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Overview

A comprehensive description of Trainee aims, learning objectives and assessment, as well as ANZCA Professional Documents relevant to Module 7.

Duration required: A minimum 30 sessions (½ days) of clinical experience is required for anaesthesia for neurosurgery — TE10 : Recommendations for Vocational Training Programs.

Trainee's Aims
Learning Objectives
Assessment
Appendix

Trainee's Aims

The aim of Module 7 is for Trainees to acquire a series of clinical abilities and skills in the perioperative care of patients undergoing such surgery. The subspecialties in this Module have a number of common considerations in anaesthesia care, such as comorbidities and an increased need for preoperative airway assessment, an airway shared with the surgeon, high risks for airway obstruction, mix of adult and paediatric patients, requirements for induced hypotension in certain procedures, and acute post-operative care problems. It may not be possible to obtain experience in all the above subspecialties, but the Trainee needs to understand the pathophysiology of the condition and the requirements of anaesthesia for surgery on the head and neck.

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

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.

Basic Science principles in clinical practice. Basic science, clinical measurement and other subjects relevant to this module include the following.

Professional documents and guidelines for practice such as ANZCA documents (see Appendix)
Relevant aspects of cardiovascular, respiratory and neurological physiology
Physiology of gases in closed body cavities
Pharmacology of local anaesthetic agents
Pharmacology of local vasoconstrictors
Anatomy of the head and neck and abnormal facies
Anatomy of the airway, nasal passages, larynx, pharynx and middle ear
Effects of surgery and radiation on the airway
Monitoring in anaesthesia
Neurological monitoring
Lasers; types, uses in surgery, complications and precautions
Airway devices and types of tracheal tubes, e.g., Pollard, Rae
Equipment for difficult tracheal intubation
Equipment for jet ventilation

Clinical Management

Anaesthesia for ENT Surgery

Trainees are expected to understand relevant principles, apply knowledge in practice, and to demonstrate abilities in the anaesthesia management of ENT surgery. These include the following.

Pre-operative airway assessment
Examination under anaesthesia
Tonsillectomy and adenoidectomy, including quinsy and postoperative bleeding
Microlaryngoscopy
Radical head and neck surgery

Laryngectomy
Pharyngolaryngectomy

Laser surgery
Nasal and sinus operations
Parotid tumour surgery
Myringoplasty
Middle ear surgery
Microsurgery of the ear
Managing partial airway obstruction including:

Epiglottitis
Foreign bodies
Laryngeal tumours
Oropharyngeal cysts and abscesses

Elective and emergency tracheostomy
Paediatric problems, e.g., relating to disease, airway, larynx and craniofacial disorders
Post-operative care

Anaesthesia for Dental Surgery

Trainees are expected to understand relevant principles, apply knowledge in practice, and to demonstrate abilities in the anaesthesia management of dental surgery. These include the following.

Outpatient dental procedures; sedation and general anaesthesia
Inpatient dental surgery
Dental procedures on the mentally handicapped
Dental procedures on patients with bleeding disorders
Oral surgery

Fractured jaw
Maxillary fractures according to the Le Fort classification
Dental sepsis

Anaesthesia for Eye Surgery

Trainees are expected to understand relevant principles, apply knowledge in practice, and to demonstrate abilities in the anaesthesia management of eye surgery. These include the following.

Understanding:

Anatomy and physiology of extremes of age
Anatomy of orbit and contents
Physiology of intraocular pressure
Ocular perfusion
Eye reflexes (oculocardiac, oculorespiratory, oculoemetic)
Anatomy of orbit, extraocular muscles, blood vessels, lacrimal apparatus
Local anaesthetic agents for eye surgery
Other drugs for eye surgery, e.g., topical agents, vasoconstrictors, mydriatics, miotics, and agents to reduce intraocular pressure

General anaesthesia for eye surgery including:

Examination under anaesthesia
Laser eye surgery
Intraocular surgery
Extraocular surgery
Retinal detachment
Plastic and orbital surgery
Emergency eye surgery and use of suxamethonium in penetrating eye injury
Monitoring
Postoperative care, management of nausea and vomiting

Principles of regional retrobulbar and peribulbar block and choosing between general and regional anaesthesia techniques
Sedation for eye procedures
Principles of anaesthesia for day-case or office-based eye surgery
Paediatric considerations

Anaesthesia for Maxillofacial, Thyroid, and Head and Neck Surgery

Trainees are expected to understand relevant principles, apply knowledge in practice, and to demonstrate abilities in the anaesthesia management of maxillofacial and head and neck surgery. These include the following.

Pre-operative airway assessment
Management of anaesthesia for major maxillofacial surgery, which may involve prolonged anaesthesia, major blood loss, hypothermia and multiple procedures
Management of anaesthesia for facial trauma: emergency and semi-elective, including fractured jaw and maxilla (see Module 3 and Anaesthesia for Dental Surgery above)
Management of anaesthesia for cancer, plastic and cosmetic surgery on the face, head and neck, including surgery for cleft palate
Management of thyroid surgery, including:

Anaesthesia for thyroid and parathyroid surgery
Stabilisation of thyroid and parathyroid disorders preoperatively
Drill for managing post thyroidectomy bleeding
Drill for managing a “thyroid storm”

Sedation for head and neck procedures
Post-operative care

Skills — Clinical Skills

In this Module, Trainees will provide safe anaesthesia for varied surgery and procedures on the head and neck.

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.

Technical skills common to all procedures that Trainees are required to be competent in include the following.

Skills learned in Modules 1 and 2
Tracheal intubation
Nasal intubation
Use of special tubes
Placement and removal of packs
Applying topical local anaesthesia to the airway
Securing the difficult airway
Recognising the high-risk airway
Use of stylets and bougies
Awake intubation
Retrograde catheter technique
Fibreoptic intubation
Laryngeal mask airway intubation
Failed intubation or ventilation drill
Cricothyroidotomy and percutaneous tracheostomy
Transtracheal ventilation
Managing the airway in trauma and Burns
Upper airway obstruction drill
Post extubation of difficult airway drill
Spontaneous gaseous induction for airway obstructionRegional and local anaesthesia of the head and neck
Management of postoperative nausea and vomiting in head and neck surgery
Management of postoperative facial and airway swelling

Skills — Educational Skills

Trainees are expected to build on the educational skills in Modules 1 to 3 and 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

During Advanced Training

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
Comprehending how decisions are made
Determining what information should be accepted or rejected in decision-making
Determining the value of information from various sources and the importance of cross validation
Assessing professional performance
Conducting and appraising literature searches
Appraising journal articles including the application of statistics
Applying the principles of evidence-based medicine to clinical practice
Carrying out oral presentations and professional communication. Specific skills in communication are outlined in Modules 2, 11 and 12
Presenting quality assurance exercises or projects
Developing facilitation skills, such as tutoring in small-group learning and conducting small-group meetings

Attitudes and Behaviours

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

Core attitudes and behaviours that Trainees must cultivate during the whole period of 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 7 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 and and gained experience in anaesthesia for head and neck surgery deemed to be adequate. It may not be possible for the Trainee to gain experience in all subspecialties of ENT, dental, eye, maxillofacial and head and neck surgery. The Module 7 Supervisor will 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 and monitoring in Module 7 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 clinical experience (sessions), 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 7. These are periodically updated on Professional Documents page on the ANZCA website and in the Bulletin.

Technical

Professional Standards

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