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Overview

A comprehensive description of Trainee aims, learning objectives and assessment, as well as ANZCA Professional Documents relevant to Module 1.

Duration required: 12-18 months. This is a mandatory module in Basic Training.

Trainee's Aims
Learning Objectives
Assessment
Appendix

Trainee's Aims

New Trainees should familiarise themselves with the goals of the Anaesthesia Training Program, the attributes they must attain, and the Modules to be completed during Basic Training. The Modules outline the curriculum content and skills for Trainees to learn and accomplish.

In this Module, clinical experience is gained in anaesthesia for uncomplicated elective surgery, day (ambulatory) surgery, and procedural sedation. This commonly includes anaesthesia for elective (non-major) general, orthopaedic, gynaecological, urological, plastic, and endoscopic procedures, including procedures performed outside the operating theatre suite.

The overall aim of Module 1 is for Trainees to develop a foundation for the ongoing development of clinical skills and abilities in anaesthesia. This includes the following:

Conducting safe general anaesthesia and perioperative care for patients where risk is considered low^*
Understanding physiology, pharmacology, clinical measurement, and monitoring as applied to anaesthesia, in preparation for presentation at the primary examination^*
Understanding the principles of acute pain management^*
Conducting safe procedural sedation
Establishing a professional team approach with patients, families, colleagues and staff
Appraising evidence-based approaches to clinical problems
Establishing a personal Learning Portfolio and self-education skills

*represents core aims

Learning Objectives

These objectives are what Trainees need 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 - Clinical Measurement and Monitoring

Trainees are required to understand the principles involved in the measurement of relevant variables and the requirements of equipment and monitoring in anaesthesia. Knowledge is expected in the areas outlined below.

Physics and Clinical Measurement

Principles of Measurement as set out in the syllabus.

SI units
Behaviour of fluids (gases and liquids)
Flow of fluids
Measurement of volumes, flows, and pressures
Measurement of temperature
Humidification
Oximetry
Analysis of gases
Capnography
Electrical safety
Fires and explosions

Equipment and Apparatus

Equipment design and standards
Gas supply in bulk and cylinders
Anaesthesia delivery system, including pressure valves and regulators
Vaporisers
Breathing systems
Devices to maintain the airway (laryngoscopes, endotracheal tubes, tracheostomy tubes, face masks, laryngeal masks, airways)
Information systems
Data storage and retrieval

Monitoring

Anaesthesia record
Minimum monitoring standards
Additional monitoring when appropriate (including central venous pressure, pulmonary artery pressure, cardiac output, cerebral function, temperature, coagulation, blood loss, blood sugar)

Knowledge — Education and Self-Development

Trainees are required to understand the principles, processes or nature of:

effective learning
self-directed learning and self-assessment
reasoning and decision-making
giving and receiving feedback
lifelong learning

Clinical Management

Trainees are expected to understand relevant principles, apply knowledge in practice, and to demonstrate abilities in the anaesthesia management of uncomplicated patients (e.g. ASA 1 and 2). These include the following.

Operating Theatre Suite Environment

Planning and physical layout of an operating theatre suite, especially the operating rooms and post-anaesthesia recovery room
Lighting, safety, and infection and pollution control in operating rooms
Services and equipment in operating rooms and post-anaesthesia recovery room
Requirements of other anaesthesia environments outside operating rooms
Principles of staffing the operating room, including assistants to anaesthetists
Principles of management of an operating theatre suite
Informed consent
Regulations relating to restricted drugs as per national or state guidelines
Principles of occupational health and safety such as lifting and positioning patients, infection control and sharps policies
Dealing with an intra-operative death or mishap
Relevant ANZCA professional documents (see Appendix)

Day Surgery Environment

Types of day surgery eg ambulatory surgery, same-day surgery, office-based surgery
Requirements of a day surgery facility
Planning and physical layout of a day surgery suite
Services and equipment in a day surgery suite
Principles of management of a day surgery suite
Relevant ANZCA Professional Documents (see Appendix)

Professional Practice

Policies, recommendations and guidelines in professional practice as contained in ANZCA Professional Documents (see Appendix)

