Goals and Objectives
During the CA-3 year any resident working in the Preoperative Anesthesia Evaluation Clinic will refine the skills necessary to obtain a focused history and physical examination and advance their understanding of the impact of comorbid conditions on planned surgical procedures. They will continue to learn how different disease states are evaluated and optimized to minimize operative risk. They will manage and prescribe medications in the perioperative period. They will order and interpret tests. They will continue to develop and communicate anesthetic and postoperative analgesic plans to patients. They will learn to function in a leadership role assisting Nurse Practitioners and nurses to function in there roles. Upon completion of this rotation the resident will be able to:
-   Function as a consultant in perioperative medical management and anesthetic planning.
-   Obtain and document a focused history and physical the clearly presents all relevant data that effect decision making pertaining to an upcoming anesthetic.
-   Develop an anesthetic and postoperative analgesia plan.
-   Communicate risks.
-   Optimize comorbid conditions.
-   Order and interpret indicated testing.
-   Manage medications.

The resident will demonstrate skills in the following six competencies:
1. Patient Care
Residents must perform a history and physical examination in a thorough, efficient, caring and compassionate manner. They must utilize information gathered to:
-   Explain risks and benefits of plausible anesthesia and analgesia techniques.
-   Explain perioperative risk related to underlying comorbidities and planned procedure.
-   Explain, arrange, and communicate the results of testing.
-   Explain, arrange, and interpret the recommendations of consultants.
-   Explain how medications are to be administered in the perioperative period.
-   Answer any questions the patient may have regarding their upcoming anesthetic or direct the patient to an expert that can.
-   Communicate effectively with surgeons, consultants, and operating room anesthesiologists so all caregivers are attuned to relevant patient conditions.

2. Medical Knowledge
Residents must demonstrate extensive knowledge of conditions that impact anesthesia planning, surgical outcome, and perioperative morbidity. They are expected to:
-   Obtain and understand the importance of information gathered regarding a patient’s previous anesthesia history, focusing on types of surgery, anesthetic technique, and any adverse reactions.
-   Understand the importance of familial anesthetic complications.
-   Obtain all the relevant components of a cardiac history and physical.
-   Understand and apply ACC/AHA guidelines for Perioperative Cardiology Consultation.
-   Understand the value of noninvasive cardiac testing.
-   Arrange Cardiology consultation or testing as needed.
-   Understand the value of myocardial revascularization.
-   Understand the impact of beta-blockade, alpha-blockade and statins on cardiac risk reduction. Prescribe such medications as indicated.
-   Understand the assessment of activity tolerance. Perform this assessment.
-   Understand the impact of various cardiac conditions on anesthetic planning and perioperative morbidity.
-   Understand ECG interpretation.
-   Understand indications for and administration of SBE prophylaxis. Write orders for these medications.
-   Understand anesthetic implications of smoking, RAD, COPD, respiratory infections. Optimize such conditions,
-   Understand PFT, ABG interpretation. Order tests as needed.
-   Understand the impact of various neurological conditions on anesthetic planning and perioperative morbidity.
-   Understand the anesthetic implications of gastroenterological diseases. Administer aspiration prophylaxis.
-   Understand the impact of various hematological conditions on anesthetic planning and perioperative morbidity.
-   Understand the anesthetic implications of renal diseases.
-   Understand the impact of various endocrinologic conditions on anesthetic planning and perioperative morbidity.
-   Understand the anesthetic implications of pregnancy.
-   Understand how to evaluate the airway.
-   Understand indications for preoperative testing. Order appropriate tests.
-   Understand preoperative management of medications. Instruct patient regarding what medications to take.
-   Understand NPO instruction.

3. Practice-based learning improvement
Residents must be able to continuously investigate and evaluate disease processes with specific consideration to adequacy of workup, optimization, effect on anesthetic planning, in reference to specific patient needs for particular surgeries. Residents are expected to:
-   Use information technology, on-line resources, expert consultation, and primary texts to expand their knowledge base.-     Apply scientific evidence to decision making.
-   Refine the ability to obtain reliable information efficiently.
-   Compare evidence-based practice to commonly taught experience based decision making to develop a personal practice strategy.

4. Interpersonal and Communication Skills.
Residents must be able to effectively communicate with patients, clinic staff, consultants, and primary services. They are expected to:
-   Communicate effectively with patients so patients clearly understand anesthetic and analgesic alternatives, technique specific risks, risks associated with given surgical procedures.
-   Explain how patients are to manage medications in the perioperative period.
-   Clearly explain the need for testing or consultation.
-   Communicate concerns with surgeons.
-   Present cases to attending anesthesiologists.
-   Communicate effectively with nurses and nurse practitioners.
-   Describe the experience patients will have the day of surgery.
-   Answer any questions patients may have.

5. Professionalism
-   Fulfill the role of a consultant in perioperative management, utilizing institutional and local resources to provide the highest quality care to patients.
-   Demonstrate sensitivity to patients’ limitations of understanding, access, and ability to participate in obtaining and receiving optimal medical care.
-   Demonstrate a commitment to being an advocate for a patient receiving care that is appropriate for their personal needs.
-   Remain attuned to the fact that a surgical condition may quite possibly be the greatest stress a patient has faced in their lifetime.
-   Understand that patients may not completely understand the significance of a surgical procedure or their comorbid conditions and may require additional explanation of circumstances or direction to someone that can clarify questions.

6. Systems-Based Practice
Residents must develop an intimate understanding of institutional, local and regional health care systems in an effort to assist patients in accessing optimal care in a cost effective convenient manner in the perioperative period and beyond.