionality
Work Hours
To add each week’s work hours, select the “This week’s work hours” link located in
the Tasks section from your home page. This will take you directly to the timesheet
where you can begin to enter your hours.

To add your hours for each day, select the start time you begin your day…

139
And select the end time of either that same day,

or the next day.

A bar will appear that totals the amount of time you worked based on your start and
end times. This is called the graphical interface view. At the bottom of the timesheet
you will have an ability to save and/or submit your hours. Saving your hours simply
saves your hours; it does not submit your hours for reporting purposes.

You also have the ability to switch to another view of the work hour timesheet. This
is called the standard interface view.

The standard interface allows you to log hours using a drop-down format vs. a
graphical representation of hours. In this format, you would also log your start and
end times. The “more entries” link below the designated drop-downs provides
additional drop-downs, in case you have multiple in and out times throughout the
day. The term “standard” in the drop down refers to your daily schedule which
encompasses all activities (rotations, clinics, etc.) that occur within a given day.

140
Once you have submitted your hours, and all associated work hour rules have met
compliance, the compliance checklist identified at the top of the timesheet will
indicate the rules where you have met compliance.

The compliant week you have submitted will show up in green on the monthly
calendar located adjacent to your timesheet.

If you submit a non-compliant work hour timesheet, the compliance checklist will
indicate what rules are not in compliance by appearing in red.

You may be required to submit rationale regarding the non-compliant submission

(i.e. patient volume).

To review past work hour submissions, select the link called, “Work Hours History”
located adjacent to the weekly work hours.

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This report provides you a listing of each week that has been submitted along with
the total number of hours for that week, days off, and any compliance rationale
based on a non-compliant week.

Residents only have 2 weeks to log hours; the current week and the most recent
prior week. Any hours that may need to be submitted prior to the last week will
need to be discussed with either your program director or program coordinator.

Mobile App
Work hours may also be logged via the MedHub mobile app. Please see the Mobile
App section below for details.

Portfolios
You have the ability to manage and track your own portfolio information. Faculty
who are identified as mentors and/or the Program Director can also view your
portfolio, along with your program coordinator.
There are approximately twenty-three portfolio entry options which you can
choose. Each portfolio entry option has its’ own specific fields related to that entry.
To access the portfolio functionality, you will select the Portfolio tab located at the
top right hand side of the home page, also known as the navigation bar.

You can select a portfolio entry type by choosing an option from the drop down list
that describes the type of entry you would like to include in your portfolio.

When adding a portfolio entry, you also have the ability to share this entry with the
faculty members who have been added as your mentor.

Some of these portfolio entry types also allow you to create a CV that will display
these entries which you can manage.

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Schedules
The schedule allows you to view the services or rotations that you have been
assigned as well as clinics and specific calls. To access the schedule, select the
Schedules tab located at the top right hand side of the home page.

You can review the schedule for all rotations you are assigned. You can view the
schedule by resident (residents or fellows listed on the left hand side of the
schedule) or by service (rotations/services listed on the left hand side of the
schedule).

The dates at the top of the rotation schedule indicate the dates of that specific
rotation block as identified by your training program.

The name of the service or rotation you are scheduled will appear in the rotation
block in the by resident view. In the by service view, your name will appear in the
block of that particular service.

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You may also see other residents, fellows and faculty members scheduled to that
same service or rotation so you’ll know who is rotating with you.

To see your clinic schedule, select the Clinics tab located at the top of the rotation
schedule.

You can filter the information based on the clinic to see who is or has been assigned
to a specific clinic.

To see your call schedule, select the Calls/Shifts tab located at the top of the rotation
schedule.

This will show you the view of the current call schedule for the day, week or month.

You can also filter the call schedule by selecting the “Call/Shift Schedule” drop down
to select a specific rotation or service to view the call assigned for that particular
rotation block.

Evaluations

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To access evaluations, select the Evaluations tab located at the top right hand side of
the home page.

This section will allow you to:

1. Complete evaluations that you have been requested to complete as well as
review all evaluations you have completed in the past.
2. Review your individual performance evaluations that have been completed
of you.
3. See an aggregate or summary information of evaluations that have been
completed of you.
4. Review competency summary or milestone summary data.
5. Assess trend data compared with peers by overall average or across the
various competencies.

