Anesthesiology residents at the CA-2 (PGY3) level are assigned to a one-month rotation that focuses on the provision of anesthesia at hospital locations outside of the operating room, eg. MRI, endoscopy, angiography. Upon completion of the Remote Site Anesthesia rotation, the anesthesiology resident will be able to:
-   Evaluate patients for remote site anesthesia procedures and determine if they are appropriate candidates to undergo anesthesia at that location.
-   Evaluate remote site locations to determine if they possess the resources and equipment necessary to provide safe anesthesia care.
-   Provide anesthesia care to adult and pediatric patients at a variety of remote site locations.

The resident will demonstrate skill in the following six competencies:
1.   Patient Care
Residents must be able to provide anesthesia care to patients at remote sites that is compassionate, appropriate, and effective. Residents are expected to:
-   Perform a thorough history and physical examination that identifies co-morbid conditions that would affect anesthetic management and then utilize that information to determine if the patient is an appropriate candidate to receive anesthesia at a remote site.
-   Provide safe and effective anesthesia care to adult and pediatric patients at various remote site locations for procedures that could include: MRI, CT scan, endoscopy, interventional neuroradiology, radiation medicine procedures, interventional cardiology.

2. Medical Knowledge
Residents must demonstrate knowledge about the anesthetic considerations unique to providing care for procedures performed at remote sites. They must also demonstrate knowledge of the scientific evidence supporting the safety and effectiveness of various anesthetic techniques for remote site anesthesia. Residents are expected to demonstrate knowledge of the following:
-   ASA Guidelines for Nonoperating Room Anesthetizing Locations - special monitoring and equipment requirements in the MRI suite
-   Effects of co-morbid conditions on anesthetic management at remote locations
-   Appropriate anesthetic techniques for procedures typically performed at remote locations, including anesthesia for: interventional neuroradiology, MRI, endoscopy, interventional cardiology, radiation medicine procedures, and electroconvulsive therapy
-   Postanesthesia care requirements for patients undergoing anesthesia at remote sites
-   Discharge criteria for outpatients who have received anesthesia care at remote sites

3. Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their anesthesia practices for remote site procedures, appraise and assimilate scientific evidence, and improve their remote site anesthesia practices. Residents are expected to:
-   Use information technology to manage information, access on-line medical information, and support their own education.
-   Understand and utilize the ASA Guidelines for Nonoperating Room Anesthetizing Locations to improve their anesthesia care to patients undergoing procedures at remote site locations.
-   Locate, appraise, and assimilate evidence from scientific studies related to remote site anesthesia and utilize this information to improve their anesthetic care of these patients.
-   Apply knowledge of study designs and statistical methods to critically analyze remote site anesthesia clinical studies.
-   Facilitate the learning of health care professionals working at remote sites concerning the implications of providing anesthesia at those locations.

4. Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange with patients, patients’ families, and professional associates. Residents are expected to:
-   Demonstrate the ability to use communication and interpersonal skills to work effectively in several unfamiliar locations with many different health care professionals to provide optimal anesthesia care to patients undergoing procedures at remote sites. This includes the ability to communicate with personnel at these locations what resources and equipment they must provide to allow safe anesthesia and postanesthesia care.
-   Demonstrate an ability to communicate with radiologists, cardiologists, and other physicians the anesthetic concerns for each patient, making certain they are considered when developing a plan for performance of a procedure at a remote location.
-   Effectively discuss anesthesia options, including risks and benefits, to patients who will undergo procedures at remote sites.
-   Use appropriate communication to allay the anxiety of patients undergoing procedures at remote locations.
-   Identify when a language interpreter is required to effectively communicate with a patient and family and utilize available resources to secure adequate language interpretation.

5. Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
-   Maintain sensitivity and responsiveness to patients’ culture and religion and care for all patients in a nonjudgmental fashion.
-   Demonstrate a commitment to ethical practices, including patient confidentiality, informed consent, and equal treatment of all patients.
-   Demonstrate respect towards all staff working at remote site locations.

6. Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:
-   Evaluate all remote site locations to make certain they meet the criteria recommended in the ASA Guidelines for Nonoperating Room Anesthetizing Locations before providing anesthesia care in those locations.
-   Facilitate timely anesthesia set-up at remote sites, utilizing anesthesia technicians and personnel from the remote sites when appropriate, in order to avoid delays in patient care.
-   Develop an understanding of the patient flow systems at various remote site locations so they can contribute to efficiency within the unit.
-   Understand the JCAHO standard that requires the level of anesthesia and postanesthesia care provided at remote site locations to be equivalent to the care provided in the operating room and PACU.

Resident Assessment
Competencies will be assessed during this rotation by the following methods:
1. Formative evaluations of patient care, medical knowledge, interpersonal and communication skills, and professionalism will be assessed via attending discussions with residents after observation of the resident providing clinical care to patients.
2. Global rating evaluation forms will be utilized by attending anesthesiologists at the completion of the rotation to summatively evaluate all six of the general competencies. These evaluations will be based on direct observations of anesthesiology attendings who have worked with the resident. Feedback from personnel who work at the remote locations may be included in some cases.
3. In some instances, evaluation of practice-based learning and improvement and systems-based practice during this rotation may be included in the resident’s portfolio, utilizing either self-assessment or the Healthcare Matrix.