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The Resident Handbook Department of Anesthesiology
Queen’s University
5th Edition 2011
Dr. Michael Cummings
Program Director Department of Anesthesiology
& Perioperative Medicine Queen’s University
July 2011
ACKNOWLEDGEMENTS Dr. Andrew Klahsen, a resident in the program, started this handbook in the early 1990's. Dr. Steve Shelley, the Program Director, assisted him at that time. Dr. Ted Ashbury produced the 2nd edition in 2000, during his term as Program Director. Dr. Melanie Jaeger revised it in July 2004 and again in January 2008. I revised it yet again, when I became Program Director, with the help of the Chief Resident at the time, Dr. JD Cyr. Kim Asselstine, the Postgraduate Program coordinator in Anesthesiology has provided many important contributions since this manual originated in 1999. Their efforts are gratefully acknowledged.
FOREWORD to the 5th Edition This handbook is intended to provide practical information for residents about the Postgraduate Royal College Program in Anesthesiology, Queen's University, Kingston, Ontario. The information in this book has been compiled over many years and is continually being updated.
All residents have certain expectations about the academic structure of a postgraduate training program. This handbook will help to outline the structure and organization of the academic program in Anesthesiology here at Queen's University. As well, every postgraduate program has a certain service component. It is through meeting the service requirements that residents learn to take responsibility for their actions and develop their skills. This handbook provides a general outline of the expected service commitment.
All components of this handbook will be revised to better reflect the educational experience for residents in the program. Thus, this document is a dynamic one, and always focused on making the Anesthesiology residency the best that it can be.
The Anesthesiology Residency Program at Queen's University complies with the PAIRO contract. The content of this document is subject to this contract and any disagreement between the two should be drawn to the attention of the Chief Resident and the Program Director without delay.
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The Anesthesiology Residency Program at Queen’s University
Queen’s University offers an outstanding five-year residency program in Anesthesiology and Perioperative Medicine. The program produces excellent clinicians, researchers, and educators who will be the leaders of tomorrow. Our graduates have gone on to challenging clinical practices, academic careers and fellowship programs around the world. We have over 30 attending anesthesiologists on our staff. All have academic appointments through Queen’s University, and are dedicated to educating the highest quality residents. Over 90% of our attending staff have post-residency fellowship training in one of the various subspecialties within anesthesiology, or have undertaken postgraduate training in research or education, and all take pride in providing the highest quality care to our region. In addition, there are two non-clinical PhD researchers, and a strong clinical research infrastructure. Research is strongly supported at Queen’s, and members of the department have produced numerous publications in highly respected peer-reviewed journals. Residents are major players in a lot of our research, contributing to many of these papers.
Our hospitals see a wide variety of interesting cases, as we are the referral center for a population of approximately 750,000. We are the regional trauma center. We provide services for all major surgical subspecialties including orthopedic, cardiac, thoracic, vascular, neurosurgery, pediatric, urologic, gynecologic, plastic, ENT and general surgery. All of our residents receive a comprehensive training in transthoracic echocardiograpy. We also provide training opportunities in transesophageal echocardiography. Both hospitals support ultrasound-guided regional anesthesia. The residents are also trained in a state of the art high-fidelity Anesthesia Simulator. Both preoperative assessment and perioperative acute pain management are stressed. Chronic Pain training is provided on our in-patient consult service and in our outpatient Chronic Pain clinic. Our residents are exposed to a wide variety of cases, and become very proficient in managing complicated patients both electively and on an emergency basis. We have a tertiary care obstetrical service with ~ 2000 deliveries per year, approximately 75% of whom receive epidural analgesia and 25% of whom undergo cesarean section. Kingston General Hospital houses a level 3 Neonatal ICU, and our residents all undertake a rotation there. Our adult ICU and our cardiovascular ICU round out the Critical Care training experience. In addition to the rotations in Kingston, all residents get a chance to work in a major pediatric hospital (usually the Children’s Hospital of Eastern Ontario) and a community hospital (usually Peterborough General Hospital). Elective time of up to 6 months can be spent anywhere in Canada or Internationally. A number of our attending anesthesiologists are involved with medical care and training in developing countries, and opportunities to accompany the physicians on these missions are available to our residents.
Our residency program is one of the smaller ones in the country, and we see that as one of our major strengths. Our residents learn to handle responsibility quickly and earn the respect of the staff early in the program. This allows them to be directly involved in complicated cases right from the start, and to manage these cases with a graded amount of independence. The small number of fellows ensures that residents get ample experience to all types of cases. The experience thus gained has produced an exceptional pass rate on the Royal College exams for our residents.
Kingston is a small, friendly town on the shores of Lake Ontario at the mouth of the St. Lawrence River and the renowned Thousand Islands. The small-town feel is complemented with state of the art education at Queen’s University and St. Lawrence College, and all the amenities that accompany such centers of higher education. Recreational activities abound, and a fulfilling life outside of work is encouraged in both staff and residents. The attending staff at Queen’s enjoy a collegial atmosphere with our resident staff, where the residents are quickly trusted to assume responsibility early in their training. This translates into confident, self-assured professionals who have the knowledge and expertise to excel as consultant anesthesiologists. Staff members have a vested interest in not only ensuring that our residents are successful in their fellowship exams, but in seeing the residency program itself provide the best possible experience.
Joel Parlow, MD, FRCPC Michael Cummings, MD, FRCPC Department Head Postgraduate Program Director
Department of Anesthesiology and Perioperative Medicine
Queen’s University and the Kingston Hospitals August 2011
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TABLE OF CONTENTS
(The page numbers refer to the pages in the paper copy of this handbook.)
ACKNOWLEDGEMENTS………………………………………………………………………. 1 FORWARD………………………………………………….…..……………….………………. 1 CHAIRMAN’S INTRODUCTION……………………………………………..……..…………. 2 SUMMARY OF EXPECTATIONS FOR THE RESIDENTS…………………………………… 3 I. DEPARTMENT OF ANESTHESIOLOGY - QUEEN'S UNIVERSITY
A. Queen's University…………………………………………………………………... 5 B. Health Care Facilities Serviced by Anesthesia………………………………….…… 5
1. Kingston General Hospital…………………………………………….…… 5 2. Hotel Dieu Hospital………………………………………………………… 5
C. Department of Anesthesiology………………………………………………………. 5 1. Department Structure………………………………………………………. 5
D. Anesthetic Services…………………….………………………………………. 6 1) Operating Rooms/PAR……………………………………………. 6 2) Pre-Anesthetic Assessment Clinics……………………………….. 6 3) Obstetrical Service………………………………………………… 6 4) Acute Pain Service………………………………………………… 6 5) Chronic Pain Service……………………………………………… 6 6) Arrest & Trauma Service………………………………………….. 7 7) ICU………………………………………………………………… 7 8) Echocardiography…………………………………………………. 7
II. RESIDENCY TRAINING PROGRAM
A. Philosophy & Goals of the Program…………………………………………………. 8 B. Program Structure……………………………………………………………………. 8
Post Graduate Education Committee……………………………………………………………. 8
Program Director……………………………………………………….………………………... 8
Residency Positions & Funding…………………………………………..................................... 9
Chief Resident……………………………………………………………………………………. 9
Resident Manager………………………………………………………………………………… 9
C. Mentorship Program ……………………………………………………………..… 10 Organization of the Educational Program D. Clinical Training……………………………………………………….…………….. 11 E. Academic Program…………………………………….….…………………….….... 13
1. Core Content Sessions…………………………………………….. 13 2. Simulation Program………………………………………………. 18
3. Educational Rounds ……………………………………………… 19 Weekly Academic Schedule…………………………….……19 Grand Rounds…………………………………………………19 Case Management Rounds……………………………………19 Journal Club…………………………………………………. 19
4. Resident Research………………………………………………… 20 F. Evaluation
1. Evaluations of Resident Performance 1. Daily OR Evaluation Criteria and Forms…………….…………… 22 2. Bi-annual Review ………………………………………………… 22 3. Written Examinations …………………………………………….. 22
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4. Oral Examinations ……………………………………..…………. 23 5. Resident Logbook ………………………………………………….. 23 6. 360 Assessment ……………………………………………………. 23 7. Simulator Scenarios ………………………………………………... 23 8. CanMeds Portfolio …………………………………………………. 23 9. Presentations …………………………………………………………24 10. Attendance Record ………………………………………………… 24 11. Participation in Program Evaluation ………………………………..24 12. Certificate of Completion of Training & FITER …………………. 24
2. Resident Evaluation of Academic Program …………………………………. 25 3. Annual Award for Teacher of the Year ……………………………………… 25 4. Resident/Staff Liaison Committee Meeting ………………………………… 25
G. Educational Resources
1. Clinical a) Kingston …………………………………………………………… 26 b) Children's Hospital of Eastern Ontario, Ottawa ………………….. 26 c) Peterborough ……………………………………………………… 26 d) Electives ………………………………………………………… 26
2. Research Unit.……………………………………………………………… 26 3. Libraries ……………………………………………………………………… 27 4. Conference Support ………………………………………………………… 27
H. Resident Responsibilities Short Summary of Expectations of Residents ………………………………………. 29 1. Patient Care ………………………………………………………………………… 30
1) Clinical Competence……………………………………………………….. 30 2) Operating Room Assignments & Responsibilities ………………………… 31 3) Preoperative & Postoperative Assessments…………………………………. 31 4) Patient Care Outside of the Operating Rooms……………………………… 31 5) On Call Coverage & Pagers KGH………………………………………….. 32
i General Comments ii Obstetrical Service iii Trauma Service iv Arrest Service v Acute Pain Service vi. Call Schedule vii Assignment of Pagers
6) Consults …………………………………………………………………….. 35 7) Vacations & Statutory Holidays……………………………………………. 35 Vacations Statutory Holidays Christmas & New Years Holidays 8) PAIRO Educational Days…………………………………………………… 37 9) Sick Leave………………………………………………………………….. 37
2. Clinical Billing ………………………………………………………………………… 37 III. QUEEN'S UNIVERSITY POSTGRADUATE EDUCATION POLICIES ………………….. 38 1. Evaluation and Promotion and Appeals 2. Moonlighting Policy 3. Intimidation and Harassment Policy 4. Health and Safety Policy 5. Supervision of Postgraduate Medical Education Trainees IV. APPENDIX
Royal College of Physicians and Surgeons of Canada Objectives of Training Specialty Training Requirements Fellowship Examinations and Preparation
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Resident Conference Support Resident Block Evaluation Form (completed for some rotations) Resident Evaluation of Program (completed quarterly) Internal Medicine Rotation Evaluation Forms (Cardiology, Respirology, Nephrology) Core Program Evaluation (completed for each seminar)
Resident Daily Evaluation Form Staff Daily Evaluation Form
I. DEPARTMENT OF ANESTHESIOLOGY & PERIOPERATIVE MEDICINE –
QUEEN’S UNIVERSITY A. Queen's University Queen's University is one of the oldest universities in Ontario. An excellent description of the University, the age of the medical school, and the area serviced by the hospitals can all be found under the Queen's University website. The Queen's University website is http://www.queensu.ca/. The medical school website is http://meds.queensu.ca/. For a description of the history of Queen's University this can be found at the following website http://advancement.queensu.ca/html/q_history. B. Health Care Facilities Serviced by Anesthesiology 1) Kingston General Hospital
The Kingston General Hospital is a multi-programmed hospital consisting of over 300 beds. Specific surgical services include: thoracic surgery, vascular surgery, cardiac surgery, general surgery, gynecologic surgery, orthopedics, pediatric general surgery, major ENT surgery, and urology. The hospital also provides a complete tertiary care service in the various medical specialties. There is also a full range of obstetrical services, catering to a wide geographic area. Our residents are members of the trauma team and are therefore commonly called to the Emergency Room to help to manage trauma victims and other patients in whom our expertise at airway management and hemodynamic stabilization are of benefit. Kingston General Hospital is a regional trauma centre and thus a great deal of trauma from the region comes to KGH. The description of Kingston General Hospital on the website can be seen at http://www.kgh.on.ca.
2) Hotel Dieu Hospital
The Hotel Dieu Hospital is an ambulatory care facility. Four to six operating rooms are run daily. In addition, there is an active Pre-Anesthetic Consult Clinic four days per week and Chronic Pain clinics. A description of the Hotel Dieu Hospital and its mission statement and activities can be found at http://www.hoteldieu.com.
3) PCCC
The Department of Anesthesiology provides anesthetic services for in-patient and outpatient ECT treatments at the Psychiatry Hospital 3 times a week. Residents are assigned on a rotating basis, in order to gain experience in this area. C. Department of Anesthesiology The Department of Anesthesiology has its own web site at www.anesthesia.ca.
Department Structure
Department Head Dr. Joel Parlow MD, FRCPC
Deputy Chief Academic Dr. Brian Milne MD, FRCPC
Deputy Chief and Clinical Coordinator Dr. Janet VanVlymen MD, FRCPC
Residency Program Director
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Dr. Michael Cummings MD, FRCPC
Resident Research Coordinator Dr. Ian Gilron, MD, FRCPC
Family Medicine/Anesthesia Program Director Dr. Brian Mahoney MD, CCFP
Undergraduate Education Coordinator Dr. Rob Tanzola MD, FRCPC
Fellowship Director Dr. Rene Allard, MD, FRCPC
Continuing Medical Education Coordinator Dr. Tarit Saha MD, FRCPC
Journal Club Coordinator Dr. Kim Turner MD, FRCPC
Chair, Finance Committee Dr. Louie Wang
D. Anesthesiology Services There are a number of services that are provided by the Department of Anesthesiology throughout the hospital. As time goes by, and as the nature of medicine and healthcare changes, different services are added to the spectrum of perioperative care.
1) Operating Rooms/PACU
KGH usually has 11 Operating Rooms working on weekdays. Hotel Dieu Hospital has 4-6 Operating Rooms running for outpatient services. During holidays and at times of major anesthesia conferences, the number of operating rooms decreases to accommodate absences. Each operating room is staffed by a member of the faculty of the Queen's University, Department of Anesthesiology. The Resident OR Manager routinely assigns residents to these OR’s.
2) Preoperative Assessment Clinics
This is a growing function of the Anesthesiology Department. Currently there are preassessment clinics staffed by members of the Department of Anesthesiology Monday through Thursday, for orthopedic, vascular, thoracic, cardiac, and pediatric patients, as well as general consults for medical problems or anesthetic issues that do not fall into these specific patient subgroups.
Residents spend a number of days throughout their training period in these clinics, where they learn to assess complicated medical conditions, optimize patients and address anesthetic concerns. This is organized as a longitudinal experience in Perioperative Medicine, and consists of approximately 20 clinic days (representing one block) over the course of the PGY 3 – 5 years. In order not to distract overly from the concurrent horizontal Clinical Anesthesia experiences, clinic assignments are limited to a maximum of 2 per block for each resident.
3) Obstetrical Service
The Anesthesiology services for the Department of Obstetrics are available 24 hours a day. The majority of patients receive epidural analgesia during their labour. A consult service is available for complicated obstetrical problems. There is always a resident assigned to cover the Obstetric service.
4) Acute Pain Management Service
Dr. Melanie Jaeger is the medical director of the Acute Pain Management Service. With the assistance of Rosemary Wilson and Valerie Wilson, our nurse practitioners, we have a very active service. Many of the patients on the service have continuous epidural analgesia or PCEA, or continuous peripheral nerve catheters. Patients with IVPCA pumps are also followed and monitored on a daily basis. This service is continually expanding as we use newer techniques to achieve better analgesia in the perioperative period.
Coupled with the acute pain service is the regional block experience in which the residents have an opportunity to practice various regional techniques for both pain management as well as the intraoperative management of patients.
5) Chronic Pain Program
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Dr. Richard Henry coordinates the anesthesia component of this program, along with other specialists who practice chronic pain and all of whom work together in a multidisciplinary fashion. Residents on this service will experience the opportunity of placing blocks and following patients who have chronic pain problems. This service involves both block and clinic time.
6) Arrest & Trauma Service
The Department of Anesthesiology is always on call for cardiac arrests and all traumas. The resident is the focal point of this service and all arrest calls and stat trauma calls are paged directly to the resident on call.
