Residency Training in Anesthesia

Residency Training in Anesthesia What the Trainer should know? Dynamics in a Training Program Working Environment: Local Culture Current Needs Resources available Within the accepted Standards or Norms of the National / World Specialty Organization Training Program Trainer Trainee Anesthesia Trainers must have… Knowledge •Anesthesiology •Internal Medicine •Surgery/Obstetrics •Pediatrics •Pain Skills •Basic skills required •Regional Block •For new modalities •Communication Attitude •To the Trainee •To Peers •To Patient •As a Teacher What to teach the Anesthesia Trainees? • Basic Sciences relevant to Anesthesia physics physiology pharmacology anatomy / neuroanatomy pathology / histology research methodology What to teach the Anesthesia Trainees? • Clinical Anesthesiology scope of anesthesia practice risk management in anesthesia clinical monitoring intensive care pain management Skills/ Procedures: airway management vascular access GA and RA techniques What to teach the Anesthesia Trainees? • Communication Skills Lecture / Paper Presentation Clinical Case Discussion • Relations with patients, peers, and subordinates what to do after a bad outcome How to deal with a “problem trainee” how to deal with a “problem peer” Key Features of a Good Training Program  Clear Goals and Expectations  Structured Program; Clinical and Educational  Comprehensive Clinical/Simulated Experience  Dedicated, Motivated Teachers  Fair Evaluation and Remediation System  Collegiality and Supportive Structured Program Residency Training CURRICULUM > didactic / educational > clinical / simulated experience Goals/ Objective/ Assessment for each component in the curriculum must be defined and congruent Appropriate “duration” and “workload” Course Planning: “Blueprinting” Objectives Teaching Methods Assessment Curriculum and Assessment: „Ideal‟ Curriculum and Assessment: “Reality” Objectives Teaching Methods Assessment What Trainers should know is… How to teach the Anesthesia Trainees? Venues for Teaching Teaching Strategies Teaching Tools Teaching Anesthesia Trainees Location Inside the OR Strategies Case - Based Problem Based Small Group Tutorials Tools Books / Journals Internet Patients Simulators Outside the OR •Bedside •PACU •Conferences Role Playing Research activities Large Group Lectures Audit reports Taxonomic Categories in Cognitive Domain Knowledge Comprehension Application Analysis Synthesis Evaluation “Keep Teaching at one Taxonomic level at a time” Keypoint Help the trainee develop decision-making skills! Clinical teachers should help trainees to develop the habits of mind that will help them SOLVE problems Non Technical Skills in Patient Management Situation awareness Decision making Task Management Patient management Team working Teaching Practical Procedures ( Skills) • There is no good evidence that psychomotor tests can predict future performance in tasks which demand manual dexterity. • No number of procedures performed will guarantee competence; there is rapid improvement in success rates after 20-30 , but this improves even after 80 procedures. Who teaches practical procedures? • Do not teach something you cannot do! • Do not teach something you have never done! • Do not get sucked into supervising something you are not competent to retrieve. • Never agree to let a trainee undertake a procedure with which you are unfamiliar- even if they claim to be competent in it. • Do not direct a trainee who lacks mastery to supervise or teach another trainee. Teaching Practical Procedures • Create sufficient time to teach • Practical procedures must only be taught by an operator who has full mastery of the task. • Follow a system for teaching skills or practical procedures System for Teaching Practical Procedures 1. The consultant demonstrates the procedure at full speed whilst the trainee observes. 2. The consultant demonstrates the procedure more slowly explaining each step. 3. The trainee does the procedure with the consultant. System for Teaching Practical Procedures 4. The trainee does the procedure. 5. Practice - repeated performance with appropriate reduction of supervision. 6. Mastery - will follow repeated performance and must be achieved before the trainee in turn teaches. Characteristics of Good Clinical Teachers • Enthusiasm is high. • Has interest and willingness to learn themselves • Good knowledge of the material • Good communication skills • Competent performers in clinical care Characteristics of Good Clinical Teachers • • • • Intellectual Honesty Be professionally assertive: earn your respect Respect for Trainees Flexible enough to allow trainees to do things their own way • Has Good Humor Consultants as Teachers and Role-Models • Use eye contact • Defer appropriate answers to the trainee • Ensure the safety of the patient ! • Be constructive: include the surgeon in your decision process How much supervision is needed? • Supervision must be appropriate! Trainees need to let consultant know also what level of participation/ supervision he wants. • Supervising competent trainees allows the consultant to watch how he deals with unexpected problems, see if vigilance is maintained in the face of familiar work. Three Processes for Monitoring Training 1. Mentoring or Supervision 2. Appraisal or Feedback 3. Assessment or Evaluation What is the difference? Assessment/ Evaluation To measure performance against an agreed criteria Appraisal / Feedback Describe the current performance; the intention is to arrive at an agreement with the trainee Purpose Information Test scores, available performance reports, Logbook or portfolio which contains evidence edited and volunteered by ratings by supervisors the trainee What is the difference? Assessment / Evaluation Methods used Outcome Knowledge tests Oral exams Practical exams Appraisal /Feedback Extended interviews Peer group reports of performance Summative assessment Formative assessment The discussion is private but an agreed statement of outcome may be public Educational Environment • Maintain an emotional environment conducive to learning: - honesty, trust and fairness • Clear statement to the rest of the clinical team about the lines of responsibilities • Not a “Culture of Blame” Trainers must be Mentors! • Seeks to help the trainee optimize an educational experience • Assist in his socialization into a disciplinary culture • Help him find a suitable employment • act as Advisors, Supporters, Masters, Sponsors, Role models Six (6) General Competencies expected from a Trainee Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Systems-Based Practice Practice-Based Learning and Improvement Training Program in Anesthesia… What Trainers should know? Have an assessment > of our respective Program… > of Ourselves Work together…as a Team Promote Growth & Development of our Specialty in the Region