Mobile App
Evaluations may be completed via the MedHub mobile app. Please see the Mobile
App section below for details.
Conferences
If conferences have been set up by your training program, you will be able to view a
conference schedule under the Conferences tab. To access conferences, select the
Conferences tab located at the top right hand side of the home page.

This allows you to see an upcoming conference schedule, as well as review the
complete conference schedule for the academic year and view your own conference
attendance (if conference attendance was taken). Scheduled conferences may also
appear on the personal calendar found on your portal or home page.

You can also run your own conference attendance report that identifies how many
conferences you’ve attended based on the requirements set up by your program.
This is found at the bottom of the list of scheduled conferences.

Mobile App
The MedHub Mobile App is available for iPhone users and may be accessed via the
App Store.

Users may search for the App by typing 'MedHub' into the search field and the
MedHub Mobile App will be displayed. When the App is initially opened the user will
be asked if they would like to receive notifications from MedHub (i.e. “Late Work
Hours,” "Pending evaluations")

145
When the App is opened the user will select their home institution from the drop-
down menu, enter their username and their password/passkey (for users who use
single-sign on credentials to access MedHub).

For Android users, the mobile app may be accessed by entering the user's
institution's MedHub URL into the browser on the device. The user will be asked if
they wish to access the 'Full Site' or the 'Evaluations App.’
Help
The Help tab, located in the navigation bar provides you the ability to search for
specific topics in case you have questions about functionality.

Aside from searching for help topics, you can also send a support ticket either to
your program coordinator/administrator or the MedHub support team if you should
have a question regarding the functionality.

146
 HCA Systems Remote Access & Email Instructions
For all residents and staff in the HCA/GME consortium, we are required by HCA
corporate to utilize our assigned HCA email address to communicate work related
information. Your HCA email account will automatically receive assignments to the
local facility groups and important hospital and residency related information will
be distributed through your HCA email. During the beginning of onboarding GME
staff will utilize email addresses provided through ERAS, but once an HCA email
address is assigned, the GME staff will have to utilize your HCA email address.
Accessing your HCA programs from home:
When using your HCA issued computer from home you have the ability to connect to
the HCA intranet using a Virtual Private Network (VPN). HCA’s VPN is called Pulse
Secure and you can find the icon in the lower right hand corner of the screen on the
taskbar.

Right click this icon and select HCA Remote Gateway and Connect. This should
prompt you to enter a password which is your HCA computer login password. Do
not exit any of the popups that flash onto your screen as these are authorizing
network connections. Once successfully logged in you should be able to open
Microsoft Outlook and access your email account.
Email Management:
As a resident you are expected to review and respond to email in a timely manner.
Delinquency in timely response will reflect poorly during evaluation of
professionalism which will result in disciplinary action. The expectation is that
residents should check their email at least once every 24 hours regardless of
rotation, schedule, or vacations. Although you may not be on service, there may
arise an occasion that requires a resident’s timely correspondence. Learning how to
manage your email account to filter important emails is paramount to ensure you do
not miss any important information.
Creating folders and assigning roles:
Open your outlook email account on an HCA
computer.
Right click within your folders tab at the
location you would like to create a new
folder

147
 Select new folder and create a name for that
folder

Once your new folder is created you can create rules for emails coming from certain
individuals to go into a determined folder for easier access. I highly recommend
creating rules for your Program Director and Program Coordinator to ensure you
receive all important emails. These folders and rules will automatically populated
into the mobile email application used on your HCA mobile phone.

Right click on the email that you choose to

create a rule for. Hover on rules and select
“Always Move Messages From …”
This box will appear. Selected the folder
you want all emails from the select sender
to arrive within. Click “OK”. All emails from
that sender will now be filtered from all
others and you will see how many are
unread in that folder with a glance.