7) ICU
There is almost always at least one resident who is on the adult ICU rotation. Our residents serve as housetaff on their first ICU rotation, and act as junior fellows during their subsequent rotations. As well, Anesthesiology is on stand-by for difficult airway problems that might arise in the ICU. Residents also rotate through NICU and the cardiovascular ICU, and can take electives in PICU.
Residents in their PGY 3 year who demonstrate a particular aptitude for Critical Care are invited to co-register in the Critical Care Fellowship program. In this way, their PGY 4 – 5 years overlap between Anesthesiology and Critical Care. By strategically using elective time, residents are able to complete the first year of the CC Fellowship by the time they finish their PGY 5 year.
8) Echocardiography
Echocardiography is becoming an increasingly important part of anesthesia practice. Already essential in cardiac anesthesia, it is becoming more readily available in other parts of anesthesia practice. Our residents all receive a course in focused transthoracic echocardiography and can incorporate these skills into their practice on a regular basis. They also are exposed to transesophageal echocardiography during their cardiac anesthesia rotations, and can take electives in TEE if they so wish.
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II. RESIDENCY TRAINING PROGRAM A. Philosophy & Goals of the Program The primary goal of the training program is to train and prepare residents to become successful Consultant Anesthesiologists, whether they choose an academic, administrative or community environment. In doing so, we inevitably focus on meeting the educational requirements of the Royal College Specialty Program in Anesthesiology and success at the specialty examinations. (c.f. the booklet ‘Goals, Objectives and Evaluation Handbook’)
The Department of Anesthesiology seeks to comply with the PAIRO contract and the Standards of the Royal College of Physician and Surgeons of Canada in all matters pertaining to its Residency Training Program. The provisions of the PAIRO contract and the Standards of the RCPSC will supersede the guidelines contained in this Handbook, where any conflict may arise.
B. Program Structure 1) Residency Program Committee
Members of this committee include:
Dr. Michael Cummings (Chair, Residency Program Director)
Dr. Melanie Jaeger (former Program Director)
Dr. Ted Ashbury (former Program Director, Departmental Ombudsman)
Dr. Joel Parlow (Departmental Chair, ex-officio)
Dr. Jessica Burjorjee (Director of Simulation)
Dr. Rob Tanzola (Undergraduate Rotation Coordinator)
Dr. Rachel Rooney (Resident Assessment)
Dr. Alison Froese (Member-at-large)
Dr. Brian Milne (Member-at-large)
Chief Resident
Junior Resident (elected)
Dr. Ian Gilron (Resident Research Coordinator, corresponding member)
Dr. Brian Mahoney (Residency Program Coordinator, FM-A program, corresponding member)
Dr. Bob Heid (Community (Peterborough) rotation coordinator, corresponding member)
Dr. Victor Neira (Pediatric Anesthesia Rotation coordinator (CHEO), corresponding members)
2) Residency Program Director
Dr. Mike Cummings has been the Program Director since 2009. With the help of the RPC, his function is to oversee the day-to-day operation of the educational component of the residency program. He is also the liaison between the Queens Postgraduate Medicine Office, the Royal College of Physicians and Surgeons, and the residents in the training program. As well, from a Departmental point of view, he functions as the resident advocate in all matters relating to maintaining the balance between the service component and the educational component of the program.
It is the Program Director's responsibility to ensure that the program meets the standards of the Royal College of Physicians and Surgeons with respect to all of the educational components. This includes setting goal-oriented objectives and setting realistic evaluative techniques to see that residents are meeting those objectives. In order to meet the educational objectives of the program, specific components of the program must be in place. These components include the establishment of educational rounds, such as Core Program, Grand Rounds, and Case Management Rounds. As well, Journal Clubs are a part of the educational program. The program is structured around the various objectives of each subspecialty area of anesthesia, which are clearly outlined in the ‘Goals, Objectives and Evaluation Handbook’.
The Chief of the Department appoints the Program Director to the position. The appointment of the Program Director must be ratified by the Associate Dean of Postgraduate Medical Education at Queen's
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University. As well the Program Director must be a member in good standing of the Royal College of Physicians and Surgeons of Canada.
3) Residency Positions and Funding
Each year the Anesthesiology Residency Program offers four PGY 1 positions to graduates of Canadian medical schools through CaRMS. The residency training in Anesthesiology is a five-year program. In addition, a position may be available an International Medical Graduate, on a case-by-case basis, depending on capacity in the Program.
As well there is a Family Practice-Anesthesia program into which up to two residents per year are accepted. This program has its own Program Director, separate goals and objectives, and a unique evaluation process. It will not be discussed further in this manual.
4) Chief Resident
The Chief Resident is the liaison between the Residency Staff and the Program Director and the Residency Training Committee (RTC). It is the Chief Resident's responsibility to design a working call schedule for the residents. As well, the Chief Resident is responsible for relaying any concerns from the residents to the Program Director and vice versa. In instances where there are conflicts, in call schedule and/or service duties for residents who are off service (e.g. Medicine) rotations, it is expected that the Chief Resident will be able to deal with these situations in the first instance.
The Chief Resident usually has a six-month to one-year appointment. No more than two Chief Residents are appointed per year, in which case each would have for six-month terms. There is a stipend that accompanies the appointment of Chief and senior residents for the extra administrative tasks that they must undertake in order to do their job.
1. The term for the Chief Resident runs from September 1st through August 31st of the next year. If there are two Chiefs for a given year, the term typically is divided September 1st through February 28th and March 1st through August 31st.
2. Residents will become eligible to serve as Chief Residents in their PGY 4 year. 3. In early February of the previous year, the cohort of eligible residents will be asked for
nominees who wish to be considered for the Chief Resident position during the coming year. 4. In late February, all of the residents and attending staff in the Department will participate in a
ballot for the nominated candidate(s). 5. The Program Director will then recommend candidate(s) for the position of Chief Resident to
the Residency Program Committee, taking into account the number of votes received by each candidate.
The Residency Program Committee, based on this recommendation, will then appoint the in-coming Chief Resident(s).
5) Resident Manager
Each block, a senior resident will be designated as Resident OR Manager.
It is his/her duty to assign the residents, and other learners, to the operating rooms at KGH and HDH, as well as other anesthetizing locations, in order that each trainee is exposed to diverse clinical encounter opportunities throughout their training. Rooms will be allocated based on seniority and educational need. Residents can request certain room allocations if they feel they need more experience in a particular area.
The residents are assigned to each OR slate, subject to guiding principles (see below), before Attending Staff are assigned. This allows the Resident OR Manager to allocate the learners according to the best learning opportunities, regardless of constraints of Staff resources. Attending Staff will be assigned to cover rooms and their assigned residents/learners by the Staff OR Manager. Changes to the resident assignments by the Staff OR Manager need to be approved by the Resident OR Manager and the Program Director, and will be approved subject to educational considerations.
When making assignments, the Resident OR Manager is asked to keep the following principles in mind:
Assignments are to be made judiciously, with attention to placing learners into rooms that are appropriate to their experience level and learning needs;
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Managers need to be cognizant of each resident’s current rotation, and assignments made to the appropriate room; Specific Rotations: i) Buddy Call (K-BC): Assigned to a room at KGH appropriate for a junior learner, or to
Connell 5 or the APMS with a senior resident, as indicated in the weekly schedule. ii) Cardiac Anesthesia (K-Hearts): Assigned to either Cardiac OR (OR-I or OR-J). One per
block, the resident on Cardiac Anesthesia will attend the Cardiac PSS clinic (Tuesday AM). iii) Obstetric Anesthesia (K-OB): Assigned to Connell 5 and In-Patient Consults. iv) Ambulatory Anesthesia (HDH): Assigned to an OR at HDH. v) Acute Pain/Regional Anesthesia: On alternating weeks, assigned to the APMS service and
an OR which offers the most opportunities to place peripheral regional blocks (at either KGH or HDH).
vi) Airway: (K-AW): Assigned to an OR (KGH or HDH) which offers the most opportunities for multiple airway management experiences, particularly with airway adjuncts.
vii) Horizontal Anesthesia rotations (K-OR): When residents are on horizontal Clinical Anesthesia rotations, they can be assigned to training level-appropriate rooms in either KGH or HDH, or other DAL’s such as MRI or C5/Consults.
It is the responsibility of the Managers to maintain a grid, tracking the daily assignments for each learner, such that experiences can be evenly and fairly distributed across the group, taking into account each learners specific goals;
It is the responsibility of the Managers to track complex, rare, or ‘interesting’ cases, as identified in clinic, consults or otherwise, and ensure that these learning opportunities are optimally assigned, either to the resident who saw the patient initially, or to another senior learner; and
List assignments need to be done in a timely fashion. The goal is to complete the assignments and return the list to the office by 10:00 hrs.
Residents on service may make special requests of the Resident OR Manager regarding their assignments. It is up to the Resident OR Manager to adjudicate special requests in light of the overall resources of the OR and the learning objectives of the other learners. If disagreements regarding list allocations cannot be sorted out between the resident involved and the Resident OR Manager, the Chief Resident is the first recourse for discussion. If the situation still cannot be resolved, then the Program Director will get involved.
If the resident manager is unable to assign the rooms due to vacation or leave, he/she must delegate the task to an appropriate resident colleague. C. Mentorship Program Our residents see the Mentorship Program as a highly valuable part of the program. Residents will be assigned a Faculty Mentor upon entry into the program, at the start of their PGY 1 year. This faculty member is there to guide and support the resident throughout their training. The objective of the Mentorship Program is that each resident feels that they have someone who is there to help them if they need it, either academically or otherwise.
1) Mentor Role Description
The role of Mentor includes, but is not limited to, the following:
Introduce yourself to your new mentee as soon as possible Help them settle into the Department and the city Let them know that you are there to offer advice for resident issues such as:
o appropriate elective suggestions o difficult colleague interactions o organizing personal study plans o research options (and direct them to most appropriate person) o Grand Rounds topics o exam prep o and many, many more!!
At the start of PGY 2, and each year thereafter, meet with them to discuss future career plans, opportunities, fellowships and jobs
Direct them to appropriate places and people that can help them fulfill their career goals
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Many more issues will undoubtedly arise during their five years of residency, so just let them know that they can come to you for advice or just for someone to listen.
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D. Clinical Anesthesia
The academic goals & objectives for each block listed below are located in the Goals, Objectives and Evaluation Handbook.
Clinical experience in Queen’s Anesthesiology is a blend of Block and Horizontal rotation assignments. The following anesthesia rotations are defined 4-week block assignments:
Cardiac Anesthesia Obstetric Anesthesia Chronic Pain Acute Pain/Regional Ambulatory Surgery Community Anesthesia Airway Block Pediatric Anesthesia (3 blocks) Electives
The other rotation goals & objectives are achieved through continuous exposure on horizontal rotations in adult and pediatric anesthesiology. Residents are assigned to different daily anesthesia locations (typically OR’s, but also PAC, obstetric, in-patient consults, trauma, etc.) each day, such that, over the course of their entire residency they receive exposure to, and instruction on, all aspects of clinical anesthesiology.
Hospital Subspecialty Coordinator Schedule Name
Duration/yr Revised
KGH Cardiac Dr. Rene Allard Cardiac 1 block PGY 2 1 block PGY 5
2011 Sept
Vascular Dr. Rene Allard KGH PGY 3-5 2011 Sept
Thoracic Dr. Melinda Fleming KGH PGY 3-5 2009 Sept
Neurosurgery Dr. Brian Simchison KGH PGY 3-5 2011 Sept
Obstetrics ** Dr. Sue Haley KGH-OB 1 block PGY 2 1 block PGY 5
2011 Sept
Orthopedics Dr. Melanie Jaeger KGH/HDH PGY 2-5 2009 Sept
Trauma **, Burns, Plastic Surgery
Dr. Mike McMullen KGH/HDH PGY 2-5 2011 Sept
General Surgery Dr. Dale Engen KGH/HDH PGY 2-5 2009 Oct
Urology Dr. Rachel Rooney KGH PGY 2-5 2011 Sept
Acute Pain **/ Regional
Dr. Melanie Jaeger KGH-AP 1 block PGY 2 1 block PGY 5
2009 Sept
Gynecology Dr. Scott Duggan KGH PGY 2-5 2009 Nov
Airway Dr. Rick Zamora KGH-AW 1 month PGY2 2009 Sept
Anesthesia in Remote Locations
Dr. Ted Ashbury KGH PGY 2-5 2011 Sept
Elective Various --- 6 blocks PGY 3-5 ---
HDH
Ambulatory: ENT, Ophthalmology Dental/Orofacial, Gen Sx, Ortho, Plastics
Dr. Rob Tanzola HDH 1 block PGY 3 1 block PGY 5
2009 Oct
Preassessment Clinics **
Dr. Janet van Vlymen PAC (HDH) PGY 2-5 2011 Sept
Chronic Pain Dr. Richard Henry CP 1 block PGY 4 2011 Sept
Pediatrics Dr. Ted Ashbury KGH/HDH PGY 2-5 2011 Sept
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CHEO * Pediatrics Dr. Victor Neira CHEO 3 blocks 2011 Sept
PETER-BOROUGH #
Community Anesthesia
Dr. Bob Heid PB 1 block 2009 Oct
* Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario The CHEO rotation is three blocks long. The rotation is supported by the Queen’s Regional Education Office. Accommodation and a travel allowance are provided. This block may be taken at any academic Pediatric Hospital if initiated by the resident and approved by the program director, however the REO will not provide financial support for Pediatric Anesthesia rotations taken at sites other than CHEO. ** The experience in the Pre-assessment clinics, in-patient Consults, Trauma and Resuscitation, additional Obstetrical anesthesia, and additional APMS experience occurs throughout the PGY 2 to PGY 5 years, while on call and during horizontal anesthesia assignments. # Peterborough Regional Health Centre, Peterborough, Ontario
Peterborough is the location of the mandatory Community Anesthesia experience. The rotation is supported by the Queen’s Regional Education Office. Accommodation and a travel allowance are provided. Residents who wish to explore other community rotations may do so during their elective time in the PGY 3-5 years. These elective rotations are not financially supported by the REO.
* Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario The CHEO rotation is three blocks long. The rotation is supported by the Queen’s Regional Education Office. Accommodation and a travel allowance are provided. This block may be taken at any academic Pediatric Hospital if initiated by the resident and approved by the program director, however the REO will not provide financial support for Pediatric Anesthesia rotations taken at sites other than CHEO.
** The experience in the Pre-assessment clinics, in-patient Consults, Trauma and Resuscitation, additional Obstetrical anesthesia, and additional APMS experience occurs throughout the PGY 2 to PGY 5 years, while on call and during horizontal anesthesia assignments.
# Peterborough Regional Health Centre, Peterborough, Ontario Peterborough is the location of the mandatory Community Anesthesia experience. The rotation is supported by the Queen’s Regional Education Office. Accommodation and a travel allowance are provided. Residents who wish to explore other community rotations may do so during their elective time in the PGY 3-5 years. These elective rotations are not financially supported by the REO.
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E. Academic Program
1) Core Content Sessions
The academic content of the program is covered by a series of weekly teaching sessions from September through June of each year. The sessions are presented in a three-year cycle. The sessions are currently scheduled to be held every Wednesday afternoon from 13:30h till 16:30h. Attending Staff are assigned to present specific topics during these sessions. They provide and distribute objectives and any supporting documentation for each session at least one week prior to the assigned date. Residents may also be assigned to research and present a particular topic related to the session; resident participation varies depending on the session. Residents are expected to prepare for the sessions in advance. The teaching style in the individual sessions will vary depending on the staff person involved. A mechanism of resident feedback is provided to assist staff presenters in maximizing the effectiveness of their sessions.
The purpose of Core Program is to provide a forum for interactive discussion of some of the key concepts related to anesthetic practice. While many important topics will be discussed, Core does not comprise an exhaustive curriculum; rather it is meant to supplement your independent study.
The following pages give a general outline of the Core Program schedule. A copy of the specific objectives for all previous individual sessions is kept in the Anesthesia Departmental Office at KGH, and is available on-line at the Departmental website.
