Goals and Objectives

Patient Care/Case Management

• Perform thorough and effective preoperative assessment of children scheduled for surgery
• Review preoperative assessment with attending prior to case with summary of pertinent issues and presentation of anesthetic management plan
• Demonstrate ability to diagnose or identify with consultation congenital and acquired pediatric disorders and be able to develop an anesthetic management plan.
• Demonstrate judgment as when to seek and obtain appropriate medical and/or surgical consultation for clarification of issues
• Demonstrate ability to provide appropriate psychological support of children and their families in the peri-operative period
• Demonstrate proficiency in the management of normal and difficult pediatric airway
• Demonstrate proficiency in mask ventilation, endotracheal intubation, and anesthesia ventilator management in routine and difficult pediatric cases in neonates, infants, children, and adolescents
• Demonstrate proficiency with alternate airway management modalities including fiberoptic endoscopy, lighted sytlet, and fiberoptic laryngoscopy with specialty blades
• Demonstrate effective management of children requiring general anesthesia for elective and emergent surgery for the spectrum of pediatric surgical subspecialty conditions, including neonatal surgical emergencies and congenital disorders. Exposure to cardiac anesthesia including management of children undergoing cardiopulmonary bypass will be provided during the cardiac anesthesia rotation.
• Demonstrate understanding and proper management of both normal perioperative fluid therapy and massive fluid and/or blood loss
• Demonstrate effective use of pharmacologic agents in support of the circulation
• Demonstrate understanding of the management priorities on cardiopulmonary resuscitation and pediatric advanced life support
• Demonstrate understanding and effective use of mechanical ventilation both within and outside the OR in neonates, infants, children, and adolescents
• Demonstrate understanding and effective management for temperature regulation in children
• Demonstrate understanding and effectiveness in obtaining and interpreting appropriate laboratory information; demonstrate appropriate response to results
• Demonstrate timely recognition and treatment of perioperative vital organ dysfunction including in the post anesthesia care unit
• Demonstrate the recognition, prevention, and treatment of pain in medical and surgical pediatric patients
• Demonstrate understanding of the indications for regional anesthesia techniques for inpatient and ambulatory surgery in children
• Demonstrate understanding of the pharmacology and proper use of analgesic agents in children in both acute and chronic pain issues
• Obtain exposure to acute post-operative and inpatient consultative pain management on the Pain Service rotation
• Demonstrate understanding of the issues and proper preparation for providing sedation or anesthesia for children outside the operating rooms, including those undergoing radiologic studies
• Demonstrate understanding of the issues of and proper preparation for transport of critically ill children between hospitals and/or within the hospital

Technical Skills

• Demonstrate proper performance of cardiopulmonary resuscitation in children
• Resident is to be certified in Pediatric Advanced Life Support
• Demonstrate ability to initiate proper fluid resuscitation
• Demonstrate ability to utilize pharmacologic agents in support of the circulation
• Demonstrate ability to utilize electrical therapy for malignant dysrhythmias
• Demonstrate proficiency of management of normal and difficult pediatric airways with proper airway assessment, mask ventilation, endotracheal intubation, LMA placement, and anesthesia ventilator management.
• Demonstrate proficiency with alternate airway modalities including:
  • Fiberoptic Intubating scope
  • Lighted Stylet
  • Fiberoptic laryngoscope blades (Glide Scope, McGraw Scope)
• Demonstrate ability to initiate one-lung ventilation and manage intra-operatively
• Demonstrate understanding and ability to prepare and potentially utilize emergency airway modalities including trans-tracheal jet ventilation, emergent cricothyrotomy
• Demonstrate proficiency in the placement of venous and arterial catheters, including central venous catheters
• Demonstrate understanding and proficiency in the use of ultrasound in the placement of venous and arterial catheters
• Demonstrate proficiency in performing regional anesthetic techniques in children
• Demonstrate ability to place caudal, lumbar, and thoracic epidural catheters in children, infant through adolescent
• Demonstrate proficiency in performance of single-shot caudal blocks in children
• Demonstrate proficiency in performance of basic peripheral nerve blocks including ilio-inguinal, femoral, axillary
• Demonstrate ability to place peripheral nerve block catheters for continuous infusions
• Demonstrate familiarity with performance of infra-clavicular block, interscalene block, popliteal block, and sciatic block
• Demonstrate facility with the use of ultrasound in performance of peripheral regional blocks, both one-shot and catheter placement

Medical Knowledge

• Discuss the pertinent developmental physiology of pediatric patients
• Discuss normal and abnormal physical and psychological development
• Discuss management of pathophysiology in cardiovascular, pulmonary, renal, hepatic, and CNS systems
• Discuss developmental pharmacokinetics and pharmacodynamics and mechanisms of pediatric anesthetic drug delivery
• Discuss congenital and acquired airway problems in children
• Discuss common medical and surgical problems in children
• Discuss congenital anomalies and developmental delay
• Discuss the metabolic and endocrine effects of surgery and critical illness
• Discuss pediatric coagulation abnormalities and therapy
• Discuss infectious disease pathophysiology and therapy
• Discuss pediatric trauma and burn management
• Discuss pediatric pain management
• Discuss use and toxicity of local and general anesthetics
• Discuss organ transplantation in children
• Discuss ethical and legal aspects of pediatric anesthesia care
• Discuss issues in transport of critically ill children

Interpersonal and Communication Skills

• Communicate effectively with patients, families, and staff
• Discuss anesthetic care effectively and compassionately to parent/guardian and child
• Organize work area and record anesthetic events accurately and in a timely manner

Practice-Based Learning and Improvement

• Effectively use self-assessment to define weaknesses and/or improve clinical practice
• Demonstrate ability to use information from a literature search or Internet engine to improve or justify anesthetic practice

Professionalism

• Prove to be responsible, reliable, and conscientious to all members of the care team
• Demonstrate a willingness to accept constructive feedback and change practice when indicated
• Demonstrate initiative by preparing for cases and asking appropriate questions

Systems-Based Practice

• Demonstrate awareness of health care costs by choosing cost-effective methods that do not compromise quality of care
• Advocate ideas for improving the quality of patient care in a constructive manner
• Work in cooperation with other health care professionals on the care team