148
List of e-Books available at Harriet F. Ginsburg Health Sciences Library UCF
https://med.ucf.edu/library/
Anaesthesia and Intensive Care A-Z, 5e
Author: Yentis, Steve M.
Year: 2013
Provider: ClinicalKey

Anesthesia and Uncommon Diseases, 6e

Author: Fleisher, Lee A.
Year: 2012
Provider: ClinicalKey

Anesthesia Equipment: Principles and Applications, 2e

Author: Ehrenwerth, Jan
Year: 2013
Provider: ClinicalKey

Anesthesia Secrets, 5e
Author: Duke, James C.
Year: 2016
Provider: ClinicalKey

Anesthesia: A Comprehensive Review, 5e

Author: Hall, Brian A.
Year: 2015
Provider: ClinicalKey

Atlas of Ultrasound-Guided Regional Anesthesia, 2e

Author: Gray, Andrew
Year: 2013
Provider: ClinicalKey

Basics of Anesthesia, 7e
Author: Pardo, Manuel
Year: 2018
Provider: ClinicalKey

Bonica's Management of Pain, 4e

Author: Fishman, Scott M.
Year: 2010
Provider: Ovid
ISBN: 978-0-7817-68276

149
Brown's Atlas of Regional Anesthesia, 5e
Author: Farag, Ehab
Year: 2017
Provider: ClinicalKey

Chestnut's Obstetric Anesthesia: Principles and Practice, 5e

Author: Chestnut, David H.
Year: 2014
Provider: ClinicalKey

Clinical Anesthesia, 7e
Author: Barash, Paul
Year: 2013
Provider: ProQuest Ebook Central

Clinical Cases in Anesthesia, 4e

Author: Reed, Allan
Year: 2013
Provider: ClinicalKey

Complications in Anesthesia, 3e
Author: Fleisher, Lee
Year: 2018
Provider: ClinicalKey

Complications in Neuroanesthesia
Author: Prabhakar, Hemanshu
Year: 2016
Provider: ClinicalKey

Cottrell and Patel's Neuroanesthesia, 6e

Author: Cottrell, James
Year: 2017
Provider: ClinicalKey

Crisis Management in Anesthesiology, 2e

Author: Gaba, David M.
Year: 2015
Provider: ClinicalKey

Essence of Anesthesia Practice, 4e

Author: Fleisher, Lee A.
Year: 2018

150
Provider: ClinicalKey

Essential Anesthesia : From Science to Practice, 2e

Author: Euliano, T. Y.
Year: 2011
Provider: Cambridge Books Online

Essentials of Anaesthetic Equipment, 4e

Author: Al-Shaikh, Baha
Year: 2013
Provider: ClinicalKey

Essentials of Neuroanesthesia and Neurointensive Care

Author: Gupta, Arun K.
Year: 2008
Provider: ClinicalKey

Essentials of Neuroanesthesia, 1e
Author: Prabhakar, Hemanshu
Year: 2017
Provider: ClinicalKey

Evidence-Based Practice of Anesthesiology, 3e

Author: Fleisher, Lee A.
Year: 2013
Provider: ClinicalKey

First Aid for the Anesthesiology Boards

Author: Bhatt, Himani
Year: 2011
Provider: McGraw-Hill

Geriatric Anesthesiology, 2e
Author: Silverstein, Jeffrey H.
Year: 2008
Provider: SpringerLink

Hagberg and Benumof's Airway Management, 4e

Author: Hagberg, Carin

151
 Year: 2018
Provider: ClinicalKey

Handbook for Stoelting's Anesthesia and Co-Existing Disease, 4e

Author: Hines, Roberta
Year: 2013
Provider: ClinicalKey

Handbook of Neuroanesthesia, 5e
Author: Newfield, Philippa
Year: 2012
Provider: ProQuest Ebook Central

Kaplan's Cardiac Anesthesia, 7e

Author: Kaplan, Joel
Year: 2017
Provider: ClinicalKey

Kaplan's Essentials of Cardiac Anesthesia, 2e

Author: Kaplan, Joel
Year: 2018
Provider: ClinicalKey

Manual of Pediatric Anesthesia, 6e

Author: Lerman, Jerrold
Year: 2010
Provider: ClinicalKey

The MGH Textbook of Anesthetic Equipment

Author: Sandberg, Warren
Year: 2011
Provider: ClinicalKey

Miller's Anesthesia, 8e
Author: Miller, Ronald
Year: 2015
Provider: ClinicalKey

Morgan & Mikhail's Clinical Anesthesiology, 5e

Author: Butterworth IV, John F.