Overview of Core Curriculum
Year 1 Year 2 Year 3
Respiratory Physiology Obstetrics Cardiovascular Physiology
Thoracic Anesthesia Pediatrics Cardiac Anesthesia
Trauma Neuroanesthesia Vascular Anesthesia
Pharmacology Acute Pain Equipment
Patient Safety Chronic Pain Perioperative Medicine
Simulation Simulation Simulation
Transthoracic Echocardiography (PGY 2’s)
Transthoracic Echocardiography (PGY 2’s)
Transthoracic Echocardiography (PGY 2’s)
Core Competencies Core Competencies Core Competencies
Guest Professors Guest Professors Guest Professors
Resident attendance at Core Program Seminars is mandatory unless the resident is on vacation, conference leave or sick leave.
Protected time to attend Core Program is provided during all clinical
Anesthesia rotations. This protected time also has been agreed to by all PGY 1 off-service rotations, and all senior off-service rotations (with the
exception of Junior ICU and Chronic Pain, which provide their own Anesthesia specific academic programs).
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CORE PROGRAM Academic Year: 2010-11
Coordinator: Dr. Mike Cummings Wednesdays 1230-1530 hrs
Location: Anesthesia Library The purpose of Core Program is to provide a forum for interactive discussion of some of the key
concepts related to anesthetic practice. While many important topics will be discussed, Core does not comprise an exhaustive curriculum; rather it is meant to supplement your independent study.
DATE
CORE TOPIC Assigned Faculty
2010 September 8
Resident Oral Exams Drs. Rooney & Cummings
2010 September 15
Respiratory Physiology I Review/Intro
Dr. Alison Froese
2010 September 21 Tuesday
Respiratory Physiology II Gas Exchange
Dr. Cara Reimer
2010 September 29
Respiratory Physiology III Respiratory Mechanics: Statics
Dr. Melinda Fleming
2010 October 6
Respiratory Physiology IV Respiratory Mechanics: Dynamics
Dr. Melinda Fleming
2010 October 13
Respiratory Physiology V Muscles
Dr. Alison Froese
2010 October 21 & 29
Simulator - Respiratory Drs. Jessica Burjorjee & Louie Wang
2010 October 27
Pediatric Anesthesia – Pitfalls and Pearls Case Discussions
Dr. Gail Wong Visiting Professor
2010 November 3
Respiratory Physiology VI Pulmonary Airway and Vascular Tone
Dr. Jason Erb
2010 November 10
Thoracics I Ventilator Strategies
Dr. Dale Engen
2010 November 17
Thoracics II Preoperative Pulmonary Assessment
Dr. Kim Turner
2010 November 24
Thoracics III OLV
Dr. Melinda Fleming
2010 November 30 Tuesday
Thoracics IV Bronchoscopy
Dr. Cara Reimer
2010 December 10 & 16
Thoracic Simulator Drs. Jessica Burjorjee & Melinda Fleming
2010 December 15
AKT Examinations
December 22/29
Christmas Holidays
2011 January 5
Resident Oral Exams
Drs. Dale Engen & Mike McMullen
2011 January 12
Core Competency – Advocacy TBA
2011 January 19
Transthoracic Echocardiography I Drs. Rob Tanzola & Rene Allard
2011 January 26 Transthoracic Echocardiography II Drs. Rob Tanzola & Rene Allard
2011 February 2
CaRMS Interviews
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DATE CORE TOPIC Assigned Faculty
2011 February 9
Transthoracic Echocardiography III Drs. Rob Tanzola & Rene
Allard 2011 February 16
Transthoracic Echocardiography IV Drs. Rob Tanzola & Rene
Allard 2011 February 23 & 25
Transthoracic Echo Simulator Drs. Louie Wang & David
Mark 2011 March 2
Pharmacology I
Principles of Pharmacology Dr. Jim Brien
2011 March 9
A Variety of Chronic Pain Topics Dr. Cathy Smyth Visiting Professor
2011 March 16 March Break
2011 March 23
Pharmacology II Volatile Anesthetics
Dr. David Mark
2011 March 30 Pharmacology III IV Anesthetic Agents
Dr. Rachel Rooney
2011 April 6
Pharmacology IV Neuromuscular Blockers
Dr. Tarit Saha
2011 April 13
Pharmacology V Local Anesthetics
Dr. Richard Henry
2011 Research Day (Friday, 2011 April 8)
2011 April 20 Pharmacology VII Opioids
Dr. Eric Dumont
2011 April 27
Pharmacology VI Sympathomimetic & Cholinergic Agents
Dr. Brian Milne
2011 May 12 & 13 Simulator - Pharmacology Drs. Jessica Burjorjee & Mike McMullen
2011 May 6 Resident Oral Exams (Senior Residents)
Drs. Cummings & Fleming
Date - TBA Resident Oral Exams (Junior Residents)
Drs. TBA
2011 May 11
Patient Safety Dr. David Goldstein
2011 May 18
Case Discussions Dr. Scott Groudine Visiting Professor
2011 May 25 Topic – TBA Dr. P.J. Devereaux Visiting Professor
2011 June 1 Trauma I Dr. Rob Tanzola
2011 June 8 Trauma II Dr. Rick Zamora
2011 June 15
Core Competency – Collaborator TBA
2011 June 22
Simulator - Trauma Drs. Louie Wang & Rick Zamora
2011 June 29
CAS Meeting
2011 May 13
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CORE PROGRAM
Academic Year: 2011-12 Coordinator: Dr. Mike Cummings Wednesday, 1330-1630 hrs
Location: Anesthesia Library The purpose of Core Program is to provide a forum for interactive discussion of some of the key
concepts related to anesthetic practice. While many important topics will be discussed, Core does not comprise an exhaustive curriculum; rather it is meant to supplement your independent study.
DATE
CORE TOPIC Assigned Faculty
2011 September 7
Resident Oral Exams TBA
2011 September 14
Core Competency – Professionalism Dr. Ted Ashbury
2011 September 21
Transfusion Medicine and Coagulation Dr. Rene Allard
2011 September 28 Ambulatory Anesthesia Dr. Janet van Vlymen
2011 October 5 Hepatology Dr. Rick Zamora
2011 October 12 Simulator I (Practice Session – ACLS Algorithms)
Dr. Jessica Burjorjee Dr. Louie Wang
2011 October 19
ENT/Ophthalmology Dr. Ron Seegobin
2011 October 26
Endocrinology and Rheumatic Disease Dr. John Cain
2011 November 2
Neuroanesthesia I Dr. Brian Simchison
2011 November 9
Neuroanesthesia II Dr. Brian Milne
2011 November 16
Simulator II (Neuroanesthesia I) Dr. David Mark Dr. Louie Wang
2011 November 21 ONA/CUPE Holiday Program TBD
2011 November 23
Obstetric Anesthesia I Dr. Susan Haley
2011 November 30
Obstetric Anesthesia II Dr. Michael Cummings
2011 December 7
Obstetric Anesthesia III Dr. Kim Turner
2011 December 14
Obstetric Anesthesia IV Dr. Lindsey Patterson
2011 December 21
AKT
2011 December 28
Christmas Holidays
2 January 4
Christmas Holidays
2012 January 11
Resident Oral Exams TBA
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2012 January 18
Obstetric Anesthesia V Dr. John Murdoch
DATE CORE TOPIC Assigned Faculty
2012 January 25
Simulator III (Obstetrics I) Dr. Jessica Burjorjee Dr. Devin Sydor
2012 Jan 30 - Feb 2
CaRMS Week
2012 February 8
Pain I – Mechanisms Dr. Ian Gilron
2012 February 15
Pain II – Medical Management Dr. Dave Ruggles
2012 February 22
Pain III – Neuroanatomy of Regional Anesthesia I
Drs. Melanie Jaeger & Mike McMullen
2012 February 29
Pain IV – Neuroanatomy of Regional Anesthesia II
Drs. Melanie Jaeger & Mike McMullen
2012 March 7
Pain V - Chronic Pain I Dr. Richard Henry
2012 March 14
March Break
2012 March 21
Pain VI – Chronic Pain II Dr. Scott Duggan
2012 March 28 Simulator IV Dr. Mike McMullen Dr. Rick Zamora
2012 March 30 Resident Research Day
2012 April 4
Pediatric Anesthesia I Dr. Ted Ashbury
2012 April 11
Pediatric Anesthesia II Dr. Richard Henry
2012 April 18
Pediatric Anesthesia III Dr. Melinda Fleming
2012 April 25
Resident Oral Exams Dr. Cummings & Guest
2012 May 2
Pediatric Anesthesia IV Dr. Dale Engen
2012 May 9
Pediatric Anesthesia V Dr. Vidur Shyam
2012 May 16
2012 May 23
Simulator V Dr. Melinda Fleming Dr. Vidur Shyam
2012 May 30 Core Competency – Collaborator
TBA
2012 June 6
2012 June 13
2012 June 15-19 CAS
2012 June 20
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2012 June 27
Simulator Boot Camp Dr. Mike McMullen Dr. Jessica Burjorjee
Draft: 2011 July 27
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2) Anesthesiology Residency Simulation Program Overview
The simulation program for anesthesia residents at Queen’s University has been up and running with regular sessions occurring since May 2006. We are committed to using this new technology to provide excellent educational sessions for our residents in a fun, safe & protected learning environment. Sessions are designed specifically for our residents to practice identifying and responding to crises, to develop team and communication skills, and to handle challenging scenarios and practice decision-making. Each simulation is followed by a group debriefing to maximize the learning from each session. It is in this way that the simulation program offers the residents a unique opportunity to apply & practice implementing their knowledge in a safe environment without compromising patient care.
Introduction to the Simulation Lab
The high fidelity simulator is located on the second floor of the new Medical School Building, 15 Arch Street, just across from Kingston General Hospital. The mannequin is set up on a simulated OR suite with a functioning anesthesia machine including ventilator and monitoring capabilities. With the drapes up and the monitor beeping in the background we have had many people believing that a real patient was in the room. There is a separate observation room for the operator of the computer that runs the simulator, as well as for the video equipment. The observation room also allows students to watch and hear what is happening in the simulator room in real time, and video allows review of the session, for debriefing purposes. Our anesthesia supplies include difficult airway equipment, a resuscitation cart, and multiple part-task trainers.
Our current mannequin is a state of the art high fidelity simulator (Laerdal 3G model), made by the company Laerdal, specifically for the purpose of medical education. We have an adult, pediatric and infant mannequins that can be used at the site and have access to a ‘pregnant’ female as well. The clinical features of the mannequins include heart and breath sounds, palpable pulses and chest excursion with generated end tidal CO2, cardiac rhythm & oxygen saturation; all of which correlate with the clinical conditions of the patient. Invasive and non-invasive monitoring is possible. The airway is anatomically realistic and allows for various methods of intubation, as well as simulation of the difficult airway through tongue swelling, airway swelling and laryngospasm. A simulated cricothyroid membrane can allow for emergency surgical airway access. The pulmonary system allows for spontaneous or mechanical ventilation and multiple physiologic parameters can be altered to reproduce the patient with atelectasis, pneumothorax, asthma or COPD. Similarly the cardiac system generates appropriate heart sounds, an appropriate ECG for the scenario as well abnormalities such as ischemia or arrhythmias. Trauma features include the ability to do pericardiocentesis and decompression of a tension pneumothorax via needle or chest tube.
Although the mannequin for our simulator often looks the same, the simulator can act like almost any patient – from the frail elderly hypovolemic granny to the robust healthy teenager. Almost any scenario can occur from common problems such as hypotension from hypovolemia or sympathectomy, high airway pressures and desaturation to full-blown anaphylaxis and MH. There is the potential for designing a scenario to meet almost any educational goals that you may have.
Simulation Program
Residents experience a ½-day simulator session, including debriefing, approximately 5 times a year as part of their Core Teaching schedule. These sessions are on topics coordinated with the didactic curriculum the residents are working on at the time. Additionally, residents visit the simulation lab several other times during their training for specific sessions, such as airway training days, ultrasound guided regional anesthesia training, ACLS/ATLS/PALS training, and a “Boot Camp” designed to aid in the transition to independent call duties. The program is in constant evolution, with new sessions being added all the time.
We welcome you to the anesthesia simulator program and look forward to your participation.
Dr. Jessica E. Burjorjee Dr. Louie Wang
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3) Educational Rounds Weekly Academic Schedule:
Monday: Tuesday: 07:00-07:30 Subspecialty Rounds (Echo/Cardiac Anesthesia every other week, Regional Anesthesia Rounds monthly)
Wednesday: 07:00-07:50 Grand Rounds 13:30-16:30 Core Program Thursday: 18:00-19:00 Journal Club (6 times per year) Friday: 07:00-07:30 Case Management Rounds
Grand Rounds
Grand Rounds for the Department of Anesthesiology are held every Wednesday morning at 0700 for the months of September through June in the Richardson Amphitheatre. These rounds will be presented by residents, staff and visiting professors. Each resident (PGY 2-4) will be expected to present on a yearly basis. In addition, residents may be asked to present at Morbidity and Mortality Rounds. There are 3-4 spots reserved for Morbidity/Mortality or Trauma Rounds. (Trauma Rounds are held once per month in Etherington Hall at KGH starting at 0730).
Case Management Rounds
Case Management Rounds are held once per week throughout the entire year. During these rounds a PGY 5 presents a difficult/interesting case and leads a discussion regarding anesthetic considerations and management decisions. Staff attendance is encouraged to provide feedback on the problem presented.
Journal Club
This is held approximately 6 times per year. Two articles are chosen by an assigned staff member and are presented by that staff member and an assigned resident. The articles should be chosen for an interesting and/or controversial viewpoint and be made available to the departmental secretaries at KGH at least two weeks in advance. This permits sufficient time for distributing copies. Presentations for each article should be 10-15 min in length and include a brief synopsis of the study, a critical appraisal of the design (guidelines are provided) and a discussion of the issues relevant to the current practice of Anesthesia. An open discussion of the respective article will follow each presentation.
Resident attendance at educational rounds is mandatory when the resident is on-service, unless the resident is on vacation, conference leave or sick leave. Those who are off-service are
encouraged to attend if time permits.
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4. Resident Scholarly Project
All residents are expected to get involved with a scholarly project of some kind. There is a wide scope in the nature of the scholarly work residents can participate in (e.g. basic or clinical research, medical education, quality improvement projects) depending on their interest and career goals. The main goal of this portion of the residency training is to foster a spirit of intellectual curiosity, and promote skills acquisition in areas of academic anesthesiology.
Dr. Ian Gilron is the coordinator for Resident Scholarly Projects. He has a wealth of knowledge and expertise in clinical research to help guide residents who choose to pursue clinical research, and has access to many resources to offer guidance and assistance to those who pursue other types of scholarly work.
Regardless of the nature of the scholarly work each resident pursues, there are some common expectations and timelines that each resident must follow. These guidelines are presented below:
PGY-1
Residents will be given times/locations of a mandatory research course. Until further notice, this will be Dr. Bob Reid's course (http://meds.queensu.ca/medicine/obgyn/research/course2003.htm)
Depending on the 3-year Core Program cycle, some years PGY-1’s will also attend Core Lecture on the critical appraisal of research literature.
Residents will be required to critically appraise a published research data article relevant to the specialty of Anesthesiology.
There will be a PGY-1 award for "Best Critical Appraisal Essay" which will be published in the Resident Research Day syllabus
PGY-2
Residents submit to the Residency Program Director (RPD) 2 one-page preliminary proposal summaries for two possible scholarly projects (with the heading format: clinical need, knowledge gap, hypothesis, project design, pitfalls/feasibility/project timeline, and project staff advisor). These proposals will be reviewed by the RPD and the Scholarly Project coordinator and only one will be approved (by October 15) for the resident to write a full proposal on.
For the proposed project, the area of inquiry is flexible but the project should be relevant to anesthesia, critical care and/or pain management.
PGY-2, February 1:
submit full proposal to RPD (for review by the Scholarly Project coordinator) and present this proposal as an oral communication at Grand Rounds in the month of February
incorporate feedback from Departmental comments at rounds and from the Project coordinator, in order to improve their proposal for Resident Research Day
PGY-2, March:
present scholarly project proposal at Resident Research Day. One Resident will be awarded prize for best proposal.
PGY-2, April 1:
start to carry out proposal plan, e.g. Ethics submission, data recording instruments, patient recruitment etc. with the help from staff advisor
PGY-3
ongoing work on scholarly project with assistance of staff advisor
PGY 3, March:
present scholarly project in-progress report at Resident Research Day.
