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Overview

A comprehensive description of Trainee aims, learning objectives and assessment, as well as ANZCA Professional Documents relevant to Module 3.

This is a mandatory module in Basic Training.

Trainee's Aims
Learning Objectives
Assessment
Appendix

Trainee's Aims

This is the next Module that new Trainees must complete after Module 1. This Module relates to clinical experience in anaesthesia for major elective surgery, emergency surgery and trauma surgery, including gastrointestinal and hepatobiliary surgery, laparoscopic surgery and the perioperative care of trauma patients.

The aim of Module 3 is for Trainees to acquire clinical abilities and skills in managing complex, high-risk, and injured patients, and those with co-existing medical conditions that are relevant to anaesthesia, and to build on what they learned in Module 1. This includes learning to integrate and apply knowledge and skills in clinical management.

Learning Objectives

These are what the Trainee needs to learn. They are presented as:

Knowledge
Clinical management (“knows how”) that applies knowledge and clinical skills to manage the patient
Skills (clinical and technical)
Attitudes and behaviours

Knowledge — Basic Sciences

Trainees are required to revise the relevant subjects in the Basic Sciences as set out in the ANZCA publication Syllabus for the Basic Sciences in Anaesthesia and Intensive Care, and as updated on the Trainee Publications page on the ANZCA website. Trainees are expected to apply Basic Science principles in clinical practice.

Knowledge — Education and Self-development

Trainees are expected to build on their self-development knowledge from Module 1. In this Module they need to understand the principles of small group learning.

Clinical Management

Trainees are expected to understand relevant principles, to apply knowledge in practice, and to demonstrate abilities in the anaesthesia management of patients for major and trauma surgery (e.g., ASA 3 and 4 and E). These include the following.

Professional Practice

Compliance with the relevant policies, recommendations and guidelines in professional practice as contained in ANZCA Professional Documents (see Appendix)

Anaesthesia for High-risk Elective and Emergency Surgery

Preoperative evaluation and resuscitation
Postoperative care
Thromboembolism prophylaxis
Perioperative and prophylactic antibiotics
Management of coagulopathies
Regional anaesthesia for abdominal, vascular, and imaging procedures including anatomy, and physiological and pharmacological aspects
Informed consent and consent for incompetent patients
Management of postoperative pain, phantom-limb pain and pain from injury

Anaesthesia for Trauma Surgery

Assessment and immediate care; primary and secondary survey
Trauma severity scores
Emergency airway management
Establishing intravenous access
Priorities of resuscitation, investigations, and surgical procedures
Physio-biochemical effects of trauma
Managing facial, head and cervical spine injuries
Glasgow Coma Scale and other scores of consciousness
Pathophysiology of head injury including changes in cerebral blood flow, cerebral metabolism and intracranial pressure
Pathophysiology and management of shock
Pathophysiology of blood loss and massive blood transfusion
Volume replacement
Managing abdominal and chest injuries
Management of burns procedures, including:
Understanding the pathophysiology of burns
Anaesthesia for debridement and skin grafting
Drills in burns resuscitation
Managing coagulopathies
Organisation of trauma and retrieval services
Transport of ventilated or injured patients including portable ventilators and monitoring systems

Co-existing Medical Conditions Relevant to Anaesthesia

Endocrine disorders including phaeochromocytoma, hyperthyroidism, hypothyroidism, and diabetes mellitus

Disorders of the cardiovascular system (see Module 5)
Disorders of the respiratory system (see Module 5)
Disorders of the nervous system
Disorders of the liver, biliary tract and gastrointestinal system
Renal disorders
Water, electrolyte and acid-base disturbances
Haematological disorders, including coagulopathies
Skin and musculoskeletal disorders, including rheumatoid arthritis and ankylosing spondylitis
Psychiatric disorders and substance abuse
Disorders associated with ageing
Obesity

Skills — Clinical Skills

In this Module, Trainees will provide safe anaesthesia for:

Major abdominal surgery
Laparoscopic surgery
Trauma surgery

Trainees will revise pre-assessment skills, including taking an appropriate history and performing an appropriate physical examination (including airway assessment, cardiovascular, respiratory and neurological examinations) to assess the patient’s status.

Trainees are required to be competent in the following technical skills.

Skills learned in Module 1, especially securing an airway, arterial and central venous cannulation, and rapid sequence induction
Cricothyroidotomy and percutaneous tracheostomy
Cannulation of major vessels for volume resuscitation
Awake fibreoptic intubation
Thoracic and lumbar epidural and spinal anaesthesia
Blood salvage and conservation
Regional nerve blocks for abdominal and lower limb surgery
Chest drain insertion
Peritoneal lavage and interpretation
Immobilisation and care of cervical spine injuries

Trainees should be familiar with clinical drills for crises management. These include:

Drills in Module 1, especially for airway emergencies eg, “cannot intubate, cannot ventilate”, difficult airway, hypoxia and abnormal end-tidal CO₂ levels
Managing major intraoperative events in aneurysm and abdominal surgery
Drill for the primary and secondary survey
Drill for raised intracranial pressure
Drill for tension pneumothorax
Drill for managing severe haemorrhage
Drill for managing cardiac arrest (ACLS Algorithm)
Drill for managing malignant hyperthermia

Skills — Educational Skills

Trainees are expected to learn educational skills in Modules 1 to 3 that will enable them to develop the following:

A review of their personal learning plan as specified in their Learning Portfolio
Identification of the factors that lead to deviation from the original learning plan
A learning plan in the Learning Portfolio in which basic science teaching is linked to clinical practice

The Trainee should acquire the following core skills.