152
Year: 2013
Provider: Access Medicine
ISBN: 9780071627030

Non–Operating Room Anesthesia

Author: Weiss, Mark S.
Year: 2015
Provider: ClinicalKey

Peripheral Nerve Blocks and Peri-Operative Pain Relief, 2e

Author: Harmon, Dominic
Year: 2011
Provider: ClinicalKey
ISBN: 978-0-7020-3148-9

Pharmacology and Physiology for Anesthesia, 1e

Author: Hemmings, Hugh C.
Year: 2013
Provider: ClinicalKey
ISBN: 978-1-4377-1679-5

A Practice of Anesthesia for Infants and Children, 6e

Author: Cote, Charles
Year: 2019
Provider: ClinicalKey

Sedation: A Guide to Patient Management, 6e

Author: Malamed, Stanley
Year: 2018
Provider: ClinicalKey

Smith and Aitkenhead's Textbook of Anaesthesia, 6e

Author: Aitkenhead, Alan R.
Year: 2013
Provider: ClinicalKey

Smith's Anesthesia for Infants and Children, 9e

Author: Davis, Peter
Year: 2017
Provider: ClinicalKey

153
Spinal Injections and Peripheral Nerve Blocks
Author: Huntoon, Marc A.
Year: 2012
Provider: ClinicalKey

Stoelting's Anesthesia and Co-Existing Disease, 7e

Author: Hines, Roberta
Year: 2018
Provider: ClinicalKey

Trauma Anesthesia
Author: Smith, Charles E.
Year: 2008
Provider: Cambridge University Press

154
 List of e-books at Access Anesthesiology
 MH AccessAnesthesiology
o https://accessanesthesiology.mhmedical.com/
o User Name: HCA1
o Password: Medicine2017

 MH AccessMedicine
o https://accessmedicine.mhmedical.com/
o User Name: HCA1
o Password: Medicine2017

 McGraw-Hill’s First Aid test prep eBooks

o https://mhebooklibrary.com/topic/fircol
o User Name: HCA1
o Password: Medicine2017

Anesthesiology, 3e
David E. Longnecker, Sean C. Mackey, Mark F. Newman, Warren S. Sandberg, Warren
M. Zapol