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PGY-4
complete scholarly project with assistance of staff advisor
PGY 4, March:
present scholarly project completion report at Resident Research Day. One Resident will be awarded a prize for best project.
Optional: It is hoped that many projects will result in a manuscript submitted to peer-reviewed journal or poster submitted for presentation at a scientific meeting (e.g. CAS).
Protected Research Time
It is expected that the majority of work on a resident’s scholarly project will be performed on their non-clinical academic time – for example, pre-call days and PAIRO Educational days. There is significant research support within the Department which residents can access to assist with project development, including: a Ph.D. research assistant for grant and ethics write-ups; a Ph.D. clinical epidemiologist, a Ph.D. statistician and several accomplished researchers (for example, in various areas of basic and clinical science, medical education, simulation medicine, health policy and quality assurance) for project design; nursing research assistants for data gathering; and several faculty with unrestricted grant moneys, as well as Departmental funds, available to assist with carrying out projects.
In specific instances where more time is needed by residents to complete a significant project, elective time can be used strategically, with the approval of the Residency Program Director, to work on scholarly projects.
Financial Support for Presenting at Conferences
When a scholarly project leads to a poster or manuscript presentation at a scientific meeting, the Department offers financial support to assist the resident in attending and presenting their work.
5. Annual Resident Research Day
A Resident Research Day is held every spring. As outlined above, residents will present a research proposal in PGY 2 and ideally a finished project in PGY 3 or 4. These days are attended by the entire Department, including faculty, residents, associated medical students, cross-appointed academics from Queen’s and their graduate/undergraduate students, research assistants, and many Departmental alumni. A guest adjudicator is invited to help judge the presentations and posters, and to provide a keynote lecture. The hospital supports this academic enterprise, and OR’s are closed to facilitate attendance. A celebratory social function is organized for after the event, at which resident and faculty prizes are awarded.
Attendance is mandatory for all residents, except those on out-of-town rotations for whom the travel would be prohibitive.
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F. Evaluation 1) Evaluation of Resident Performance
The process of Resident Evaluation in the Department of Anesthesiology and Perioperative Medicine complies with the policy on evaluation promulgated by the Queen’s Office of Postgraduate Medical Education, as set forth in the document “Evaluation, Promotions & Appeals”. This document can be found on the Departmental website and the PGME office website:
http://meds.queensu.ca/education/postgraduate/policies/epa
Specific elements of the resident evaluation process follow below:
1. Bi-annual Performance Review
Residents will meet with the Program Director two times per year. This will provide opportunity to review the resident's overall progress towards consultant practice. Evidence which is used in the review includes scores on written and oral examinations, individual staff daily evaluations, ITER’s from off-service rotations, presentations made to the Department at Resident Research Day, Grand Rounds and other venues, the Resident Log Book, and any other periodic performance evaluations that may be available.
The performance review is an opportunity to confirm that the resident is meeting his or her educational goals, both personal and Departmental (i.e. Resident Research Day). The review is also a chance for the residents to provide informal feedback to the Program Director about the program, their own perception of their progress, and any particular needs they have such as arranging electives.
Either party may initiate additional meetings if specific concerns are identified between scheduled reviews. Residents are encouraged to seek out the Program Director as soon as possible when issues arise to allow timely intervention. The benefits of having a small program include an “open door” policy between staff/Program Director and residents.
2. Daily OR Evaluation Criteria and Forms
Attending Staff complete individual resident evaluations on a daily basis. It is expected that the resident will encourage the staff person to fill out the evaluation form each day. The results of this will be compiled by the Program Director and discussed with the resident during the Performance. The form that is filled out by the faculty member is confidential. It is the means of communication that the faculty member uses to inform the Program Director about the resident’s performance on that day.
The most important part of the daily evaluation is the feedback that the staff individual gives to the resident at the end of the day. This feedback should give the resident basically the same information that is communicated to the Program Director on the daily evaluation form. Residents are encouraged to actively seek out this feedback. Faculty members know that part of their daily responsibility is to give this feedback.
3. Written Examinations – AKT
Residents are required to write the Anesthesia Knowledge Test (AKT) at multiple points throughout their training; during their Orientation month on clinical anesthesia as a PGY 1 (AKT-0), during their Introduction to Anesthesia rotation at the end of PGY 1 (AKT-1), and in December of each year thereafter (AKT-6 as a PGY 2 and 3, AKT-24 as a PGY 4 and 5).
This exam will be scored and results will be compared against reference cohorts drawn from many other US and Canadian residents at a similar level of training. The results of this knowledge based MCQ test gives the residents, and the Program, information about their progress along the learning curve towards consultant level practice.
The Program sets the expectation that each resident will achieve a score above the 30th percentile in comparison to his or her reference cohort. Residents who score below this level are encouraged to revisit their personal reading program to ensure its adequacy. Additionally, they are required to
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rewrite the AKT at the six-month mark (in the next June) in order to judge the success of their personal study plan.
4. Oral Examinations
An oral examination, in the RCPSC style, is administered in September, January and April/May to each PGY 2-5 resident. During the spring exam, an external examiner is invited to participate, and helps examine the senior residents (PGY 4-5). The exam will be graded in the same fashion as the RCPSC oral examinations, and the standard for each resident is the same. While it is not expected that junior residents will pass all questions, it is a good opportunity for them to experience a RCPSC level examination and learn the standard they are expected to achieve.
All residents are expected to take the oral examination. At the time of each examination, residents will receive detailed oral feedback about the style and content of their responses. After each session, written feedback on their performance, including reference scores so they can judge their position on the learning curve, are also provided.
5. Resident Log Book
It is mandatory that each resident maintain a current log of all of the anesthetics that they have been involved with. The “Resident Log Book” is the electronic logging tool that the Program provides for this function. The use of this RLB program is required for every Anesthesiology resident in the country.
Residents keep a record of all the cases in which they have significant involvement. They will record these cases on the web-based logging tool. Instructions for how to access the Resident Log Book (RLB) are given to each resident during their first rotation in Anesthesiology during the PGY1 year. The RLB allows residents to log information such as surgical procedure, anesthetic technique, invasive procedures, regional anesthetic blocks, and patient characteristics. Room is provided for free-text notes associated with each case. Cases can be assigned individual identifying numbers (this should not be the patient’s hospital CR number, as the web-based tool is password protected but is not behind the hospital firewall), and cases can be searched. A reporting tool is also provided, so that residents can use their RLB log to identify volume of clinical experience in different domains, thereby identifying areas where they may wish to seek additional experience.
At each semi-annual Performance Review, the Program Director will review the resident’s RLB data to ensure that they are actively logging their cases. This review may also help plan the resident’s future schedule and elective needs, based on overall clinical experience to date.
Failure to participate in case logging on the RLB will be reflected under Professionalism on the semi-annual Performance Review.
6. 360o (Multi-source) Peer Assessment
In the fall of each resident’s PGY 4 year, the Program will conduct a 360o peer assessment. This assessment consists of a number of questionnaires that are sent to colleagues and coworkers around the hospital. The questions asked seek feedback regarding the resident’s function in domains such as Communication, Collaboration, and Professionalism. The individual questionnaires are confidential, but a distillation of the picture the multiple questionnaires provide regarding the resident’s function is provided to them during their subsequent semi-annual Performance Review.
7. Simulation Scenarios
At this point, simulator sessions provide formative feedback but are not evaluative. No feedback based on performance in the simulator is provided from the simulation group back to the Program.
8. CanMEDS Portfolio
The Office of Postgraduate Medical Education has created a set of seven on-line modules relating to the non-Medical Expert CanMEDS roles (an “Introduction to CanMEDS” module, and one each for the other roles).
Each resident, in the fall of their PGY 2 year, is expected to complete these modules. Each takes approximately one hour to complete. By creating an account, residents can review the modules and complete the on-line exercises. Their responses are recorded in a .pdf portfolio which is password protected.
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The portfolio of reflection upon CanMEDS remains the property of the resident, since it may contain personal opinions and information. Each resident is asked, however, to submit a copy of his or her portfolio to the Program. This is reviewed in a confidential manner to ensure compliance with the project. The paper copy of the portfolio does not itself form part of the resident’s permanent record.
9. Presentations
Each resident is required to make presentations to the Department from time to time throughout their residency. In each of PGY 2-4 residents present a Grand Rounds. While on their Cardiac Anesthesia rotations, they present at the Subspecialty Tuesday morning rounds. As PGY 5’s they present several times at Friday morning Case Management rounds. During each of their PGY 2-4 years they also present at the Resident Research Day.
Each of these presentations is evaluated, by the audience, using the electronic One45 system. An anonymized collated summary of the evaluations is provided back to each resident, so they can gauge and improve their presentation skills. A copy of this summary is kept as part of their record.
10. Attendance Record
Attendance at teaching sessions and rounds is mandatory for all residents who are in-town, on-service (or off-service where attendance has been negotiated, which is most rotations), and are not on sick leave, LOA’s, or on vacation.
A sign in sheet is provided for all rounds and teaching sessions. Residents need to sign in to each session attended – failure to sign in will be taken as absence. A pattern of absences will be reflected under Professionalism on the semi-annual Performance Review.
11. Participation in Program Evaluation
The process of Program evaluation is detailed below. Each resident is expected to participate actively in Program review for the betterment of the educational curriculum. Residents are given multiple opportunities to provide feedback:
Daily evaluations of individual Attending Staff teaching Quarterly Anesthesia Program evaluations Individual rotation evaluations Evaluations of Core Program seminars, Grand Rounds, Subspecialty rounds and other
teaching sessions During semi-annual Program Reviews with the Program Director (fall meeting and joint
Resident – RPC meeting at the Resident Retreat each June)
Participation in this process is a Professional duty. Feedback is anonymous and confidentiality is maintained. However, especially in the case of daily evaluations of Attending Staff, the Program tracks participation (i.e. the system reports quarterly the number of evaluations you’ve completed, but not who you evaluated or what was said). Failure to participate in Program improvement will be reflected under Professionalism on the semi-annual Performance Review.
12. Certificate of Completion of Training & FITER
A Certificate of Completion of Training and a Final In-Training Evaluation Report (FITER) will be completed near the end of the residency program by the Program Director. The Royal College of Physicians and Surgeons requires these documents before the resident is allowed the opportunity to challenge the College examinations.
i. Deadlines for Applications for Royal College Exams
Residents are eligible to challenge the RCPSC examinations in Anesthesiology in the calendar year that their residency ends. It is very important that you are aware of the Royal College application deadlines for your exams – the process begins about 18 months prior to sitting the examination.
It is the resident’s responsibility to contact the Royal College in their PGY4 year in order to meet any necessary deadlines for the resident Royal College exams in PGY5 year. You are encouraged to submit your application early. You will need to determine the following:
deadline for notifying the Royal College that you will be sitting the Royal College exams;
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deadline for fee and submitting a request for a preliminary Assessment of Training; and deadline for submitting examination application and fees.
There is a penalty fee for late applications and there is no guarantee that you will be able to sit the exams if you submit your application late. For further details, the Royal College website is: www.rcpsc.medical.org.
2) Resident Evaluation of the Academic Program Residents are encouraged to provide feedback to the Program Director and the Residency Program Committee about all aspects of the training program. Various forms have been developed to facilitate this feedback. Residents are encouraged to provide thoughtful, constructively critical feedback about the program at any time. Evaluations will be done in the following areas. (see appendices for forms)
Anesthesia Block Evaluation Form – for defined anesthesia rotations (Community Anesthesia, Cardiac Anesthesia)
Program Evaluation Form – for overall program, including horizontal clinical anesthesia rotations (completed online quarterly)
Core Program Evaluation Form - used to evaluate each seminar Internal Medicine Rotation Evaluation Forms (Cardiology, Respirology, Nephrology) Faculty Teaching Evaluation Form (completed online, through RLB)
Residents are expected to evaluate the staff on a daily basis, just as they are evaluated. This is done on a web-based program and can be done at the same time one is entering their data on the RLB. This provides specific feedback on the role of each staff person and their effectiveness as a clinical teacher. The information obtained from these evaluations is compiled quarterly, with no reference to any resident and is completely confidential. The Department Head will summary report for each staff that contains averaged numerical scores and anonymized comments. The evaluation will become a permanent part of the staff person's teaching dossier at Queen's University. 3) Annual Award for "Teacher of the Year" At the end of each academic year, residents will vote for the staff person that has been the best overall teacher for the past year. The Chief Resident will make a formal acknowledgment to the winner of the award at the annual Resident Research Day, and present the “Teacher of the Year” award. 4) Resident/Staff Liaison Committee Meeting Resident attendance at this meeting is mandatory unless the resident is on vacation, conference leave, sick leave, or off service.
Meetings between the resident body, the Program Director and the Department Head are to be scheduled by the Chief Resident. These meetings should be held at least every six months. One meeting is typically the afternoon session of the Resident Retreat, the other is in the fall. Extra meetings can be scheduled as necessary. These meetings provide both parties with the opportunity to raise concerns and issues regarding the residency program in an open forum. An itinerary of topics to be discussed is to be distributed at least one week in advance by the Chief Resident.
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G. Educational Resources 1) Clinical Sites 1. Kingston
The clinical experience in anesthesia at Queen's University is provided at both the Kingston General Hospital and the Hotel Dieu Hospital. See section on "Department of Anesthesiology, Health Care Facilities Serviced by Anesthesia" for more detail.
2. Children's Hospital of Eastern Ontario, Ottawa
Residents in the Queen's University Residency training program in Anesthesia must spend three blocks in an accredited pediatric hospital to learn pediatric anesthesia. Queen's has a formal arrangement with the Children's Hospital of Eastern Ontario (CHEO: http://www.cheo.on.ca). The Queen’s Office of Regional Education provides residents with accommodation in Ottawa and a travel allowance.
Residents may choose to do their 3-block pediatric anesthesia elective in another suitable teaching pediatric hospital (e.g. Hospital for Sick Children in Toronto). Arrangements for alternate rotations must be made by the resident and approved by the Program Director. Funding cannot be provided for rotations taken outside of Ottawa.
3. Peterborough
Residents have a one-block rotation in Peterborough during their second year to give them an opportunity to work in a community setting. The Queen’s Office of Regional Education provides residents with accommodation in Peterborough and a travel allowance.
4. Electives
Up to six months of anesthesia related elective time may be set aside for residents if their clinical performance is considered adequate. Electives are organized in consultation with the Program Director. Residents will need to identify a site, appropriate supervisor, and learning objectives for their elective experiences.
The Program is quite flexible in the use of elective time, and residents have taken electives all over the world. Electives have been arranged in third world settings with Dr. Alison Froese. She has years of experience providing developing areas with anesthetic services and takes interested residents on certain missions. Dr. Joel Parlow has taken residents with him on his CAS sponsored education projects in Rwanda. Residents have also organized rotations with faculty from outside Queen’s – the scope of electives is quite broad.
It is recommended that any such requests for electives, especially overseas, be made to the Program Director by April for the upcoming academic year, as scheduling and paperwork can be quite time consuming. 2) Research Unit Queen’s University has a Clinical Research Unit at KGH. The CRU is available to assist residents with the design, conduct and analysis of their clinical research. They offer a wide range of services:
i. Biostatistical services – correct inference requires that results are produced by a valid data analysis, but a valid data analysis may not be possible for data collected from a poor study design. The CSU can ensure that your study is designed soundly and data analyzed appropriately so that the conclusions are reliable.
ii. Data management – by explicitly defining the data base elements and data management procedures at the beginning of the study you can avoid unexpected problems that lead to cost overruns, delays and poor quality data. The CSU team can also assist with obtaining patient consents, data collection, and data entry.
iii. Technical writing services – assistance with proposal development, ethics board applications, manuscript and poster preparation, and submissions to peer-reviewed journals.
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3) Libraries Bracken Library - The main medical library at Queen’s University is located beside KGH in Botterell Hall, and is available to all residents. In addition to reference materials, Bracken library provides a host of support services, including electronic references, literature search assistance, meeting rooms, copy services, paper retrieval, interlibrary loans, and courses on accessing & using library materials.
Hospital Libraries - Both HDH and KGH have medical libraries available to all house staff. These include electronic access to journals and textbooks.
