Description:

The rotation is designed as a three-month block at the University Hospital and Shriner’s Hospital Lexington. There is a directed reading program for this rotation, which is appended to these Goals and Objectives. During these rotations, residents are directly supervised by faculty members of the UK Department of Anesthesiology in the provision of anesthesia and post anesthetic care for newborns, infants, children, and adolescents to age 21 undergoing therapeutic, diagnostic, and surgical procedures. This care is inclusive of general anesthesia, regional anesthesia, intravenous sedation, as well as appropriate regimes for analgesia in this population.
A core curriculum of topics in Pediatric Anesthesia is presented yearly as a supplement to clinical work. This didactic material emphasizes the anatomy, physiology and pharmacology as it pertains to the practice of pediatric anesthesiology. A syllabus of reading material is presented to each resident at the beginning of the three months and each resident is expected to read the relevant material.

Goals:

At the completion of this rotation, the resident will:
• understand important anatomical considerations which impact on the delivery of anesthesia for infants and children
• recognize the important physiological principles associated with pediatric anesthesia and how these effect anesthetic management
• be proficient at critically assessing infants and children with complex medical and surgical problems who present for surgery
• be proficient at conducting anesthetics for infants and children for complicated pediatric patients
• be able to manage short, rapid turnover pediatric outpatient cases
• be proficient at using the critical monitoring devices employed during a pediatric anesthesia
• understand the anesthetic complications following pediatric anesthetics
• be proficient at managing critical post-anesthetic care issues of the pediatric patient

Education Objectives:
MEDICAL KNOWLEDGE:

Cognitive ability: residents will develop an in depth knowledge of the principles of anesthesia for pediatric patients including the anatomy and physiology of neonates and children; the more common congenital anomalies; the pathophysiological process involved in pediatric surgical conditions; the pharmacology of anesthetic agents as it effects neonates, infants and children; the more advanced equipment and monitoring devises used in pediatric anesthesia; the more complex surgical procedures in pediatric patients.

Psychomotor ability: residents will develop a working knowledge and understanding of the indications and contraindications, risks and benefits of the various procedures they learn; residents will develop advanced technical skills such as intravenous, intra-arterial, and central venous catheter insertion in smaller infants and neonates, neuraxial and other regional procedures in infants and children.

Affective ability: residents will develop behavior patterns related to working with pediatric patients and their parents in the preparation and administration of anesthesia, including the need for careful assessment, the ability to respond to rapidly changing patient conditions and the team approach to pediatric anesthesia.

PATIENT CARE:

Cognitive ability: residents will develop an in depth understanding of the principles of caring for pediatric patients undergoing surgery for general, urological, orthopedic, ENT, cardiac, neurosurgical, ambulatory and other surgical procedures; residents will understand the principles of sedation and monitoring for pediatric patients having procedures outside the operating room such as radiological procedures; the recognition, treatment and prevention of postoperative pain in children and infants.

Psychomotor ability: residents will have the opportunity to anesthetize pediatric patients with complex medical conditions and congenital abnormalities; residents will learn how to perform invasive procedures with appropriate concern for patient safety such as epidural, caudal and spinal anesthesia; sedation and monitoring techniques; residents will run operating list of short cases requiring rapid turnover and a high level of organization.

Affective ability: residents will develop a behavioral approach that pays attention to all aspects of caring for pediatric patients and their parents in the perioperative period; residents will pay particular attention to patient safety; residents will be expected to work at the appropriate level of supervision for a senior resident and will be expected to demonstrate independent thinking, good judgment and appropriate decision making; they will be expected when appropriate to seek help from their supervising attending.

INTERPERSONAL & COMMUNICATION SKILLS:

Cognitive ability: residents will develop techniques for effective communication with pediatric patients and their parents concerning pre-operative assessment, explaining the process of anesthesia and discussing risks of general and regional anesthesia in pediatric patients.

Psychomotor ability: residents will be able to demonstrate skills for making a thorough preoperative assessment of each patient, they will also develop effective communication skills for explaining the process of anesthesia and discussing risks of general anesthesia to patients and their parents; residents will develop effective listening skills and show effective communication with patients, their parents and families and other members of the pediatric care team.

Affective ability: residents will demonstrate behaviors that show commitment to effective communication with patients, their families, and other members of the pediatric surgical team; residents should be able to communicate pertinent data about the patient to their attending in a precise and efficient manner.

Professionalism: residents will learn the basic definitions of professional conduct as it applies to the practice of anesthesia for pediatric surgery and basic ethical principles.

Psychomotor ability: residents will act in a way that shows commitment to professional practice in their interactions with patients, their parents and families, colleagues and other members of the pediatric health care team; residents will be expected to contribute to the smooth running of the pediatric operating rooms; residents will be expected to complete all pre, intraoperative and post operative documentation in accordance with departmental requirements.

Affective ability: residents will demonstrate commitment to professional practice in their interactions with patients, their families, colleagues and other members of the pediatric health care team.

PRACTICE-BASED LEARNING:

Cognitive ability: residents will learn the practice of reflection on their performance and how to learn from mistakes; they will understand the principles of life-longer learning and evidence based medicine as it relates to pediatric anesthesia.

Psychomotor ability: residents will demonstrate reflective practice and develop skills to enhance learning from various sources including the use of web-based learning; residents will participate in feedback with their tutors to help improve their practice of pediatric anesthesia.

Affective ability: residents will demonstrate commitment to continually trying to improve their performance and take an active role in furthering their knowledge by attending and taking an active role in the organized educational activities and the didactic lecture schedule; residents will be expected to prepare a 20-minute presentation during the rotation.

SYSTEMS BASED PRACTICE:

Cognitive ability: residents will understand the team approach to how pediatric patients present, are investigated and assessed and optimized for their surgical procedures and how their management impacts on this team approach; residents will understand how the pediatricians, surgeons, nurses and intensive care departments interact with the pediatric surgical patients.

Psychomotor ability: residents will take part in practices and initiatives such as quality improvement programs that interact with other areas of the health care system; residents will be expected to function as a team member and work with nurses, surgeons and operating room staff to improve the care they offer their patients and their own understanding of the broader aspects of the health care system.

Affective ability: residents will develop behaviors that show an appreciation for the impact of their practices to the whole system caring for pediatric patients undergoing surgery.

Evaluation

Verbal, formative feedback, based on the evaluation of the faculty is given to each resident informally throughout the rotation. A written, summative evaluation using a global rating system is completed at the end of the rotation.