EVALUATION • Evaluation will be Formative and Summative. FORMATIVE Daily preceptor reports: • There will be ongoing feedback from your preceptor as you deal with patients. • At the end of each day, the preceptor should take five minutes to summarize your progress and highlight strengths and areas for improvement. • Areas that should be discussed are listed on the “daily medical student evaluation form” • Copies of the evaluation form will be included in the package you receive on the first day of your rotation. Please be aware that there will be occasions when your preceptor may be too busy to be able to give you immediate feedback. Please respect this, as patient care always comes first. MEDICAL STUDENT DAILY EVALUATION FORM – MUN ANESTHESIA RESIDENCY TRAINING PROGRAM DATE_______________STUDENT ________________________ PRECEPTOR ___________________ MEDICAL EXPERT -Clinical Skills-History and Physical -Ability to identify clinical issues and apply medical/ anesthetic knowledge. Ex. DDX, problem recognition, anesthetic plan. - Technical skills PROFESSIONAL -Responsible- punctuality, attendance -Integrity and respect- ethics, confidentiality -Empathetic towards patients COMMUNICATOR -Able to communicate effectively with patients and OR team - Able to summarize and present patient information SCHOLAR -Knowledge base reasonable for level of training BA / A / AA / NA COMMENTS BA / A / AA / NA COMMENTS BA / A / AA / NA COMMENTS BA / A / AA / NA COMMENTS -Interested in expanding knowledge and identifying knowledge gaps COLLABORATOR -Takes initiative to be involved effectively with the OR team and patient care MANAGER -Aware of OR time constraints -Able to prioritize and use time efficiently. Ex. prepares for tasks ahead of time. HEALTH ADVOCATE -Awareness of patient safety peri-operatively and application of CAS guidelines -Aware of issues influencing patient health and impact on anesthetic care ADDITIONAL COMMENTS Describe any outstanding strong or weak points BA / A / AA / NA COMMENTS BA / A / AA / NA COMMENTS BA / A / AA / NA COMMENTS Evaluation – FORMATIVE CONTINUED Anesthesia Clerk Logbook • Keep track of cases that you have been involved with to follow up with reading in relevant areas. • Document topics that you have covered with your preceptor through learning modules or discussion. • Document your progress as you perform procedures and identify problem areas to focus on: Technical skills checklist Formative feedback cards( IVs and intubation) Date and OR Site CASE 1 CASE 2 CASE 3 CASE 4 CASE 5 CASE 6 CASE 7 CASE 8 Attending or Resident List type Surgical Procedure Technical Skills Comments, Learning points Topics discussed TECHNICAL SKILLS CHECKLIST FOR ANESTHESIA CLERKSHIP ROTATION SKILL REQUIRED intravenous (adult) bag -mask ventilation airway insertion adult intubation (specify oral/ nasal) insertion of LMA NOT REQUIRED insertion of nasogastric tube intravenous (pediatric) intubation (pediatric) use of glidescope use of lightwand / trachlight use of fiberoptic scope insertion of double lumen tube central line arterial line spinal epidural / caudal other regional blocks (specify other procedure not listed ( specify) # ATTEMPTS # SUCCESES # OBSERVED COMMENTS Follow the steps below for successful IV insertion Identify site and apply tourniquet Cleanse skin Immobilize vein Insert angiocath to flash. Advance canula over needle into vein and remove needle. Remove tourniquet after occluding canula to avoid blood spillage. Secure canula and safely connect to IV set-up. Insure IV is running and not tissued. Select appropriate mask size and oral airway Check suction device Select appropriate ETT size (and ½ size above and below). Prepare tube (cuff check and styelet as necessary) Pick appropriate size blade for laryngoscope and check light. (insure extra scope available) Position head in sniffing position, using head/shoulder support as necessary. Blade insertion- open mouth sufficiently to avoid contact with teeth. Do not damage lips between teeth and blade. Insert blade on right side of tongue using left hand and supports head with right hand. Apply reasonable force in correct direction to lift jaw appropriately without lifting patients head off the bed. Identify epiglottis and vocal cords Successfully pass ETT through vocal cords Fill pilot balloon until no audible leak Attach ETT to ventilation source Check ETT placement- distance at the lip, bilateral A/E, equal chest movement, ETCO2. Evaluation- SUMMATIVE Standard elective evaluation form from Undergraduate Medical Education • • Progress documented from the daily ITERs will be considered when the final summative ITER is completed. The elective evaluation ITER will be sent by undergrad to the site coordinator for your elective and will be returned for your perusal and signature. Case write –up • You will be asked to submit a write –up online of a case that you followed in the OR. Undergraduate Anesthesia Rotation Case write-up Briefly describe your patient. Include age, sex, and surgical procedure. (emergency / elective) E.g. 54 year old man for repair of inguinal hernia Name three medical / surgical considerations relevant to this patient’s preoperative assessment that may impact the anesthetic? E.g. Patient has IHD with recent chest pain, patient has COPD with 30pck year smoking history. 1. 2. 3. What are your anesthetic options? Consider whether the patient needs a general anesthetic or could be done under regional anesthesia (neuraxial /nerve block) or some combination of GA and regional. 1. 2. 3. What is your anesthetic plan? 1. Patient monitoring 2. Induction of anesthesia ( include drugs and airway management) 3. Maintenance of anesthesia 4. Intraoperative pain relief What is your plan for post-op pain management? Where should your patient go following surgery? E.g. PACU then home, PACU then ward, PACU then special care, PACU then ICU, direct to ICU...) What is the most outstanding thing that you learned from this case?