Department of Anesthesia Library - This is located in the Department at KGH. Its resources include study areas, four computers for accessing hospital patient records and online resources, wireless access to the internet, major anesthesia and related textbooks, a photocopier and printing machines, and a state-of-the-art multimedia presentation system. The Department also provides online access to a number of anesthesia related reference materials. The Postgraduate Medical Education office provides each resident with a subscription to “Up to Date”.
Reference materials should only be removed for a single night and you are required to sign them out on the board provided. Core textbooks are clearly identified and are not to be signed out, as they are frequently accessed by all.
The library door is locked and access is through a security code. The door is to be kept closed and locked at all times. Stolen and lost items will not be replaced. Also, although food and drink are permitted in the library, please endeavor to keep the area clean. 4) Conference Support Residents in the PGY2 to PGY5 years are encouraged to attend at least one major conference during their training. The faculty has donated some money to the residents, which can be used specifically for the purpose of attending a conference. The policy regarding accessing these funds is presented below:
1. Residents shall receive a general allowance of $3000 from the Department towards travel, accommodation, and registration expenses (meals are not covered), in order to support attendance at conferences, courses, workshops and the like, which further their educational goals. These moneys can be drawn upon at the resident’s discretion during their PGY2 through PGY5 residency years. The goal is to support residents in developing the skill sets and knowledge base necessary to begin independent practice as a Consultant Anesthesiologist, and it is recognized that participation in the CME and conferences provided by our professional associations constitutes an important part of our practice.
2. All applications for conference and CME support should be approved by the Program Director prior to attendance in order to qualify for expense coverage. (Request forms for Conference money are available on the Departmental website, and can be obtained from Kim Asselstine, Residency Program Administrative Secretary).
3. Residents are expected to make their own travel, accommodation and registration arrangements.
4. Residents must submit the original receipts to the Departmental Academic Secretary to qualify for reimbursement.
5. Unused portions of the $3000 conference money will be used at the discretion of the Departmental Chairman and Program Director for resident related activity.
6. Residents who have abstracts accepted for presentation, or who are invited to present at a major conference, can receive support for travel, accommodation and registration expenses in addition to the general allowance money described in #1 above. It is expected that the resident will have
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played an instrumental role in the research project, its publication and the preparation for the presentation. This support is subject to a maximum of $3000 per application.
1. Residents will be supported for only one conference per original abstract (i.e. the resident will not be supported for presenting the same abstract at more than one conference). The resident may qualify for special allowance money for more than one conference if the Departmental Research Coordinator and the Program Director agree that the abstract to be presented at the second conference is sufficiently different to be considered another original work.
7. Should there be a disagreement about any aspect of a particular request for Conference money support, the resident can present his/her case to the Residency Program Committee of the department. The RPC will make the final decision about the eligibility of the resident’s request.
Revised Sept 2009
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H. Resident Responsibilities Short Summary of the Expectations of the Residents The academic and service components of the job are intimately intertwined. There are barely 500 days of clinical anesthesia exposure in your PGY2 to PGY5 years when one subtracts holidays, educational leave days as well as the days in medicine and the ICU rotations. Further lessening the experience are the days off before and after call. In Kingston, anesthesia call is limited to 16 hour shifts, and is scheduled approximately 1:5 to 1:7 days.
It is expected that the residents will quickly demonstrate that they have the attitude and professional sense of responsibility to be capable of becoming the responsible person giving the anesthetic. To this end, the resident will:
See the inpatients, or review the charts, for the next day’s patients on the day before surgery. This includes Sundays, so if the resident is unable to see their patients or their charts, they are to make arrangements with the resident on call.
Recognize that there are patient problems + surgical concerns + anesthesia needs for every case.
Discuss any perceived problems with their staff person if necessary. Arrive at the OR having read about the case, prepared to discuss the relevant issues. Have their OR ready to start at the designated time. This means arriving early enough to see
their patients preoperatively, completely set up the OR (‘early enough’ is 1 hour before “hearts” and big cases, ½-hour before the smaller cases), and arrange for any special equipment needed. On days that rounds are held before the OR starts, this will require arriving a ½ hour ahead of rounds in order to set up the anesthesia equipment.
Think about how you want to do the case; confirm with staff person what you want to do, and discuss other approaches to the case.
Stay until the case is done (or at least to a reasonable hour), and see patients the next day to see the outcomes of decisions made in the OR.
See consults promptly Answer your pages promptly Prepare the anesthesia machines on C5 daily (when assigned to the obstetric anesthesia
service) Keep the anesthesia emergency pack fully stocked Let the staff individual to whom you are responsible know where you are when outside the
OR. This facilitates good communication within the anesthesia team.
It is expected that the residents will supplement their practical clinical education by reading throughout the duration of their training. Residents are expected to be self-directed learners. Residents are expected to read before Core Program sessions, and to come to these sessions prepared to discuss cases, as well as ask and answer questions. Attendance at Core Program is mandatory and expected even when one is pre- or post-call.
Residents are expected to attend:
All rounds (Grand Rounds, Case Management rounds, Visiting Professor Rounds, Subspecialty Rounds)
All CME events, even the ones on evenings and weekends.
Residents are expected to ask the staff to fill in their daily evaluations, and to evaluate their staff using the Resident Log Book every day.
It is expected that all residents will teach people with less experience (medical students, clinical clerks, junior residents).
Residents are expected to record all cases done in the Resident Log Book.
Residents are expected to fill in all quarterly evaluation forms, Medicine rotation evaluations, and Program evaluations.
Residents will always ensure that the Department has their most up-to-date contact information, including Email address. This is the most important form of communication.
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All residents will participate in a scholarly project. These research projects will be presented at the Resident Research ay each spring.
All residents are expected to participate in a Quality Improvement project during their PGY 3 or 4 year, and present the results to the Department.
Encourage us to teach you and to ask you questions, so we can develop the best program possible. The more questions you ask the more answers you’ll get! 1) Patient Care 1. Clinical Competence
Residents are required to acquire and maintain certification in ACLS, ATLS, and NRP throughout their residency. The Department will cover the cost of these courses. Certification in PALS is optional. Residents can apply to use a portion of their Conference Support moneys to attend this course if they wish. Please contact the Program Director for further details.
2. Operating Room Assignments & Responsibilities
Residents at KGH will be assigned to an operating list for the next day by 14:00 by the Resident OR Manager. Every effort will be made to assign residents to a list which is appropriate for their level of training. Concurrent coverage rooms may occur up to 2 times per month per resident in PGY 3-5. This will consist of having two residents covered by one Attending Staff. It is the resident's responsibility to confirm the exact list that they are assigned to for the following day.
The Deputy Clinical Head (or delegate) does the list assignments at KGH for staff. If there are any concerns regarding the assignment of resident lists, this should be addressed to the Resident OR Manager. If the difficulties cannot be resolved by the involved parties, then they should be taken up with the Program Director or the Chief Resident.
At HDH resident lists are assigned in the same manner as KGH. Concerns regarding appropriateness of the assigned lists should be directed to the Resident OR Manager, and then with Program Director or the Chief Resident as necessary.
Operating rooms at both hospitals start at 08:00 daily, except for Wednesdays, when it is delayed to 08:30 because of departmental Grand Rounds. (n.b. In the summer months, Rounds are cancelled, and so the OR starts at 08:00 every day). This means that the rooms must be ready to begin, and patients assessed, by 07:45 (08:15 on Wednesdays). This allows the nurses to perform their assessment of their patient and bring them to the room in time for a 08:00 start.
Residents must take primary responsibility for the list they are assigned to. It is expected that they will arrive early enough to set up their room (including any special equipment required), assess their first patient, and consult with their Attending Staff so that they are ready to begin their first case by 07:45. Earlier starts may be required if one plans to place a block prior to the anesthetic. Residents are reminded that any early morning Rounds do not change the need to have rooms ready by the above times. If a resident is unable to have the assigned room ready on time, it is his or her responsibility to inform the staff person assigned to the list as soon as possible. On weekends, residents should arrive in the OR at 07:30 to ensure adequate time for handover and a 08:00 start to the OR.
When preparing the OR for the first case, it is expected that the resident will:
set up and check the anesthesia machine; prepare the appropriate monitors; draw up necessary drugs and infusions; prepare IV lines; prepare trays for invasive monitors and procedures (e.g. epidurals); arrange for any special equipment required (e.g. difficult airway cart); and ensure that blood is available, as indicated.
Staff Anesthesiologists should ask residents about their plans for the anesthetic, and may make suggestions for changes in the plan to illustrate new ideas or correct problems. It is expected that the Staff Anesthesiologist is aware of the activities of the resident in regards to patient care. Cases
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should not be started without the Staff Anesthesiologist being in the hospital and aware of the situation under any circumstances. He or she should be immediately informed of any significant change in the status or treatment of a patient with which a resident is involved.
KGH has an Acute Pain Management Service (APMS) that is covered by an Attending Staff each day. Residents are frequently assigned to this service as part of the Regional Anesthesia rotations, and also cover the service while on call. It is assumed that resident involved with a patient who is placed on the APMS will setup and initiate the epidural/nerve block infusions, or the PCA. They must also complete the appropriate pre-printed order sheet, and enter them into the computer database. If there are special features to the patient, a page to the APMS staff to facilitate good communication is also a good idea.
Failure to enter a patient into to the APMS computer system means that the APMS staff will be unaware of the patient. In these circumstances, they will not be able to round on the patient, and the resident who placed the block, epidural, or PCA will remain responsible for that patient each day until the APMS is notified.
3. Preoperative & Postoperative Assessments
At Kingston General Hospital, residents are expected to assess all in-patients on their list the evening prior to surgery. They must also review all Same Day Admission (SDA) patient charts for patients on their assigned list. This includes Sunday evenings before a Monday list. If they are unable to see their patient/charts then they must make arrangements with the resident on call. This does not, however, relieve the resident of the expectation that he/she is aware of and prepared for their day.
At Hotel Dieu Hospital, there are no in-patients, and charts are not available until the morning of surgery. Residents are advised to come to the OR early enough in the morning that they can review all the charts for their day’s list, and write preop orders as necessary.
It is advised that all patients on the list be assessed, even if the resident plans to be away from the OR for a set period of time (i.e. Core Content Sessions). Lists are often rearranged at the last minute and one cannot guarantee that the resident will only see the cases originally assigned during his or her scheduled OR time. Residents are encouraged to freely discuss patient management with Attending Staff, and any concerns regarding the patient's care should be conveyed in a timely manner. This may mean contacting the staff person at home during the evening. It is important to try to resolve issues the day prior to surgery if possible – this makes cancelling cases much less likely, and allows the surgeon to book an alternative case if the patient is not ready for surgery.
Any complication resulting from a resident's intervention should be referred back to that specific resident for follow-up. (e.g. an inadvertent spinal tap done during call should be followed by the resident and staff person responsible at the time of the epidural insertion, not the resident assigned to the Obstetrical Block for the following day)
4. Patient Care Outside of the Operating Rooms
Residents are required to inform, in a timely manner, the appropriate staff person of any clinical intervention done outside the operating room environment. This is necessary to ensure complete patient care, as well as to provide a certain degree of protection for the resident should any complication arise from his or her involvement.
The appropriate Attending Staff person is defined as:
i. Between the hours of 0800-1530 the Obstetrics/Consults anesthetist is responsible for coverage of Connell 5, as well as all emergency interventions and all consultations (unless preceded by the situation described in #2).
ii. Between the hours of 1530 and 1800 the 2nd-on-call anesthetist is responsible.
iii. Between the hours of 1800-0730 the 1st-on-call anesthetist is responsible for coverage (unless preceded by situation described in #2.)
iv. At any time of the day, if an Attending Staff person becomes the primary anesthesiologist for a case (regardless of the call schedule – e.g. coverage of emergency C-sections by the first available staff anesthetist, or if a consult is directed to a specific staff person) they become the person to whom the resident should report.
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v. The Acute Pain Management Service is covered by an assigned staff during weekdays, 08:00 – 15:30, and weekends 08:00-12:00. Beyond these hours, the on-call anesthesiologist assumes responsibility, as per sections (ii) and (iii).
5. On-Call Coverage & Pagers
Residents on ‘first call’ will be assigned to no more than 16 hours of clinical Anesthetic coverage per shift. N.B. This does NOT include educational responsibilities (i.e. educational rounds, core content sessions).
i) General Comments
The Department of Anesthesiology provides 24-hour in-house coverage of services at KGH. This includes a resident and an Attending Staff anesthesiologist. The resident on call carries a voice pager and a numeric pain pager, and is expected to respond to ALL calls within 10 minutes (immediately for emergencies) in a professional manner.
i. pager #100 - Anesthesia services (OR, obstetrics, PACU, cardiac & respiratory arrests, etc.) and Trauma pager
ii. pain pager – Acute Pain Pager
Residents also carry an in-house phone (x7080).
On weekdays, two residents are on call. On is assigned 2nd-call (or late call). This resident works in a clinical assignment from 07:30-15:30, and is a second in-house resident from 15:30-18:00. The other resident is on 1st-call, and has non-clinical duties (study, Core, research, etc.) until 16:00. At 16:00 they assume clinical duties and hold the pagers until 07:30 the next morning.
On weekends, four residents are on-call. They follow the schedule presented below:
Day Time Resident A Resident B Resident C Resident D Friday 18:00-07:30 1st-Call
Saturday 07:30-18:00 2nd-Call Pain Call 08:00-12:00
Saturday 18:00-07:30 1st-Call
Sunday 07:30-18:00 2nd-Call Pain Call 08:00-12:00
Sunday 18:00-07:30 1st-Call
On all days, the resident who is 2nd-call provides a backup to the 1st-call resident. By this, we mean that, should the 1st-call resident be unable to cover their shift on short notice (emergency, illness) the 2nd-call resident is expected to cover that shift, unless another suitable substitute can be found. Both the Program office and Chief Resident can help to organize coverage for unexpected last-minute absences, but ultimately, the backup for coverage will be the 2nd-call resident.
The resident carrying the pager is responsible for ensuring that the emergency Anesthesia Pack located in the OR pharmacy room is fully stocked and includes fresh medications that are drawn up, dated, and signed. This should be completed as soon as possible in the morning. After using the Pack, it should be restocked immediately with clean equipment and fresh drugs from the main OR supply.
Two "on call" sleep rooms are available for anesthesia residents on Connell 6 (sleep area).
The first case on Saturday, Sunday or holiday mornings should be ready to begin at 0800 hours. Connell 5 should be checked, new drugs made ready (see above), and the emergency OBS OR anesthesia machine and equipment should also be checked and ready by 0800 hours.
Weekend APMS rounds begin at 0800h until all patients are seen. A separate staff and resident are assigned to APMS weekend rounds. On long weekends, the APMS service on the third and subsequent day is covered by the 2nd-call resident and Attending anesthesiologist.
ii) Obstetrical Service
The resident carrying the #100 pager has a primary responsibility to the Obstetrical service. This resident will be the first point of contact for all obstetrical anesthesia calls. They should ensure that the anesthesia equipment on Connell 5 is checked and ready as soon as is practical after the shift
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begins. This means a full machine check out and fresh medications drawn up, dated and signed daily (including STP (or propofol immediately available), sux, phenylephrine and oxytocin)).
The "Board" on Connell 5 should be checked to ascertain how many patients are on the floor and what stages they are at in their labors and deliveries. It is also appropriate to talk to the Obstetrical house staff about potential problems that might be brewing at that time. The resident should report to the Staff anesthetist covering Connell 5 and should keep him/her aware of any potential or developing problems throughout the day.
Booked C/S are to start at 08:00. There are usually 2-3 elective C/S per day, Monday through Friday.
Residents must respond to requests for epidurals or deliveries as soon as possible, if not in person then by phone, to confirm the estimated time of their arrival on the floor.
Epidurals
Calls for epidurals on Connell 5 are understood to be urgent consultations to the Department of Anesthesiology, made by the Department of Obstetrics, for an anesthetic assessment to determine if a specific patient is a suitable candidate for an epidural. The resident is not a technician arriving to do another service's bidding. When you arrive on Connell 5 in response to such a request, you should follow the steps below:
review the patient's chart and old records; review the patient's medical history with her; do a complete anesthetic assessment (including physical exam) to determine the
patient's candidacy for spinal or epidural techniques; review any available investigations. If specific investigations are required but not
available, order them and delay the epidural until they are available; review risks, complications, expectations and alternatives to epidural anesthesia
with the patient; provide opportunity for patient questions involving epidural anesthesia; specifically ask the patient if she wants to have an epidural; and once the epidural is placed – assess the degree of block post insertion, complete
charting and orders, ensure nurses are happy to assume care before you leave the floor.