During Basic Training

Maintaining a Learning Portfolio
Developing a study plan for the rest of the training period
Reviewing study plans and correcting for deviations (e.g., catching up on deficient knowledge or experience)
Reflecting on previous learning experiences with the aid of the Learning Portfolio
Linking basic science teaching with clinical practice
Studying effectively
Participating in small-group learning and educational activities
Being aware of decision-making processes
Managing time effectively for study, work and home/leisure
Giving and receiving feedback
Developing insight into personal limitations
Using the Internet including email
Conducting and appraising literature searches
Appraising journal articles including the application of statistics
Carrying out oral presentations and professional communication. Specific skills in communication are outlined in Modules 2, 11 and 12

Attitudes and Behaviours

Trainees are expected to develop the attitudes and behaviours that are obligatory in specialist medical practice.

Core attitudes and behaviours that Trainees must cultivate during the whole period of Anaesthesia Training Program include the following.

Specialist Practice

To attain the attributes of a specialist as a:

Medical expert
Communicator
Collaborator
Manager
Health advocate
Scholar and teacher
Professional
To practise good communication with colleagues, patients and others
To work as a member of a team, but to assume responsibilities and/or delegate duties as a team leader when necessary
To commit to, and believe in, a culture of safety and ethical, high quality care
To accept that medical knowledge and skills are not the only requirements of specialist practice
To be aware of medicolegal obligations relating to medical practice
To have insight into one’s own limitations, abilities and areas of expertise
To commit to lifelong continuing professional development

Professionalism and Ethics

To commit to, and believe in the ethical and professional principles of:

Altruism: the best care for the patient must be the principal driving force of practice
Patient autonomy: patients’ ability to determine their treatment
Beneficence: the principle of “doing good” to patients
Non-maleficence: the principle of not doing harm to patients
Fidelity: faithfulness to one’s duties and obligations. This principle underlies excellence in patient care, confidentiality, telling the truth, a commitment to continuing professional development and lifelong learning, and not neglecting patient care
Social justice: the right of all patients to be fairly treated
Utility: the principle of doing the most good for the greatest number of people
Duty to oneself in terms of personal health care, and maintenance of competence to practise
Accountability: the anaesthetist is responsible for his/her actions
Honour and integrity in all conduct, including the generation and use of resources
Respect for others, including a responsibility to work as a team and to practise conflict resolution
Appropriate response to clinical error

Patient Considerations

To commit to, and believe in, the rights of patients with respect to:

Autonomy
Confidentiality of the doctor-patient relationship
Appropriate, excellent clinical care, including pre-operative assessment
Informed consent
Comprehension of the risks of anaesthesia techniques
Appropriate care irrespective of race, culture, gender, and socio-economic status

Research Considerations

To value rigorous educational and scientific processes
To distinguish between practice with a sound scientific basis and that which requires further objective assessment
To commit to the ethical principles of research

Assessment

The Module 3 Supervisor will validate the Trainee’s completion of the module in accordance with the process outlined in College Professional Document TE2 : Policy on Vocational Training Modules and Module Supervision. This will involve the Trainee assessing whether she/he has achieved the core aims (Trainee’s aims) of the module. The Module 3 Supervisorwill review the Trainee’s Learning Portfolio as part of this assessment.

The Supervisor of Training and other Consultants will evaluate the Trainee’s overall performance in the In-Training Assessment (ITA) process. Aspects of clinical performance, education skills, and attitudes will be reviewed. The ITA will remain a formative assessment conducted every six months, independent of Module assessment.

The Primary and Final Examinations will be summative assessments of the Trainee. Knowledge of basic sciences, clinical measurement, monitoring, and statistics in Module 3 will be assessed in the Primary Examination. Clinical management and clinical skills in this Module will be assessed in the Final Examination.

The Learning Portfolio is an integral tool for self-assessment (as well as for recording clinical experience and developing study plans). The Trainee is expected to self-evaluate his/her education skills and learning experience from the Learning Portfolio. For example, the Learning Portfolio should show the Trainee’s progress through the Module, as records of technical skills learned, topics reviewed and oral presentations delivered.

The Learning Portfolio is mailed to each Trainee upon their registration with ANZCA. A PDF copy can be downloaded from the Trainee Publications page on the ANZCA website.

Appendix

Relevant ANZCA Professional Documents for Module 3. These are periodically updated on the Professional Documents page on the ANZCA website and in the Bulletin.

Technical

Training and Educational

Professional Standards

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