PGY 1 Goals and Objectives  

 Core Skills: PAGEREF _Toc38211146 \h 1

Anesthesia Rotational Goals for PGY1 Residents: PAGEREF _Toc38211147 \h 2

Emergency: PAGEREF _Toc38211148 \h 3

General Surgery: PAGEREF _Toc38211149 \h 4

Internal Medicine Rotation: PAGEREF _Toc38211150 \h 5

Obstetrics & Gynecology: PAGEREF _Toc38211151 \h 5

Pediatrics: PAGEREF _Toc38211152 \h 6

Psychiatry: PAGEREF _Toc38211153 \h 6

The Specialty of Anesthesia interfaces with many other medical disciplines.  The PGY1 Anesthesia year at the University of Ottawa consists of 13 four-week block rotations in a broad range of medical / surgical disciplines to help the resident to be well prepared for the LMCC II examination in the fall of the PGY2 year.  The LMCC II examination is a current requirement of all Canadian licensing authorities for licensure.

The PGY1 year in Anesthesia at the University of Ottawa consists of: 

Core Skills:

 During Basic Clinical Training, at the University of Ottawa, the residents will be rotating through core rotations, which will each have their own objectives. The following objectives are of a general nature to provide skills and attitudes, which all residents should acquire

Communication Skills

 A competent PGY1 resident should be able to: 

1.        Listen and acquire information from patients and their families, as well as clinicians, nurses and other members of the health care team.

2.        Ask appropriate questions to clarify information.

3.        Explain clearly to other members of the health care team as well as patients and their family's relevant medical information.

4.        Demonstrate non-judgmental and empathic behaviour.

 B)     History

 A competent PGY1 resident will be able to:

1.        Obtain an appropriate history from the patient, family or other sources.

2.        Demonstrate the ability to record their history in a clear organized manner.

3.        Demonstrate the ability to provide a clear verbal summary of the patients' history for the benefit of other members of health care team.

 C)     Physical Examination

A competent PGY1 resident will be able to:

1.                  Perform a physical examination appropriate to the circumstances.

2.         Record the physical examination in a clear appropriate manner.

 D)     Investigations

 A competent PGY1 resident will demonstrate the ability to:

 1.        Select the appropriate diagnostic procedures.

2.        Discuss the limitations and contra-indications of common investigations.

3.        Determine the reliability and predictive value of common investigations.

4.        Perform common procedures consistent with the level of the training.

E)              Clinical Judgement and Decision Making

          A competent PGY1 resident will demonstrate the ability to:

   Differentiate relevant from irrelevant information.

   List of probable causes of clinical problems in order of their likelihood in a particular clinical situation.

   Demonstrate an appreciation for the relevant seriousness of clinical situations.

   Differentiate between the situations that he/she should handle and those, which require assistance.

F)       Management

A competent PGY1 resident will be able to:

   Outline initial management for both common and more rare but life ­threatening conditions.

   Evaluate the response to therapy.

   Discuss management appropriately with staff physicians and other members of the health care team.

G)       Health Promotion and Maintenance

A competent PGY1 resident will be able to:

   Describe common disease prevention strategies.

   Council the patient concerning health promotion.

H)       Critical Appraisal/Medical Economics

A competent PGY1 resident will be able to:

   Evaluate scientific literature.

   Outline the principles of cost benefit analysis.

I)        Law and Ethics

A competent PGY1 resident will be able to:

   Demonstrate the ability to discuss common medical/legal issues and know how to obtain information about more difficult situations.

   Demonstrate a basic understanding of bio-ethics.

J)        Inter-professional Skills

A competent PGY1 resident will be able to:

   Demonstrate an understanding of the appropriate consultant/primary physician relationship.

   Demonstrate the appropriate use of non-physician health care workers in patient management.

Anesthesia Rotational Goals for PGY1 Residents:

PGY1 residents in Anesthesia at the University of Ottawa will complete three four-week block rotations in adult anesthesia. The guidelines of our training programs expectations for residents responsibilities with respect to direct faculty supervision for patient care as well as a progressively increasing assignment of responsibilities for patient care during the PGY2 to PGY5 years is presented in the Anesthesia PGY2 - PGY5 Rotational Goals and Objectives.  