Not all patients are candidates for epidural analgesia, and not all epidurals can be placed successfully. If you have any questions or technical difficulties, call your Attending Staff for advice/assistance immediately.
Deliveries
Residents may be called to any delivery for a patient with an epidural (e.g. trial of forceps), as well as any high-risk deliveries (e.g. twins). At the delivery:
Immediately assess the adequacy of the epidural block. The resident is responsible for the management of the epidural as well as general patient monitoring;
The resident should check the neonatal resuscitation equipment and ensure it is set up properly and functioning. A team from neonatology usually arrives to assist with these deliveries, but if they are not present, you will be the primary physician responsible for resuscitating the neonate; and
Be prepared for an emergency Cesarean Section at any moment. If the vaginal delivery fails, or the fetus does not tolerate the obstetrical intervention, the mother may well be rushed back to the OR immediately.
iii) Trauma Service
KGH is the Trauma Centre for the Kingston area and Anesthesia will be routinely called for any incoming trauma. Residents must make every effort to respond immediately to trauma calls. Documentation of all assessments and services provided is required for every call, including appropriate completion of the "Trauma Team Anesthesia Sheet" available in the Emergency Department.
The Trauma Team is run by a Trauma Team Leader, usually one of the emergency or surgery residents. The role of the anesthesia resident is to assist with the care of the patient, under direction
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of the Team Leader, in whatever way possible. For anesthesia, there is a specific emphasis on managing the airway as well as hemodynamic management and resuscitation.
Other services that may be asked of the anesthesia resident include assisting with patient transport to and from radiology, the ICU or the OR, especially if the patient is intubated, ventilated and/or hemodynamically compromised. The resident must inform the appropriate Staff anesthesiologist (see above) as soon as possible if they are going to be committed for a significant period of time to this kind of task. It will be necessary to arrange appropriate supervision, as well as perhaps coverage for other resident obligations (e.g. C5) if you are going to be tied up. It may be more appropriate for the Emergency physician, or the Intensivist, to supervise the patient transfer.
iv) Arrest Service
Arrests are identified as either cardiac arrests (code blue) or otherwise code 99-anesthesia. The resident holding the #100 pager is the first responder to these calls. The majority of other medical emergencies in the hospital are now managed by the RACE team. The RACE team may also call upon the anesthesia resident to assist with airway management during their calls. Residents must make every effort to respond immediately and documented follow-up is required for every call.
Arrests are run by a Team Leader, usually the junior ICU resident. However, if the anesthesia resident is the first on the scene then he or she should assume this role until the appropriate person arrives. The role of the resident is to assist with the arrest in whatever way possible, with specific emphasis on managing the airway. The anesthesia resident also serves as a diagnostician and advisor to the Team Leader. All resuscitations are a team effort.
v) Acute Pain Service
The Acute Pain Service is run by Attending Staff anesthesiologists who are assigned on a daily or weekly basis. The APMS team includes the Attending, the resident, and the Pain nurse-practitioner. Patients utilizing PCEA, continuous epidural analgesia, or continuous peripheral nerve blocks, are assessed twice daily by the APMS team. Patients on IV PCA are usually assessed daily unless they have complications.
Residents are often called to trouble shoot problems for patients on the APMS, or to see new consultations. The resident must respond to the calls promptly and appropriately. It is assumed that residents or staff will set up and initiate the appropriate postoperative analgesia regime on any of their own patients who require it. The APMS Staff anesthesiologist should be informed of any new pain consults.
vi) Assignment of Pagers
On weekdays between the hours of 07:30 and 16:00, the #100 pager is carried by the resident assigned to Connell 5 for the day. The pain pager is carried by the resident assigned to the acute pain rotation. If there is no resident on the acute pain rotation for the block then the pain pager is carried by the APMS Attending Staff. After 16:00 on weekdays, the 1st-call resident carries both pagers until 07:30 the next morning.
On weekends, the #100 pager is carried by the 2nd-call (day) resident from 07:30-18:00. It is carried by the 1st-call resident (night) from 18:00-07:30 the next morning. The pain pager is carried by the resident on pain call between the hours of 08:00-12:00, and then by the resident holding the #100 pager thereafter.
Residents are provided with a protected half-day for Core teaching (typically Wednesday afternoon). During this time, the resident holding the #100 pager may hand it off to the Attending Staff covering Obstetric anesthesia. A resident holding the pain pager may hand it off to the APMS Attending Staff.
vii) Call Schedule
The call schedule is made up by the Chief Resident, on a per-block basis. It is released at least 14 days prior to the first day of the new block. The Department of Anesthesiology restricts clinical duties for residents to 16-hours or less during on-call assignments, and seeks to comply with the PAIRO contract in all matters pertaining to the call schedule.
Any requests for time off must be made to the Chief Resident, in writing, by the 1st day of the previous block. The Chief Resident will endeavor to honor these requests, subject to minimum service obligations and fairness to other residents. Late requests are harder to honor.
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Once the call schedule is published, changes are possible. Residents may trade "on-call duties" without confirmation with the Chief Resident. It is the responsibility of the resident initiating the scheduling changes to inform the following locations at the respective hospitals of any changes to the "Resident Call Schedule”:
Kim Asselstine, Program Secretary Anesthesia Library/Mail room Operating Room Connell 5 Switchboard Emergency Department
Once a trade has been agreed to and the schedule has been updated with the new information, the assignment becomes the responsibility of the accepting resident. If the accepting resident subsequently decides they do not want that shift, they must initiate a new trade acceptable to both parties.
6. Consults
Consults are covered by the anesthetic resident on the C5/consult assignment that day, or by the 1st-call resident during on-call hours. At KGH consults are transmitted to the resident by the Anesthesia secretaries as soon as they become available (or via the #100 pager during on-call hours). The resident assigned to consults should check with the secretaries on a regular basis and respond in a timely manner.
All consults should be reviewed with an Attending Staff. During the day, this is usually the OBS anesthesiologist. On call, it is the 1st, or 2nd-call anesthesiologist. (See section "Resident Responsibilities - Patient Care - Patient Care Outside of the Operating Rooms" for the appropriate staff person).
The one exception to the above pertains to consults to the Cardiac Anesthesia service. At times where there is a resident assigned to Cardiac Anesthesia for the block, this resident will perform Cardiac anesthesia consults from Monday-Friday. At other times the resident on C5/consults, or on-call, will perform the consult. Many of these consults are for patients slated to have surgery the next day, and are to be reviewed with the Cardiac anesthesiologist assigned to do the list. If this person is not available, or the case has not yet been booked, the resident can review the consultation with the Cardiac anesthesiologist on CVRI (available 2 days per week on a rotating schedule). If there is no anesthesiologist assigned to the CVRI that day, the final resort is to review the consult with the Cardiac anesthesiologist assigned to J-OR that day, or assigned to Cardiac call if it is after hours or on the weekend.
7. Vacations & Statutory Holidays
i) Vacations
Vacations will be allotted as per the PAIRO contract. It is recommended that any requests be made in seven-day blocks with the preferred weekend off specified (i.e. Monday - Sunday or Saturday - Friday). Every effort will be made to provide both weekends off for each block requested (i.e. Saturday through the following Sunday), however this cannot be guaranteed. If specific requests are made that do not conform to this format (e.g. individual vacation days) they should be followed up directly with the Chief Resident to confirm if they can be accommodated.
When vacations are requested/taken during off-service rotations, you must also inform the Anesthesiology postgraduate secretary in writing of these, so that an up-to-date record of your vacation can be maintained.
ii) Statutory Holidays
Residents scheduled to work on statutory holidays (except for Christmas Day, Boxing Day & New Years Day) will be permitted to take a lieu day, subject to the restrictions of the PAIRO contract. This includes both the resident who was on-call during the holiday, as well as the resident on-call for the night prior to the holiday. Scheduling of the lieu day should be done at least one week in advance, confirmed by the Chief Resident, and recorded by the Anesthesiology postgraduate secretary.
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Differences in OR scheduling for statutory holidays occur between KGH & HDH (i.e. both hospitals do not always recognize the same holidays). Under the PAIRO contract, residents are allotted 11 statutory holidays. If a resident works at an institution that recognizes a statutory holiday which is not listed in the PAIRO agreement, it shall be considered as one of the resident's floating holidays. Over the course of the year, each resident will be entitled to a maximum of 11 statutory holidays. Floating holidays may be taken as lieu days and applied for as described above.
Holiday PAIRO KGH HDH
New Years Day X X X
Family Day X X X
Easter Friday X X X
Easter Monday X
Victoria Day X X X
Dominion Day X X X
August Civic Holiday X X X
Labour Day X X X
Thanksgiving Day X X X
Remembrance Day
Christmas Day X X X
Boxing Day X X X
Floating Days 1
Note that at KGH, the OR’s are closed on a Monday in November for a contract day of for the nursing union. This day is NOT a holiday. The OR’s at HDH still run, as do other clinical anesthesia services. While occasionally the day is used for group educational activities, residents should expect to be present and working on this day.
iii) Christmas & New Years Holidays
Scheduling for Christmas and New Years will be done on a special call schedule. Each hospital will have unique requirements during this period depending on the number of OR’s and other clinical services running. Difference in the annual timing of each holiday will also vary the requirements for each year. The PAIRO clause requiring each resident to have at least 5 consecutive days off over either Christmas or New Years will be respected (equivalent of Christmas Day, Boxing Day, New Years Day, & one weekend). In addition, the following guidelines will be used by the Chief Resident in making the schedule for this time period:
1. Each resident is guaranteed up to 5 consecutive days of vacation over the Christmas or New Year’s block of time, and shall be guaranteed one of either Christmas day or New Year’s day off. Extra time can be booked, subject to the following conditions:
a. All call services for the residents must be covered within the confines set out by PAIRO and the Departmental call guidelines;
b. Essential day time resident services must be covered; and c. Enough residents must be available in each of the Christmas and New Year’s blocks to
maintain the essential daytime and call services in the eventuality of sickness/unexpected absence of another resident.
In order to balance the assignment of call and day work amongst the resident body in a fair and equitable manner, half of the residents on service during Block 7 will be assigned to each half of the holiday period (i.e. half to the Christmas period and half to the New Year’s period).
In order to assign residents to the two blocks of time, the following rules will apply:
1. Residents must submit their request for their preferred block of vacation to the Chief residents by October 1st.
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2. The Chief residents will endeavor to make up the Christmas Call Schedule as soon as possible thereafter, subject to the timing of the OR Committee’s decisions about the Christmas vacation OR dates and slow down period. They will publish the schedule as soon as possible once made. If a vacation request cannot be granted, the Chief residents will provide the decision in writing as soon as possible, and no later than two weeks after the OR Committee sets the Christmas OR schedule;
3. Where possible, vacation requests will be granted in accordance with the resident’s request and in concordance with the above principles. In situations where more than half of the resident cohort on service apply for the same block of time off, ‘ties’ will be broken according to the following:
a. Requests submitted on or after October 1st will be placed on a first-come first-served waiting list;
b. Requests submitted before October 1st will be honored according to seniority, with residents of higher PGY level taking precedence over more junior residents;
c. Were residents are of the same PGY level, requests will be honored with consideration to the previous year’s schedule, with those who worked the previous Christmas taking precedence over those who did not; and
d. Were a tie remains, the decision will fall to the Chief residents, who will make a final decision regarding which block of time each resident will work.
Residents are advised not to make nonrefundable bookings until the Chief residents have confirmed their vacation request in writing and the Christmas Call Schedule is published.
8. PAIRO Educational Days
Residents may apply for up to 7 days of paid Educational days per year, as per the PAIRO contract. These days can be taken individually or as a block. These days are booked through the office of the Program Director, with the Program secretary. Resident requests will be honored, subject to maintaining minimum numbers for essential resident clinical services. Residents are encouraged to book these days as far in advance as possible.
9. Sick Leave
The Program follows the Queens Office of Postgraduate Medical Education policy regarding sick leaves.
Residents who are unable to work due to illness must contact the following: the Departmental secretaries (x7827), the staff person you were scheduled to work with for the day, and the OR, as early in the morning as possible so that appropriate coverage can be arranged. This may mean calling the staff person directly at home. Any information regarding the estimated duration of the sick leave would be appreciated to assist in scheduling for the next day.
Residents who have extended illness and require more than 2 weeks of absence from work will be placed on a Leave of Absence. The policies regarding Leaves of Absence can be found on the PGME office website:
http://meds.queensu.ca/education/postgraduate 2) Clinical Billing An essential part of daily professional function is billing for clinical services rendered. All funding for the Program ultimately derives from the clinical billings of the Department. Since residents are the first point of contact for many clinical services, it is their responsibility to collect billing information and pass it on to the Attending Staff that they are working with that day. Without this billing information, the Department will have fewer funds for academic activities, and the Program will suffer.
There is NO clinical contact that is not billable. While it is the Attending Staff’s responsibility, ultimately, for assigning the correct billing code(s) and submitting the bill to the office, the resident must collect the necessary information for this to occur. To that end, for EVERY patient seen, please collect:
Patient hospital sticker Date and time of the contact
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End time of the contact Procedure or service rendered (it is sufficient to write a brief description (e.g. labour
epidural, resuscitation, lap chol’y on the back of the sticker). ASA code A diagnosis (any single patient comorbidity will do)
Your Attending may ask for other information in specific circumstances, but the above is a good minimum for all patient contacts around the hospital.
It is important that residents learn proper billing practices during their training. While there are differences in the various jurisdictions across Canada, the general principles apply universally. Your Attending Staff should take some time to explain billing in general to you. If you have specific questions, however, don’t be afraid to ask either the Staff you are working with or the Chair of the Departmental Finance Committee.
III. Queen’s University Postgraduate Education Policies Many of the policies of the Postgraduate Education Office, Faculty of Medicine, at Queen’s University can be found at their web site: http://meds.queensu.ca/education/postgraduate
The following policies are not reproduced here. The web address is noted here for easy access.
1. Evaluation, Promotion and Appeals: http://meds.queensu.ca/education/postgraduate/policies/epa
2. Moonlighting Policy: http://meds.queensu.ca/postgraduate/policies/moonlighting
3. Intimidation and Harassment: http://meds.queensu.ca/education/postgraduate/policies/intimidation
4. Health and Safety http://meds.queensu.ca/education/postgraduate/policies/safety
5. Supervision of Postgraduate Medical Trainees http://meds.queensu.ca/education/postgraduate/policies/supervision_of_postgraduate_trainees
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APPENDIX
OBJECTIVES OF TRAINING IN ANESTHESIA The Royal College of Physicians and Surgeons of Canada
Approved by Education Committee, 2008
DEFINITION
Anesthesia is a medical specialty which includes patient assessment and provision of life support, amnesia, and analgesia for both surgical procedures and childbirth; assessment and management of critically ill patients; and the assessment and management of patients with acute and chronic pain.
GENERAL OBJECTIVES
Upon completion of training, a resident is expected to be a competent specialist anesthesiologist, capable of assuming a consultant's role in the specialty. The resident must acquire a working knowledge of the theoretical basis of the specialty, including its foundations in the basic medical sciences and research. Training must also encompass the provision of anesthesia services for all age groups in varied clinical situations. Performance must, therefore, reflect the anesthesiologist's knowledge of surgery, intensive care and resuscitation, the management of acute and chronic pain and includes assessment and provision of appropriate care of the mother and neonate in obstetrics. The resident must demonstrate a thorough knowledge of how perioperative management should be modified in the presence of concurrent medical problems.
The resident must also demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Anesthesia. In addition, all residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.
Specifically for Anesthesiology, at the completion of training, the resident will have acquired the following competencies and will function effectively as:
Medical Expert
General Requirements
Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
Access and apply relevant information to clinical practice.
Demonstrate effective consultation services with respect to patient care, education and legal opinions.
Specific Requirements
Demonstrate knowledge of the basic sciences as applicable to anesthesia, including anatomy, physiology, pharmacology, biochemistry and physics.
Demonstrate knowledge of general internal medicine with particular reference to the cardiovascular, respiratory, renal, hepatic, endocrine, hematologic and neurologic systems.