Morgan & Mikhail's Clinical Anesthesiology, 5e

John F. Butterworth IV, David C. Mackey, John D. Wasnick

Anesthesia Equipment Simplified

Gregory Rose, MD, J. Thomas McLarney, MD

The Anesthesia Guide

Arthur Atchabahian, Ruchir Gupta

Anesthesiology Core Review: Part One Basic Exam

Brian S. Freeman, MD, Jeffrey S. Berger, MD, MBA

Anesthesiology Core Review: Part Two Advanced Exam

Brian S. Freeman, Jeffrey S. Berger

Anesthesiology Oral Board Flash Cards

Jeff Gadsden, Dean L. Jones

Atlas of Pain Medicine Procedures

Sudhir Diwan, Peter S. Staats

Atlas of Sonoanatomy for Regional Anesthesia and Pain Medicine

Manoj K. Karmakar, Edmund Soh, Victor Chee, Kenneth Sheah

The Basics of Anesthesiology

Gaurav Patel

155
The Big Picture: Gross Anatomy
David A. Morton, K. Bo Foreman, Kurt H. Albertine

Cardiac Anesthesia and Transesophageal Echocardiography

John D. Wasnick, Zak Hillel, David Kramer, Sanford Littwin, Alina Nicoara

Clinical Manual and Review of Transesophageal Echocardiography, 2e

Joseph P. Mathew, Madhav Swaminathan, Chakib M. Ayoub

Clinical Pharmacology for Anesthesiology

Ken B. Johnson

Critical Care
John M. Oropello, Stephen M. Pastores, Vladimir Kvetan

Critical Care Ultrasonography, 2e

Alexander B. Levitov, Paul H. Mayo, Anthony D. Slonim

Essentials of Mechanical Ventilation, 3e

Dean R. Hess, Robert M. Kacmarek

Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13e

Laurence L. Brunton, Randa Hilal-Dandan, Björn C. Knollmann

Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional

Anesthesia, 2e
Admir Hadzic

Hadzic's Textbook of Regional Anesthesia and Acute Pain Management, 2e

Admir Hadzic

Handbook of Critical Care and Emergency Ultrasound

Kristin A. Carmody, Christopher L. Moore, David Feller-Kopman

Handbook of Pediatric Anesthesia

Philipp J. Houck, Manon Haché, Lena S. Sun

Hung's Difficult and Failed Airway Management, 3e

Orlando R. Hung, Michael F. Murphy

Obstetric Anesthesia
Alan C. Santos, Jonathan N. Epstein, Kallol Chaudhuri

Primer of Biostatistics, 7e
Stanton A. Glantz

156
Principles and Practice of Mechanical Ventilation, 3e
Martin J. Tobin

Principles and Practice of Pain Medicine, 3e

Zahid H. Bajwa, R. Joshua Wootton, Carol A. Warfield
Principles of Critical Care, 4e
Jesse B. Hall, Gregory A. Schmidt, John P. Kress

Procedures in Critical Care

C. William Hanson III

Syndromes: Rapid Recognition and Perioperative Implications

Bruno Bissonnette, Igor Luginbuehl, Bruno Marciniak, Bernard J. Dalens

Thoracic Anesthesia
Atilio Barbeito, Andrew D. Shaw, Katherine Grichnik

CURRENT Procedures: Surgery

Rebecca M. Minter, Gerard M. Doherty

157
 RESPONSIBILITY OF CHIEF RESIDENTS
Policy: To define the responsibilities and duties of the Chief Residents.

Purpose: To ensure that the responsibilities and accountabilities are consistent with the framework of the role of the
Chief Residents and to establish the authority of the Chief Residents as the leader and spokesperson for all the residents

1. The Chief Residents will be selected, via ballot, by the Anesthesiology staff and residents, and serve for a
12-month period, beginning on July 1 and extending through June 30th of each academic year.

2. The Chief Residents will act as liaison between the residents and the Program Director.

3. The Chief Residents will be responsible for making out the resident call schedule both monthly and yearly
(holidays).

4. The Chief Residents will serve as the representative of the residents on the Education, Competency and
Resident Selection Committees.

5. The Chief Residents will assign a resident to serve on the Quality Assurance Committee of the Department
of Anesthesiology at Ocala Health.

6. The Chief Residents will actively participate in resident recruiting interviews and assign residents to
participate at interview dinners if there are no volunteers.

7. The Chief Residents will help the Program Director plan for and initiate resident enrichment conferences.

8. The Chief Residents have the authority per the Program Director to delegate approved program related
functions and responsibilities to program residents.

9. The Chief Residents will meet with the Program Director on a regular basis to report on resident
issues/concerns and to make recommendations on how to improve the training program.

10. The Chief Residents will call a monthly meeting of all the residents, establish an agenda for the meeting,
and keep minutes of all resident meetings.

11. The Chief Residents will serve as a role model for all residents.

12. The Chief Residents may be relieved their duties by the program director without cause and without
academic or human resources appeal at any time.

13. The Chief Residents understand that their first commitment and foremost priority at all times is their
educational curriculum and learning as a senior resident. The administrative chief will not at any time
sacrifice their senior curriculum, personal learning plan or professional development for administrative
responsibilities.

14. The Chief Residents will be evaluated on their performance by the program director, associate program
director(s) and residents (in a confidential, non-identifiable manner) at the end of the academic year.
Formative feedback will be presented continuously as needed.

15. The Chief Residents are not disciplinarians for the program, nor responsible for resolving resident concerns
nor conflicts. The Chief Residents, as with all senior residents, should, in a professional and polite manner,
assist in educating and coaching peers in appropriate actions and behaviors. The Chief Residents should
relay any concerns or conflicts to the program leadership.

158