At the PGY1 level, direct continuous faculty supervision is expected for all new and unfamiliar techniques as well as at anesthetic induction, emergence, and with any significant event for all ASA classes of patients undergoing both emergency and elective surgical procedures. A period of paired resident call with senior residents will be provided prior to the assignment of full resident call responsibilities.

Knowledge:

The PGY1 resident is expected to acquire a basic knowledge in the following areas:

1.     The anesthetic implications of systemic diseases particularly those of the respiratory and cardiovascular systems.

2.     The anesthetic implications of the physiological changes due to pregnancy.

3.     The basic principles of the function of the anesthesia machine including the machine checkout procedure prior to the induction of anesthesia

4.     The basic principles of perioperative monitoring and interpretation including:

   Electrocardiography and ST segment analysis

   Blood pressure monitoring (non-invasive and invasive)

   Pulse oximetry

   Capnography

   Temperature monitoring

   Minute ventilation monitoring (VT, RR)

   Airway pressure monitoring

   Invasive pressure monitoring (arterial, CVP, pulmonary artery)

   Arterial blood gas monitoring

5.     The basic principles used in assessing intraoperative fluid losses and replacement requirements.

6.     A basic knowledge of the pharmacology of the commonly used general and local anesthetic agents.

7.     A basic knowledge of the methods used in the management of postoperative pain and labour pain.

8.     A basic knowledge of the evaluation and management of the critically ill postoperative patient in the recovery room and the intensive care unit.

9.     A basic knowledge of matters relating to stress management, substance abuse, medical-legal affairs and quality assurance.

Skills:

The PGY1 resident should:

1.     Be able to perform a basic preoperative assessment on all adult patients. 

2.     Have a basic understanding of appropriate investigations that need to be carried out in to prepare the patient for surgery.

3.     Be able to formulate a basic perioperative plan for adult patients excluding cardiac, thoracic and neurosurgical patients.

The PGY1 residents will receive a basic introduction to the following procedures:

   inspection and preparation of anesthesia equipment prior to the induction of anesthesia

   preparation of appropriate anesthetic and resuscitative medications

   instruction for obtaining vascular access including peripheral intravenous insertion, arterial line insertion, and central line insertion techniques

   instruction in endotracheal intubation, LMA placement, and a review of the protocol for managing a difficult intubation

   instruction in epidural, spinal, and intravenous regional anesthesia

4.     During the PGY1 year it is expected that the resident should be proficient in ACLS.  Residents who have not completed their ATLS training will undertake this in the first six months of their PGY2 year.

Attitudes:

Attitudes of diligence, reliability, honesty and good rapport with other staff and patients will be expected and assessed on an on-going basis.

Emergency:

Rotation supervisors:         Civic Campus                     Dr. Gord Wallace      Tel: 761-4347

The RCPSC recognizes an elective four-week block rotation in emergency medicine as an internal medicine rotation counting towards the accreditation of specialty training in Anesthesia.  The resident will be expected to have completed their ACLS and ATLS training as a prerequisite to this rotation.  The resident will be expected to play active role as a member of the Emergency Department medical team, sharing in shift and call duties, and actively participating in the Emergency medicine’s department teaching rounds.  The resident should actively use the Emergency Medicine department’s teaching files and computer simulation teaching aids.  The rotational goals and objectives are listed below.

To gain an appreciation of the principles of the triage of emergency patients including trauma patients and to communicate and function effectively as a member of the Emergency Department medical team.

To gain confidence in clinical assessment skills and to rapidly priorize tasks for acute resuscitation, investigation and / or appropriate referral of the emergency patient.

To gain an appreciation of the rational use and limitations of appropriate investigational tools in the emergency patient.

To enhance the residents skills in the interpretation of radiological and laboratory tests (including CXR’s, C-Spine X-rays, ECG, ABG, and other laboratory tests (CBC, electrolytes, glucose, urea, creatinine, LFT’s, toxicology screening tests, troponin, etc)) in the emergency patient.

To expand upon the residents knowledge base, differential diagnosis, investigation, and clinical management of the emergency patient with:

1. Acute respiratory insufficiency (including asthma, COPD and pneumonia)
2. Acute drug overdose
3. including airway management
4. fluid resuscitation
5. use of activated charcoal
6. indications for urinary alkalinization
7. indications for hemodialysis
8. use of the Drug Information Service
9. Acute myocardial infarction

Trauma; specifically including:

1. Head injury: GCS scoring, acute management of raised ICP, indications for surgery
2. C-spine injury: stabilization, investigation, and ‘clearing the C-Spine’
3. Airway burn and enclosed space smoke inhalation
4. Chest injury: myocardial and pulmonary contusion
5. Penetrating and blunt injuries of the chest and abdomen

To enhance the residents knowledge base and clinical skills in the ACLS resuscitation of the VSA patient, and the ATLS resuscitation of the trauma patient.

Skills: 

The resident should review the following procedural skills, and gain experience when possible:

1. Insertion of large bore intravenous access lines.
2. Insertions of central venous access lines.
3. Appropriate use of local anesthetics analgesics and sedatives in the emergency patient.
4. Endotracheal intubation (awake, asleep, oral, nasal).
5. Chest tube placement.
6. Gastric lavage.
7. Application of MAST pants.

General Surgery: 

The aim of the rotation is to provide exposure to what general surgeons see and do, and to provide teaching in the early management of surgical disease.

Knowledge

The PGY1 trainee should be able to diagnose the common general surgical conditions. The trainee should be able to diagnose and plan for the management of the acute abdomen.  The trainee should be familiar with the in-hospital management of surgical patients.

The trainee should be able to differentiate between serious life threatening conditions and non-serious illnesses.

Skills

The PGY1 trainee should be familiar with common surgical procedures that are carried out in the emergency room and the operating room.

The trainee should be familiar with basic wound care and basic suturing skills.

Attitude

The trainee should be part of a health care team and use resources appropriately.

The trainee should be aware of ethical issues relating to the surgical management of patients.

The trainee should know when to seek advice and assistance.

Internal Medicine Rotation:

Knowledge

To enhance the ability to perform a comprehensive history and to improve knowledge of the importance (and limitations) of history taking in the diagnosis of medical illnesses.

To improve the ability to perform a physical examination relevant to Internal Medicine and to improve the interpretation of the findings.

To learn to request, gather and interpret ancillary information obtained from Radiology and the Laboratories in the diagnosis of common diseases seen in the practice of Internal Medicine.

To acquire the ability to organize and synthesize the above information in a coherent fashion, to frame differential diagnoses and to initiate logical and comprehensive diagnostic and therapeutic plans for common medical illnesses.

Skills

To become proficient with some of the commonly performed procedures in Internal Medicine including CPR, arterial blood gases, IV catheter insertion, LP’s, bone marrow aspirations and thoracentesis/paracentesis.

To acquire improved critical appraisal skills of relevant medical literature, using the tools of clinical epidemiology and clinical decision making.

Attitudes

To become more familiar with the moral and ethical issues important in the care of medical patients.

To improve the ability to interact and communicate with patients, their family and professional colleagues involved in the care of medical patients.

Obstetrics & Gynecology: 

To provide a broad base clinical exposure in obstetrics and gynecology.  The PGY1 trainee will:

1.        Have a working knowledge of normal labor.

2.        Understand and know the basis of antepartum risk assessment.

3.       Understand the principles of management of obstetrics emergency.

4.       Have exposure to and understand the management of preinvasive disease of the lower genital tract.

5.                Know and manage common gynecological emergencies i.e.: ectopic pregnancy and abdominal pain.

6.                Have exposure to the surgical aspects of gynecology i.e.: preoperative and postoperative care.

7.        Have exposure to and understand the basis of management of gynecological malignancies.

8.        Have a working knowledge of common outpatient gynecological problems.

OBSTETRICS:  The trainee will:

1.        Be able to perform intrapartum vaginal examination for the assessment of cervical dilatation and descent.

2.        The determination of the lie of the fetus through abdominal palpation.

3.        Interpret an intrapartum fetal tracing.

4.        Apply a scalp electrode.

5.        To assess and determine the diagnosis of labor.

6.        Follow and determine the natural course of labor.

7.        Assist in Cesarean sections.

8.       Assist or perform normal spontaneous vaginal deliveries.

9.       Assess and admit patients in high-risk group's i.e.: pre-eclampsia and diabetes.

10.      Understand and be able to evaluate antepartum and postpartum hemorrhage.

11.      Attend the outpatient antenatal clinics and assess risk assessment for the pregnant patient (see attached guidelines).

GYNECOLOGY:  The trainee will:

1.        Assess emergency calls i.e.: abdominal pain and ectopic pregnancy.

2.        Manage and work up these patients.

3.        Assist in gynecological surgery.

4.        Understand and be able to advise on contraception alternatives.

5.        Be able to perform a pelvirectal examination.

6.        Be able to insert a speculum.

7.        Be able to perform a pap test.

8.        Have exposure to colposcopy.

9.        Be involved in preoperative and postoperative management of gynecologic patients.

10.      Have exposure and understand the role of:

a)        Hormonal replacement therapy

b)                Diagnosis and management of menopause

          c)       Concepts of well women care

Pediatrics: 

The aim of the rotation at CHEO is to familiarize PGYI trainees with the differences between pediatrics and adult medicine.

Knowledge

The trainee should appreciate how growth and development may affect the presentation and course of illness in children.

The trainee should appreciate the psychosocial effects of pediatric illness and some of the strategies for treating them.

The trainee should be aware of the fluid and nutritional needs of children of differing ages and the effect of disease on these needs.

The trainee should be familiar with the doses of common drugs used in pediatrics and the methods of modifying adult drug dosages for children.

The trainee should be familiar with the general warning signs of serious illness in children. The trainee should be familiar with common pediatric surgical problems.

Skills

The trainee should be able to provide primary care for common pediatric emergencies and manage common pediatric illnesses.

The trainee should be familiar with commonly performed pediatric procedures.

The trainee should be able to conduct a pediatric history and physical examination and formulate management plans.

Attitudes

The trainee should be able to develop professional relationships with children and their families.

The trainee should be able to establish good working relationships with other caregivers.

The trainee should be part of a health care team and be able to communicate with the community agencies, e.g. schools and CAS.

The trainee should be aware of ethical aspects of pediatrics and professional standards, e.g. issues of obtaining consents and children's rights.

The trainee should know when to seek advice and assistance.

The trainee should keep appropriate and accurate records of patient care.

Psychiatry:

The PGY1 trainee should:

1. Be able to describe and discuss the major psychiatric diagnoses, as related to the different stages of the life cycle.

2. Be able to assess patients from a biopsychosocial standpoint, and be able to formulate a management plan based on that assessment.

3. Be able to assess and provide emergency management of psychiatric emergencies including suicidal states, agitation, acute psychosis, delirium, and anxiety states.

4. Be aware of the indications, contraindications, side effects, drug interactions and appropriate doses of the major biological therapies in psychiatry, including anti-depressants, anti-psychotics, anxiolytics, sedative/hypnotics, mood stabilizing agents and electroconvulsive therapy.

5. Be aware of the range of psychological treatments available and their uses, including supportive/exploratory psychotherapy, cognitive-behavioural therapy and group, family and couples therapy.

6. Be aware of the indications for hospitalization and the use of alternatives to hospitalization such as day-treatment and use of community resources.

7. Be aware of systemic issues as they affect psychiatric and other illnesses including family and marital, socio-economic, and cultural issues.

8. Be aware of legal and ethical aspects of psychiatry, particularly as they pertain to certification, consent and competency.