Demonstrate knowledge of age related variables in medicine as they apply to neonatal, pediatric, adult and geriatric patient care.
Demonstrate knowledge of the principles and practice of anesthesia as they apply to patient support during surgery or obstetrics.
Demonstrate clinical skills necessary for basic resuscitation and life support as practiced in critical care facilities.
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Demonstrate knowledge of the principles of management of patients with acute and chronic pain.
Demonstrate knowledge of the role of the consultant anesthesiologist in the provision of safe anesthetic services within both community and teaching facilities.
Demonstrate clinical skills necessary for the independent practice of anesthesia, including preoperative assessment, intraoperative support and postoperative management of patients of any physical status, all ages and for all commonly performed surgical and obstetrical procedures.
Demonstrate clinical skills necessary to general internal medicine and intensive care including the ability to investigate, diagnose, and manage appropriately factors that influence a patient's medical and surgical care.
Recognize that prior to provision of anesthetic care specific medical intervention and modification of risk factors may be required.
Demonstrate competence in all technical procedures commonly employed in anesthetic practice, including airway management, cardiovascular resuscitation, patient monitoring and life support, general, and regional anesthetic and analgesic techniques and postoperative care.
Demonstrate knowledge of basic legal and bioethical issues encountered in anesthetic practice including informed consent.
Communicator
General Requirements
Establish a professional relationship with patients and families.
Obtain and collate relevant history from patients, and families.
Listen effectively.
Discuss appropriate information with patients and families and other members of the health care team.
Specific Requirements
Demonstrate consideration and compassion in communicating with patients and families.
Provide accurate information appropriate to the clinical situation.
Communicate effectively with medical colleagues, nurses, and paramedical personnel in inpatient, outpatient, and operating room environments.
Demonstrate appropriate oral and written communication skills.
Ensure adequate information has been provided to the patient prior to undertaking invasive procedures.
Collaborator
General Requirements
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
Specific Requirements
Demonstrate ability to function in the clinical environment using the full abilities of all team members.
Manager
General Requirements
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Utilize personal resources effectively in order to balance patient care, continuing education, and personal activities.
Allocate finite health care resources wisely.
Work effectively and efficiently in a health care organization.
Utilize information technology to optimize patient care, and life long learning.
Specific Requirements
Demonstrate knowledge of the management of operating rooms.
Demonstrate knowledge of the contributors to anesthetic expenditures.
Demonstrate knowledge of the guidelines concerning anesthetic practice and equipment in Canada.
Record appropriate information for anesthetics and consultations provided.
Demonstrate principles of quality assurance, and be able to conduct morbidity and mortality reviews.
Health Advocate
General Requirements
Identify the important determinants of health affecting patients.
Contribute effectively to improved health of patients and communities.
Recognize and respond to those issues where advocacy is appropriate.
Specific Requirements
Provide direction to hospital administrators regarding compliance with national practice guidelines and equipment standards for anesthesia.
Recognize the opportunities for anesthesiologists to advocate for resources for chronic pain management, emerging medical technologies and new health care practices in general.
Scholar
General Requirements
Develop, implement, and monitor a personal continuing education strategy.
Critically appraise sources of medical information.
Facilitate learning of patients, students, and other health professionals.
Contribute to the development of new knowledge.
Specific Requirements
Develop criteria for evaluating the anesthetic literature.
Critically assess the literature using these criteria.
Describe the principles of good research.
Using these principles, judge whether a research project is properly designed.
Professional
General Requirements
Deliver highest quality care with integrity, honesty and compassion.
Exhibit appropriate personal and interpersonal professional behaviours.
Practice medicine ethically consistent with the obligations of a physician.
Specific Requirements
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Periodically review his/her own personal and professional performance against national standards.
Include the patient in discussions concerning appropriate diagnostic and management procedures.
Respect the opinions of fellow consultants and referring physicians in the management of patient problems and be willing to provide means whereby differences of opinion can be discussed and resolved.
Show recognition of limits of personal skill and knowledge by appropriately consulting other physicians and paramedical personnel when caring for the patient.
Establish a pattern of continuing development of personal clinical skills and knowledge through medical education.
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SPECIALTY TRAINING REQUIREMENTS IN ANESTHESIA The Royal College of Physicians and Surgeons of Canada
Approved by Education Committee, 2006
The purpose of the training required under Section 1 of the training requirements is to introduce and expose the resident to independent responsibility for decisions involving clinical judgment skills; the further development of an effective and mature physician-patient relationship; and the achievement of competence in primary technical skills across a broad range of medical practice, and an understanding of the nature of the relationships between a referring physician and consultant clinical anesthesiologist. MINIMUM TRAINING REQUIREMENTS 1. Five years of approved residency training. This period must include:
1. One year of basic clinical training, which must be completed before Section 2 training begins. Training done during this year can be credited only under Section 1.
2. Four years of approved training. This period must include:
a. two and a half years (30 months) of approved resident training in anesthesia. This period is designated as the primary training for the science and clinical practice of anesthesia; required elements of the training must therefore reflect the need to diversify the experience to enable the resident to fulfill the consultant role. The following minimum required elements of training may be undertaken as separate rotations, or interspersed with one another, provided that it can be demonstrated that experience fulfilling the minimum requirements has been obtained:
i. adult anesthesia (12 months minimum) - including experience in out-patient surgical management, recognized general and subspecialty surgical procedures, and associated emergency conditions; an appropriate combination of general and regional anesthetic experience must be demonstrable;
ii. pediatric anesthesia (3 months minimum);
iii. obstetrical anesthesia (2 months minimum);
iv. chronic pain management (1 month minimum) incorporating experience in long-term care.
b. one year of approved resident training in general internal medicine, to be undertaken preferably after a year of clinical training in anesthesia. This year, in conjunction with the basic clinical training, is designed to allow the resident to achieve primary skills across a broad range of medical practice; to develop a mature and effective physician-patient relationship; to acquire the general medical knowledge necessary to function as a competent consultant in anesthesia. Therefore, this year must include:
i. at east six months of approved resident training in adult internal medicine. Rotations eligible for credit include general internal medicine and/or any combination of experience in at least two of the following subspecialties: cardiology, coronary care, respirology, neurology, hematology, nephrology, endocrinology, and infectious diseases;
ii. at least three months of approved resident training in adult intensive care. In addition, it is strongly recommended that the acute care experience include broader elements, such as neonatal/pediatric ICU, coronary care and emergency medicine. A maximum of six months I.C.U. experience is allowed under this section;
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iii. up to six months of research done in an approved centre may also be acceptable for credit in this section, where special arrangements have been made to include intensive care training under Section 2(a). [Please see NOTE on Research or Clinical Pharmacology after Section 2(c)iii.];
iv. up to six months of training in an accredited clinical pharmacology program during the final residency year may be credited under this section, when special arrangements have been made to include intensive care training under Section 2(a) [Please see Note under 2(c).].
c. six months of training that may include:
i. further training in an approved anesthesia program;
ii. research experience in a clinical or basic science department approved by the Royal College;
iii. six months training in clinical pharmacology undertaken in an accredited program during the final residency year.
iv. any other course of study and training relevant to the objectives of anesthesia and acceptable to the director of the training program and the Royal College.
NOTES:
Research or Clinical Pharmacology
In appropriate circumstances and upon the recommendation of the program director, to facilitate a one-year commitment to either an approved research program or an accredited Clinical Pharmacology program, three months of ICU training may be taken under 2(a) of the above requirements. The six months of research or clinical pharmacology training permitted under sections 2(b)iii, and 2(c)ii for research, and 2(b)iv and 2(c)iii for clinical pharmacology allows the option of a full year of research or clinical pharmacology within the limitations of the training requirements. The purpose of this period is to develop subspecialty interests, diversify the resident's experience, or address deficiencies in earlier training.
Those who have completed four years residency in Anesthesia in a non RCPSC program within a system that has been deemed acceptable to the RCPSC and within acceptable time frames and have:
1. been in a continuous practice of Anesthesia for one or more years post certification and
2. maintained continuous enrolment with their certifying authority may fulfill the requirements for Section 2 (b) with one of the following options:
2.1. additional critical care training, to a maximum of 12 months,
2.2. acceptable training in Pediatrics at a senior level to a maximum of six months credit,
2.3. one year of other post graduate clinical training (as outlined in the Policies and Procedures for Certification and Fellowship under Section IV, Part 1.2.2) in Anesthesia,
2.4. An additional year of acceptable Anesthesiology specialty practice which must be completed in an accredited, university-affiliated, academic department. The department head of that institution must be asked to complete a FITER as a reference for the candidate
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SPECIALTY EXAMINATIONS IN ANESTHESIA The Royal College of Physicians and Surgeons of Canada
RCPSC Examination preparation:
Preparation for taking the RCPS examinations in the PGY5 year begins in the PGY1 year. Residents are encouraged to study consistently throughout the residency program. Such consistent reading in preparation for cases, as well as preparation for core program, grand rounds, and case management rounds generally ensures that residents will acquire the knowledge necessary to write the RCPS exams. Further preparation and evaluation occurs during oral exams conducted three times per year plus substantially more practice oral exams in the PGY5 year, particularly in the last 6 months prior to the oral exam.
The written exam consists of multiple choice and short answer questions. Residents prepare for these exams by reading from the 11 or 12 approved textbooks from which all exam questions are taken. The oral exams are based on questions that come from 12 domains in Anesthesiology. These domains are well known, however the format of the questions continues to evolve over the years. Residents have all felt well prepared to take the oral exams in the past several years.
Protected Time
During the PGY 5 year residents are given protected time to prepare for their examinations. Starting in July, PGY 5’s have a protected ½-day of time (Tuesday afternoons) each week for group or individual study. With the resumption of the Program’s academic year after Labour Day in September, the final year residents are given a protected full day of study time.
This time is in lieu of time to attend Core teaching. Final year residents are not required to attend Core teaching. Should they wish to attend Core on a given week (for example, when there is a Guest Lecturer (they are welcome to reschedule a ½-day of their protected time. In this way, they would have a ½-day of protected study time and a ½-day to attend Core (or other academic activity) for that week.
Final year residents are expected to attend all other rounds and teaching provided by the Department (e.g. Case Management Rounds, Grand Rounds, Journal Club).
Specific Information Regarding the Royal College Anesthesiology Examination
2010 WRITTEN COMPONENT
The written component consists of two three-hour papers:
Paper I - Multiple Choice Questions (MCQs): approximately 150 questions
Paper II - Short Answer Question (SAQ): 20 to 30 questions
Both papers assess knowledge in the areas which are considered necessary for the practice of anesthesiology – clinical anesthesiology, internal medicine, and basic sciences. The questions are based on the knowledge necessary for the practicing anesthesiologist and not esoteric material. They are largely derived from review articles in journals, standard textbooks (latest editions), syllabi from courses (ACLS, ATLS, NRP), and national/international guidelines, including, but not limited to, CAS, ASRA, Canadian Blood Services.
Journals
Anaesthesia Anaesthesia and Intensive Care Anesthesia and Analgesia Anesthesiology British Journal of Anaesthesia Canadian Journal of Anesthesia
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New England Journal of Medicine Regional Anesthesia and Pain Medicine
Standard Textbooks
Barash, Clinical Anesthesia Chestnut, Obstetrical Anesthesia: Principles & Practice Cote, Ryan, & Goudsouzian, A Practice of Anesthesia for Infants and Children Cousins & Bridenbaugh, Neural Blockade Fleisher, Anesthesia and Uncommon Diseases Kaplan, Cardiac Anesthesia Miller, Anesthesia Stoelting, Pharmacology & Physiology in Anesthetic Practice Stoelting, Anesthesia & Coexisting Disease
Paper I - Multiple Choice Questions
Every question has a stem, followed by four options, one of which must be chosen as the best answer. Note that marks are only given for correct answers; no marks are deducted for incorrect responses. Pencils and answer sheets will be provided to you.
Examples of MCQ:
Question 1 All of the following are absolute indications for one-lung ventilation EXCEPT ONE. Indicate the exception.
1. Bronchopleural fistula 2. Bronchoaveolar lavage 3. Thoracoscopy ** 4. Massive pulmonary hemorrhage
Questions 2 Which ONE of the following is metabolized by plasma cholinesterase?
1. Bupivacaine 2. Lidocaine 3. Ropivacaine 4. Tetracaine **
Paper II - Short Answer Questions
Marks are only given for correct answers; no marks are deducted for incorrect responses. If a specific number of answers is requested (e.g. list FOUR), do not list more than requested since they will not be marked (e.g. if four are requested, only the first four will be marked). Please write or print as legibly as possible. Be as brief and as direct as possible, making use of the space provided after each question.
Examples of SAQ:
Question 1 A 53-year-old man with an open forefoot fracture presents for open reduction and internal fixation. He has been difficult to intubate in the past. His past medical history is significant for a PTCA and stent for stable angina one month ago. He is asymptomatic from a cardiac standpoint. His only medication is Plavix which he took this morning. He absolutely refuses an awake intubation.
a) List all FIVE target nerves for an ankle block. (5 marks) Saphenous, sural, superficial and deep peroneal, posterior tibial nerve
b) Name THREE anatomic (non-sonographic) landmarks for a posterior popliteal nerve block. (3 marks)
Popliteal fossa crease, tendon of biceps femoris, tendon of semitendinosus muscle
Question 2 According to Canadian Anesthesiologists’ Society (CAS) guidelines, which FOUR monitors must be exclusively available for each patient, but are NOT required to be in continuous use during an
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anesthetic? (4 marks)
apparatus to measure temperature peripheral nerve stimulator stethoscope appropriate lighting
ORAL COMPONENT
The oral component consists of one session either in the morning or the afternoon. The session lasts approximately 2 hours and consists of four stations (approximately 25 minutes each). After registration, an official invigilator will direct the candidates to the appropriate waiting areas before the examination. You may not take any electronic devices, for example, PDA, cell phone, Blackberry, into the examination with you.
Two examiners are present in every station and each examiner will present a scenario. The examiners may interrupt during the scenario to seek information or to move the scenario forward. Some scenarios focus on assessment, others on management, and all scenarios cover domains related to the practice of anesthesia. No examination of a patient is required.
There will be indication instructing when the station is almost over, as well as when candidates should exit the room, move to the next station or enter the next room. There will be time allocation between stations to allow examiners to complete their marking and candidates to move to the next station.
You may encounter other candidates in the corridor between room changes or in the waiting room area. It is imperative that you do NOT communicate with each other during the oral examination process. Communication between candidates, in the corridor, or in the waiting room area may be construed as irregular behavior and may result in an invalid examination for the candidate, as well as potential denial of entry to future examinations.
After the examination, each candidate will be asked to fill out a post-examination survey. Upon completion, you will be asked to collect your belongings in the waiting area and promptly leave the examination center.
Note that no feedback will be given by the examiners and your results will only be available via the Royal College website.
A Royal College Anesthesiology oral question is written and reviewed by the examiners. It is designed so that specified objectives can be assessed. It consists of two or three parts where the examiner gives information to the candidate then asks a question. The answers expected have been identified when the question is written and certain items identified as critical features which the candidate must cover in order to pass. Not every feature of a case may be identified as a critical feature of the question. The examiner will interrupt the candidate both to probe for critical features not yet offered by the candidate and to advance the question.
Below is an example of a Royal College Anesthesiology oral question, the text in italics is what the examiner would read to the candidate.
You are asked to anesthetize a five year old boy with Down syndrome for magnetic resonance imaging-MRI.
What are your considerations?
Here the examiner is expecting to hear the considerations for anesthesia in this case e.g. The consideration for Down syndrome (to include but not limited to airway features such as large tongue, small high larynx, cervical spine instability; Cardiac anomalies, Developmental delay and cooperation, Thyroid insufficiency), the considerations of anesthesia in a child, the considerations for anesthesia outside the operating room and the considerations for anesthesia in a hostile environment- Magnetic Resonance imaging (MRI) ( e.g. risks to patient, risk to anesthetic equipment, risk to MR machine and images, risks to personnel) Also the candidate should inquire concerning the indication the for the MRI.
The child is a relatively healthy Down syndrome boy. He had an ASD repaired in infancy and the cardiologists are happy with his status. He has had a recent X-ray of his c-spine reported as normal. He has a history of recurrent upper respiratory tract infections (URTIs but is clear at this time).