Preoperative Assessment

Pre-anaesthesia clinics
Appropriate history taking
Physical examination including airway assessment, respiratory, cardiovascular and neurological examinations
Referral to other specialists when necessary
Establishment of a rapport with the patient to provide reassurance, disclosure of risk, information, and discussions on complementary medicine and informed consent
Communication and consultation skills face-to-face, by phone and in writing
Pulmonary function tests
Measurement of cardiovascular function
Interpretation of common radiology and imaging scans and investigations
Other investigations as appropriate

Conducting Anaesthesia

Applied cardiac and respiratory physiology
Applied pharmacology and variability in drug response
Selection and planning of the anaesthesia technique
Decision-making relating to postponement or cancellation of surgery
Routine inhalation and intravenous inductions
Maintenance of anaesthesia
Correct use of anaesthesia delivery systems
Application and interpretation of monitored variables and neuromuscular blockade
Use of muscle relaxants
Application of mechanical ventilation
Management of the airway and intraoperative complications outlined in “Drills” below
Common regional anaesthesia techniques (e.g., epidural and spinal anaesthesia and upper limb blocks)
Maintenance of accurate records

Postoperative Care

Safe recovery transport and handover in the post-anaesthesia recovery room
Post-operative consultations
Management of postoperative pain, fluid requirements, and nausea and vomiting

Complementary Medicine

Common complementary or alternative medicine drugs and therapy
Interactions with drugs used in anaesthesia and analgesia
Principles of acupuncture
Views of patients from different cultures on complementary medicine

Skills - Clinical Skills

Trainees will provide safe anaesthesia care and pain management for uncomplicated patients undergoing non-major surgery.

In providing anaesthesia care, Trainees should be competent in certain technical skills, such as the following.

Maintenance of an adequate airway
Rapid sequence induction
Advanced Life Support
Aseptic techniques
Venous access
Arterial blood gas collection
Arterial cannulation
Central venous cannulation
ECG recording and interpretation
Lumbar puncture
Blood culture collection
Emergency management of a pneumothorax

Trainees should be familiar with clinical protocols (drills) in the delivery of safe anaesthesia care, and be able to respond accordingly for crisis management. These include the following.

Checking of the anaesthesia delivery system
Airway assessment
Identification and management of the following problems, which are commonly acute and may be life-threatening:

Inadequate airway; failed intubation, obstructed airway, oesophageal intubation, endobronchial intubation, and unplanned extubation
Laryngospasm
Bronchospasm
Hypertension
Hypotension
Arrhythmias
Myocardial Ischaemia
Hypoxia
Hypocarbia
Hypercarbia
Hypoventilation
Hyperventilation
Hypothermia
Hyperthermia
Malignant hyperthermia
Anaphylaxis
Residual neuromuscular blockade
Inadequate neuraxial blockade
Seizures
Gas embolism
High ventilator peak inspiratory pressures
Pulmonary aspiration
Pneumothorax

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 core skills outlined below.

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 e-mail
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 which are obligatory in specialist medical practice.

Core attitudes and behaviours that Trainees must cultivate during the whole period of Anaesthesia Training Program are outlined below.

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

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 1 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 completed a minimum of 12 months clinical experience. The Module 1 Supervisor will review the Trainee’s Learning Portfolio as part of this assessment. At least one oral presentation to the department and evidence of group learning activities (as recorded in the Learning Portfolio) will also be required to complete Module 1.

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 Supervisor will test the Trainee’s ability to check the anaesthesia delivery system one to three months into Module 1. The Module 1 Supervisor, in conjunction with the Supervisor of Training will perform a structured assessment of the Trainee’s competence to assess whether the Trainee should be permitted to practise beyond level 1 supervision (TE3 : Policy on Supervision of Clinical Experience for Vocational Trainees in Anaesthesia).

The Primary and Final Examinations will be summative assessments of the Trainee. Knowledge of basic sciences, clinical measurement, monitoring, and statistics will be assessed in the Primary Examination. Clinical management and clinical skills 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 using 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 1. These are periodically updated on the ANZCA Trainee Publications page on the ANZCA website and in the Bulletin.

Technical

Training and Educational

Professional Standards

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