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He requires the MRI because of two recent seizures associated with pyrexia of 40 C during an URTI.
On examination he has the typical Downs face with a large protruding tongue. He is very active and fighting being held He thrashes out when you attempt examination and is difficult to hold still. He is 25kg.
How do you plan to proceed with this child?
Here the candidate is expected to provide a plan for managing this patient for MRI. This would include (but not be limited to) a plan for induction to minimize upset, a plan for anesthesia in MRI unit including a plan for monitoring and for recovery. This plan should identify appropriate drugs with route of administration and dosages, appropriate techniques and equipment as well as personnel. The candidate needs to state his/her chosen plan. Alternatives should also be offered with reasons why the chosen technique is preferred.
At the end of the procedure you remove any airway device placed. You notice the O2 sats falling and cannot feel or hear any respiration.
What is your differential diagnosis?
Here a prioritized differential diagnosis is required. It should include upper airway obstruction, laryngospasm, drug overdosage.
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Guidelines for Conference Support for Residents Department of Anesthesiology and Perioperative Medicine
Queens University Residents shall receive a general allowance of $3000 from the Department towards travel, accommodation, and registration expenses, in order to support attendance at conferences, courses, workshops and the like which further their educational goals. These moneys can be drawn upon at the resident’s discretion during their PGY2 through PGY5 residency years. The goal is to support residents in developing the skill sets and knowledge base necessary to begin independent practice as a Consultant Anesthesiologist, and it is recognized that participation in the CME and conferences provided by our professional associations constitutes an important part of our practice.
All applications for conference and CME support should be approved by the Program Director prior to attendance in order to qualify for expense coverage. (Request forms for Conference money can be obtained from the Kim Asselstine, Residency Program Administrative Secretary). Residents are expected to make their own travel, accommodation and registration arrangements. Residents must submit the original receipts to the Departmental Academic Secretary to qualify for reimbursement. Unused portions of the $3000 conference money will be used at the discretion of the Departmental Chairman and Program Director for resident related activity. Residents who have abstracts accepted for presentation, or who are invited to present at a major conference, can receive support for travel, accommodation and registration expenses in addition to the general allowance money described in #1 above. It is expected that the resident will have played an instrumental role in the research project, its publication and the preparation for the presentation. This support is subject to a maximum of $3000 per application Residents will be supported for only one conference per original abstract (i.e. the resident will not be supported for presenting the same abstract at more than one conference). The resident may qualify for special allowance money for more than one conference if the Departmental Research Coordinator and the Program Director agree that the abstract to be presented at the second conference is sufficiently different to be considered another original work. Should there be a disagreement about any aspect of a particular request for Conference money support, the resident can present his/her case to the Residency Training Committee of the department. The RTC will make the final decision about the eligibility of the resident’s request.
Revised Sept 2009
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Queen’s University Department of Anesthesiology
Resident Evaluation of Clinical Block
Resident:____________________________________Block:___________________________ No. of days on assigned block: ______ No. of cases specific for block: ________ I was aware of the learning objectives for this block Yes:______ No:______ Strongly disagree Strongly agree These objectives enhanced my learning during this block 1 2 3 4 5 These objectives were appropriate for my level of training 1 2 3 4 5 My evaluation was consistent with these objectives 1 2 3 4 5 Comments The knowledge component was well covered as far as: The basic sciences 1 2 3 4 5 The clinical sciences 1 2 3 4 5 Comments: Specific Clinical Skills obtained during this rotation (e.g. Double lumen tube placement, central line placement, etc.): 1. ____________________________ No. of opportunities: _____________ 2. ____________________________ No. of opportunities: _____________ 3. ____________________________ No. of opportunities: _____________ I received appropriate opportunities to acquire clinical skills: 1 2 3 4 5 Comments: I received appropriate instruction in clinical skills 1 2 3 4 5
Comments:
I received enough feedback daily on how I was progressing 1 2 3 4 5 Comments: The feedback that I received from the faculty was valuable 1 2 3 4 5 Comments: I especially valued the feedback that I receive from the following faculty:
1. __________________ 2. __________________ 3. __________________
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I received the appropriate amount of clinical supervision: 1 2 3 4 5 Comments: The quality of the reference material suggested was excellent 1 2 3 4 5 Comments: Aspects of this block that I would like to see improved at this time are:
1. ______________________________________________________________________ 2. ______________________________________________________________________ 3. ______________________________________________________________________
Aspects of this block that are particularly good at this time are:
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________ Other Comments: Strongly disagree Strongly agree Overall, this block met my expectations 1 2 3 4 5 Comments
PLEASE RETURN TO KIM ASSELSTINE IN THE DEPARTMENT OF ANESTHESIOLOGY OFFICE
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Department of Anesthesiology Resident Evaluation of the Program
Strongly disagree Strongly agree Overall, the program is meeting my expectations 1 2 3 4 5 Comments: The knowledge component is well covered as far as: The basic sciences 1 2 3 4 5 The clinical sciences 1 2 3 4 5 Comments: I receive appropriate opportunities to acquire clinical skills: 1 2 3 4 5 Comments: I receive appropriate instruction in clinical skills 1 2 3 4 5
Comments:
I receive enough feedback daily on how I am progressing 1 2 3 4 5 Comments: I value the feedback that I receive from all the faculty: 1 2 3 4 5 Comments: I especially value the feedback that I receive from the following faculty:
1. __________________ 2. __________________ 3. __________________
I receive the appropriate amount of clinical supervision: 1 2 3 4 5
Comments: Aspects of the residency program that I would like to see improved at this time are:
1. _________________________________________________________________ 2. __________________________________________________________________ 3. __________________________________________________________________
Aspects of the residency program that are particularly good at this time are:
4. __________________________________________________________________ 5. __________________________________________________________________ 6. ______________________________________________________________________
If you have important concerns that are not covered in the above questionnaire, please speak to Dr. Mike Cummings.
Please complete and return to Kim Asselstine
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Queen's University Department of Anesthesiology
Medicine Rotation Evaluation: Cardiology (CSU)
Name/PGY Level: Date of Rotation: Hospital: (NOTE: This evaluation is only for our departmental use. Confidentiality will be maintained.) Were you aware of your goals and objectives for this rotation? Yes: No:
Please Rate Your Rotational Experience Using the Scoring System Below: 1 = poor to none 2 = below expectations 3 = met expectation 4 = above expectations 5 = excellent to outstanding Quality of Teaching by Attending Supervisor(s): 1 2 3 4 5
1. Dr.
2. Dr.
3. Dr.
Overall Quality of Formal Teaching Rounds
Did you have teaching, and gain experience in: 1 2 3 4 5
ECG Interpretation
Holter Monitor Interpretation
Echocardiography
Exercise Treadmill Testing
Persantine Thallium Scanning
Dobutamine Stress Testing
Cardiac Pacemakers
Arrhythmia Management
Coronary Angiography, Angioplasty, Stenting (observational experience)
Assessment and management of new patients with chest pain
Institution of anticoagulant therapy in patients with an evolving MI
Management of post-MI complications (failure, ischemia, arrhythmias)
Management of cardiogenic shock
Pre-op Assessment and Optimization of patients for non-cardiac surgery
Were your physical examination skills actually observed?
Were you given adequate supervision and feedback on your consultations?
Did you have an opportunity to teach and supervise junior housestaff?
Please feel free to provide comments on strengths, weaknesses, or suggestions for improvement below and on the reverse side:
Please return to Kim Asselstine, Department of Anesthesiology, K.G.H.
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Queen's University Department of Anesthesiology
Medical Rotation Evaluation: Respirology
Name/PGY Level: Date of Rotation: Hospital: (NOTE: This evaluation is only for our departmental use. Confidentiality will be maintained.) Were you aware of your goals and objectives for this rotation? Yes:____ No: ______
Please Rate Your Rotational Experience Using the Scoring System Below: 1 = poor to none 2 = below expectations 3 = met expectation 4 = above expectations 5 = excellent to outstanding
Quality of Teaching by Attending Supervisor(s): 1 2 3 4 5
1. Dr.
2. Dr.
3. Dr.
Overall Quality of Formal Teaching Rounds
Did you have teaching, and gain experience in: 1 2 3 4 5
Pulmonary Function testing (Observed)
Pulmonary Function Interpretation
Arterial Blood Gas Interpretation
Ventilation Perfusion Scanning/Interpretation
Topical Anesthesia of the airway
Fiberoptic bronchoscopy
Assessment and management of patients with Obstructive Lung Disease
Assessment and management of patients with Restrictive Lung Disease
Assessment and management of patient with respiratory infections
Preoperative assessment and optimization of patients for thoracic surgery
Preoperative assessment and optimization of patients for non-thoracic surgery
Were your physical examination skills actually observed?
Were you given adequate supervision and feedback on your consultations?
Did you have an opportunity to teach and supervise junior housestaff?
Please feel free to provide comments on strengths, weaknesses, or suggestions for improvement below and on the reverse side:
Please return to Kim Asselstine, Department of Anesthesiology, K.G.H.
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Queen's University Department of Anesthesiology
Medical Rotation Evaluation: Nephrology
Name/PGY Level: Date of Rotation: Hospital: (NOTE: This evaluation is only for our departmental use. Confidentiality will be maintained.) Were you aware of your goals and objectives for this rotation? Yes: _____ No: ____
Please Rate Your Rotational Experience Using the Scoring System Below: 1 = poor to none 2 = below expectations 3 = met expectation 4 = above expectations 5 = excellent to outstanding
Quality of Teaching by Attending Supervisor(s): 1 2 3 4 5
1. Dr.
2. Dr.
3. Dr.
Overall Quality of Formal Teaching Rounds
Did you have teaching, and gain experience in: 1 2 3 4 5 Understanding normal renal physiology
Methods of evaluation of renal function
How altered renal function affects drug pharmacokinetics
Assessment of the anephric patient
Management of the patient with renal transplant
Management of the patient on hemodialysis
Placement of double lumen central dialysis lines
Understanding the components of writing dialysis orders
Understanding continuous renal replacement therapy
Evaluation of the patient with abnormal electrolytes
Evaluation of the patient with abnormal acid-base status
Were your physical examination skills actually observed?
Were you given adequate supervision and feedback on your consultations?
Did you have an opportunity to teach and supervise junior housestaff?
Please feel free to provide comments on strengths, weaknesses, or suggestions for improvement below and on the reverse side:
Please return to Kim Asselstine, Department of Anesthesiology, K.G.H.
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CORE PROGRAM EVALUATION Topic: Date:
Presenter: 1. All things considered, how would you rate this person's effectiveness as a teacher? 2. Was well organized 3. Showed concern for participants 4. Had enthusiasm for teaching 5. Encouraged participants to participate in the session 6. Stimulated my interest in the subject 7. Gave clear explanations 8. Spoke clearly 9. Showed how the subject topics were related to each other 10. Successfully related to participants 11. The pace at which the subject matter was presented was...
NoOutstanding Very Poor Applicable 7 6 5 4 3 2 1 X Strongly Undecided Strongly Agree Disagree 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X 7 6 5 4 3 2 1 X Very Fast Reasonable Very Slow 7 6 5 4 3 2 1 X
12. What were the most useful aspects of this seminar, and why? _____________________________________________________________________________ 13. How could this seminar be improved? _____________________________________________________________________________ 14. What was the "muddiest" point of the seminar? _____________________________________________________________________________
If you would like to make further comments on this seminar, please do so below and over. Thank you for answering this questionnaire.
** Please return to Kim Asselstine**
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Queen’s University Department of Anesthesiology
Staff Daily Evaluation of Anesthesiology Trainee
Resident: Year of Training (PGY ____): Staff: ______________________________ Date of Evaluation: _________________________ Today the Trainee Meets Expectations: Not Inconsistently Meets Sometimes Consistently N/A At All Meets Exceeds Exceeds Medical Expertise Demonstrates an appropriate knowledge base: 1 2 3 4 5 Performs a thorough and complete preoperative 1 2 3 4 5
evaluation: Develops an appropriate plan of anesthetic 1 2 3 4 5 management: Demonstrates appropriate emergency management skills: 1 2 3 4 5 Performs technical skills commensurate with their 1 2 3 4 5 level of training: Comments (including strengths and weaknesses): Communication Communicates well with patients and families: 1 2 3 4 5 Communicates well with other health care professionals: 1 2 3 4 5 Provides clear and concise charting: 1 2 3 4 5 Comments: Scholar Is a self-directed learner: 1 2 3 4 5 Demonstrates critical appraisal skills: 1 2 3 4 5 Practices evidence based medicine: 1 2 3 4 5 Demonstrates good teaching skills with junior trainees: 1 2 3 4 5 Comments: Teaching topic reviewed today with trainee:______________________________________________________
(over)
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Today the Trainee Meets Expectations: Not Inconsistently Meets Sometimes Consistently N/A At All Exceeds Exceeds Collaboration and Professionalism Is a positive and effective team member: 1 2 3 4 5 Is responsible, reliable and professional: 1 2 3 4 5 Performs well during stressful circumstances: 1 2 3 4 5 Displays insight into own strengths and weaknesses: 1 2 3 4 5 Comments: Health Advocate Identified important determinants of the patient’s health and advocated for their best outcome: 1 2 3 4 5 Comments: Management Skills Demonstrates appropriate initiative and independence: 1 2 3 4 5 Is able to manage time effectively: 1 2 3 4 5 Arranges for special resources as necessary: 1 2 3 4 5 Comments: Overall Comments: Fails to meet Meets Exceeds Expectations Expectations Expectations
Global Performance 1 2 3 4 5 Focused feedback provided to the resident at the end of the day Yes No Staff Signature:
Please complete and return to Kim Asselstine
Anesthesiology & Perioperative Medicine
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Queen’s University Anesthesiology Staff Daily Evaluation
(to be filled out by Resident at the end of the day)
DEPARTMENT OF ANESTHESIOLOGY
1.1 PRECEPTOR EVALUATION This evaluation is confidential. Your preceptor will not see this form. The Program Director and/or the Department Head provide feedback on a semi-annual basis to the preceptor. You may request a discussion of this evaluation with the Program Director.
1 2 3 4 5 NA
I do not agree Needs
improvement Satisfactory Good
I definitely agree
Not Assessed
Deficiencies of consequence
Few significant deficiencies
Not great but not bad
Good performance
No deficiencies, exemplary
**COMMENTS ARE REQUIRED FOR MARKS LESS THAN 3**
Feedback 1 The preceptor provided constructive feedback.
1 2 3 4 5 NA
Feedback 2 The preceptor’s feedback contained these elements: timely, specific, non-judgmental manner, in a private setting.
1 2 3 4 5 NA How could the preceptor’s feedback be improved? _______________________________________________________ ________________________________________________________________________________________________
Organization of Teaching The preceptor taught in a clear, organized manner.
1 2 3 4 5 NA
Clinical Supervision 1 The preceptor involved me in patient management at an appropriate level for my level of training and understanding.
1 2 3 4 5 NA
Clinical Supervision 2 The preceptor appropriately demonstrates/critiques clinical procedures.
1 2 3 4 5 NA
Resident Interaction 1
The preceptor treated me in a respectful manner.
1 2 3 4 5 NA
Resident Interaction 2
The preceptor created a positive learning environment.
1 2 3 4 5 NA
How could the preceptor improve the learning environment? ________________________________________________
_________________________________________________________________________________________________
Resident Interaction 3
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The preceptor was open to discussion of alternative views or approaches to the clinical management of patients.
1 2 3 4 5 NA
Scholarly Influence 1
The preceptor related theories and concepts to clinical practice in a manner that was clear.
1 2 3 4 5 NA
Scholarly Influence 2
The preceptor influenced me to broaden my knowledge of the literature.
1 2 3 4 5 NA
Scholarly Influence 3
The preceptor encouraged me to broaden my problem solving skills.
1 2 3 4 5 NA
Availability
The preceptor was accessible for advice perioperatively.
1 2 3 4 5 NA
Supervision
The preceptor provided effective supervision when necessary.
1 2 3 4 5 NA
OVERALL
The preceptor as a teacher/role model:
1 2 3 4 5 NA
**COMMENTS ARE REQUIRED FOR MARKS LESS THAN 3** COMMENTS
Other Comments: