Department of Family & Community Medicine

Enhanced Skills Program: Family Practice Anesthesia — CanMEDS FM Goals and Objectives

The FP Anesthesia Program at the University of Toronto is a 52-week Residency Program designed to provide Family Physicians with the knowledge and the skills to be able to provide anesthesia care for low risk patients undergoing relatively uncomplicated procedures, particularly in smaller rural communities. It is of interest to recent graduates from family medicine training programs as well as Family Physicians who have been in independent pract ice who wish to acquire the knowledge, the skills and the judgment necessary for independent FP Anesthetic practice.

Participants in the program rotate through a combination of downtown hospitals (including The Hospital for Sick Children), community hospitals and rural hospitals so that they will acquire the knowledge, the skills and the experience required to provide anesthesia to a wide variety of patients in a number of different settings.

Presently, the following hospitals are involved in the academic and clinical training of FP Anesthesia residents:

  1. Michael Garron Hospital: 28 weeks
  2. Hospital for Sick Children: 12 weeks
  3. Mount Sinai Hospital: 8 weeks
  4. Rural Community Hospital: 4 weeks
  5. Intensive Care (NYGH): 4 weeks

In this Residency Program, FP Anesthesia Residents will acquire the knowledge and the
skill set as described below in the CanMEDS-FM Goals and Objectives:

Medical Expert

During the Residency, the FP-Anesthesia Resident will demonstrate and consolidate the following areas of knowledge in order to fulfill the CanMEDS-FM role as Medical Expert in Family Practice Anesthesia:

Assessment of the Patient:

By the end of the Residency, the FPA Resident will be able to:

  • Demonstrate an understanding that the primary goal of the pre-anesthetic assessment is to obtain the information required to plan an anesthetic management for the patient.
  • Obtain all aspects of the patient’s medical and surgical history, findings on physical examination and laboratory investigations that are relevant to anesthetic management. The history is to include past and current medical problems, current and recent drug therapy, unusual reactions or responses to drugs and any problems or complications associated with previous anesthetics as well as a thorough review of the airway and major organ systems (respiratory, cardiovascular, hepatic, renal, neurologic, and endocrine). A family history of adverse reactions associated with anesthesia should be obtained as well.
  • Determine and record an American Society of Anesthesiologists’ physical status classification (ASA) for each patient.
  • Obtain Medical consultations from Medical Specialists if the preoperative assessment suggests a specialist(s) expertise in management is required before surgery.
  • Arrange for the referral of a patient to a tertiary center, when indicated. Such referrals may be the result of the patient’s medical status, the type(s) of surgery that is needed and/or the appropriate level of postoperative care that may be needed.


Anesthesia Record:

By the end of the Residency, the FPA Resident will be able to:

  • Chart all monitored physiologic variables at intervals appropriate to the clinical circumstances. The physiologic variables include: heart rate, respiratory rate, blood pressure, oxygen saturation, end-tidal carbon dioxide, and temperature, as well, documentation of airway pressure, and end-tidal inhalational gases should be documented where patients are receiving inhalational anesthetics.
  • Chart the monitors, equipment and techniques used, as well as time, dose and route of all drugs and fluids delivered.
  • Chart the type of intraoperative anesthetic care administered.
  • Chart on the anesthesia record the following information: patient’s level of consciousness, heart rate, blood pressure, oxygen saturation and respiratory rate upon arrival to the Post Anesthetic Care Unit (PACU).


Standards of Anesthesia:

By the end of the Residency, the FPA Resident will be able to:

  • Follow the Standards of Anesthesia delivery according to the guidelines outlined by the Canadian Anesthesiologists’ Society and the American Society of Anesthesiologists, including NPO guidelines.

Anesthesia Gas Machine, monitors, equipment:

By the end of the Residency, the FPA Resident will be able to:

  • Demonstrate knowledge of the function of the anesthesia gas machine, including how the machine works, the ability to detect machine malfunctions, and when and how to take corrective action to prevent patient injury.
  • Describe the four component subsystems of the anesthesia gas machine: high-pressure system, low-pressure system, breathing system and the scavenging system.
  • Use the appropriate monitors used in monitoring the patient’s vital signs during the delivery of an anesthetic.
  • Demonstrate the ability to troubleshoot problems that can occur with the anesthesia gas machine and demonstrates the ability to correct those problems.
  • Demonstrate clinical skills such as starting intravenous catheters, arterial lines and central venous lines.

Airway

By the end of the Residency, the FPA Resident will be able to:

Assessment of the Airway:

  • Examine a patient’s airway (easy, difficult and/or compromised airway) by obtaining a patient’s history, physical examination, and reviewing previous anesthetics in the past. 
  • Demonstrate the ability to successfully and consistently hand ventilate a patient with the anesthesia breathing circuit and the Laerdal Bag.
  • Demonstrate the ability to intubate the trachea by many methods that are available to the FP Anesthetist, including the use of the fibre optic bronchoscope, trach-light, glidescope, Laryngeal Mask Airway.
  • Demonstrate appropriate knowledge of the difficult airway algorithm.
  • Manage the unanticipated difficult airway effectively.
  • Describe Rapid Sequence Induction (RSI) correctly - the definition of RSI, discuss when to use RSI, discuss the contraindications to RSI, and describe the drugs used in RSI.
  • Demonstrate the ability to develop plans of delivering anesthesia for shared airway surgeries.

Pharmacology

Basic Pharmacology:

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The various types of drugs used in Anesthesia
  • The pharmacokinetics of the drugs used in Anesthesia
  • The pharmacodynamics of the drugs used in Anesthesia
  • The various routes of administration of the drugs used in Anesthesia
  • Drug - drug interactions of Anesthesia drugs with other non-anesthesia drugs
  • How drug dosages, onset of action, duration of action, offset of action, half-life, volume of distribution, and metabolism/elimination can vary between patients depending on parameters such as bioavailability as well as patient factors such as coexisting disease, age, sex, race, medications, smoking, and even surgery and anesthesia
  • How the effects of anesthetic drugs have on patients with diminished function/reserve in the following organ systems: respiratory, cardiovascular, hepatic, renal, endocrine, neurological and hematological

Inhalational Agents:

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The various inhalational agents used in Anesthesia
  • MAC (Minimum Alveolar Concentration)
  • How to deliver inhalational agents safely
  • How to deliver an inhalational induction of anesthesia
  • The adverse reactions of inhalational agents
  • The contraindications of the usage of inhalational agents

Intravenous Agents:

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The various types of intravenous agents used in Anesthesia including induction drugs, benzodiazepines, opioids, NSAIDs, other analgesic agents/adjuvants, local anesthetics, muscle relaxants and reversal agents, anti-emetic agents, vasopressors, inotropic agents and cardiac resuscitation drugs (ACLS) 
  • How to deliver intravenous agents safely
  • How to deliver an intravenous induction of general anesthesia
  • The adverse reactions of intravenous agents used in anesthesia
  • The contraindications of the usage of the types of intravenous agents used in Anesthesia

Respiratory

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • Normal respiratory physiology
  • The various diseases affecting normal respiratory physiology
  • The differences between oxygenation and ventilation 
  • The various methods of delivery oxygen 
  • The various modes and types of ventilators used in anesthesia 
  • How Obstructive Respiratory Diseases and/or Restrictive Respiratory Diseases can influence the plan for anesthesia

Cardiac

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • Normal cardiac physiology
  • How coronary artery disease (atherosclerotic heart disease) can influence the plan for anesthesia
  • How hypertensive heart disease can influence the plan for anesthesia
  • How valvular heart disease can influence the plan for anesthesia
  • How dysrhythmias can influence the plan for anesthesia
  • How patients with pacemakers can influence the plan for anesthesia
  • How congenital heart disease can influence the plan for anesthesia
  • How the different types of shock (cardiac, hypovolemic, neurogenic, hemorrhagic, septic) can influence the plan for anesthesia
  • How peripheral vascular diseases can influence the plan for anesthesia

Gastrointestinal

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • Normal physiology and pathologies of the gastrointestinal system 
  • How a patient with a “full stomach” influences the plan of anesthesia
  • The various types of surgeries of the gastrointestinal system and the various plans of anesthesia that can be delivered for these types of surgeries

Renal

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • Normal physiology and pathologies of the renal system
  • How acute and/or chronic renal failure can influence the plan for anesthesia
  • How to maintain and to correct electrolyte and fluid balance peri-operatively in patients
  • The various types of surgeries of the renal, genitourinary and urinary systems and the various plans of anesthesia that can be delivered for these types of surgeries

Hepatic

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • Normal physiology and pathologies of the hepatic system
  • How alcoholic liver disease can influence the plan of anesthesia
  • How acute and/or chronic liver disease/failure can influence the plan of anesthesia

Musculoskeletal

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The neuromuscular junction - normal physiology and pathologies
  • How to monitor neuromuscular blockade
  • How osteoarthritis and rheumatoid arthritis can influence the plan of anesthesia
  • How myopathies and myotonias can influence the plan of anesthesia

Hematology

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of: 

  • The composition of blood - normal physiology, rheology and diseases of blood
  • How to use blood component therapy peri-operatively - indications, contraindications, adverse effects
  • The methods of homologous blood conservation techniques
  • How blood diseases can influence the plan of anesthesia
  • How to treat massive blood loss/hemorrhagic shock and the complications that can arise with massive blood transfusion therapy

Neurology

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The central and autonomic nervous system - normal physiology and diseases/pathologies of the CNS and ANS
  • How raised intracranial pressure (ICP) can influence the plan of anesthesia
  • How cerebral vascular accidents (strokes) can influence the plan of anesthesia
  • How seizure disorders can influence the plan of anesthesia
  • How paraplegia and quadriplegia can influence the plan of anesthesia

Endocrine

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • Normal endocrine physiology and diseases/pathologies of the endocrine system
  • How diabetes mellitus (types 1 and 2) can influence the plan of anesthesia
  • How hypothyroidism can influence the plan of anesthesia
  • How hyperthyroidism can influence the plan of anesthesia

Pregnancy

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The changes in maternal physiology during the three trimesters of pregnancy
  • How coexisting maternal diseases during pregnancy can influence the plan of anesthesia
  • How fetal presentations during labour can influence the plan of anesthesia
  • How maternal emergencies and/or fetal emergencies can influence the plan of anesthesia and/or analgesia

By the end of the Residency, the FPA Resident will be able to: 

  • Deliver anesthesia and analgesia for an obstetrical patient in labour
  • Deliver anesthesia and analgesia for vaginal births
  • Deliver anesthesia and analgesia for operative births (Caesarian Sections)

Paediatric

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The anatomic and the physiological differences in the paediatric patient versus the adult patient
  • The various methods of induction of general anesthesia for the paediatric patient

By the end of the Residency, the FPA Resident will be able to:

  • Manage the various types of paediatric surgeries that a FP Anesthetist can see in his/her career - ENT, dental, genitourinary, abdominal, orthopedic surgeries

Intra-operative Emergencies

By the end of the Residency, the FPA Resident will be able to:

  • Demonstrate knowledge of the various types of intra-operative problems and emergencies that can occur in the operating room
  • Quickly develop a differential diagnosis and treatment plan for each of the problems/emergencies that can occur in the operating room
  • Develop strategies in prevention of intra-operative problems and emergencies

Recovery Room - Post Anesthesia Care Unit

By the end of the Residency, the FPA Resident will be able to:

  • Demonstrate an understanding of the function of the PACU/Recovery Room
  • Apply the discharge criteria correctly for patients from the PACU/Recovery Room
  • Demonstrate knowledge of the various problems that can occur in the PACU/Recovery Room
  • Develop treatment options for problems that can occur in the PACU/Recovery Room

Temperature Control

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The role of temperature monitoring in the operating room
  • The various sites for monitoring patient’s temperature 
  • The thermoregulatory changes/responses in anesthetized patients
  • How to maintain normothermia in the operating room
  • Where temperature loss from the patient occurs in the operating room
  • The various methods of actively warming a patient in the operating room

Regional Anesthesia

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • How to evaluate a patient for a regional anesthesia plan 
  • The anatomy of the spinal column and peripheral nerves and plexi
  • The types of regional anesthesia available (central and peripheral) and be proficient clinically to perform central axial regional blockade
  • The types of anesthetic agents that are used in regional anesthesia
  • The adverse reactions, complications, contraindications to regional anesthesia

Resuscitation

By the end of the Residency, the FPA Resident will be able to:

  • Demonstrate an understanding of the role of the anesthesiologist in a resuscitation situation
  • Demonstrate an understanding of the methodology and “protocols” of treatment in a resuscitation situation
  • Assess and manage a resuscitation situation
  • Use the most appropriate type(s) of pharmacological therapy in a resuscitation situation

Peri-operative Pain Management

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of: 

  • The various modes of pain management used peri-operatively
  • The role of the Acute Pain Service
  • How to assess pain objectively
  • How to treat acute pain peri-operatively
  • How to use many types of drugs to treat pain peri-operatively, including the use of local anesthetics, regional anesthesia and intravenous narcotics
  • The types of surgical cases that require the Acute Pain Service

Malignant Hyperthermia

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The pathophysiology of malignant hyperthermia
  • What “triggering” agents that can cause malignant hyperthermia
  • The signs and symptoms of malignant hyperthermia
  • The treatment of malignant hyperthermia
  • How to deliver an anesthetic to a patient with known malignant hyperthermia and/or family history of malignant hyperthermia

Obesity

By the end of the Residency, the FPA Resident will be able to:

  • Define obesity
  • Recognize the co-morbid diseases that can be associated with obesity
  • Modify the plan of anesthesia appropriately for obese patients

Positioning of the Patient in the Operating Room

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The various positions a patient can be placed in during surgery
  • The changes to a patient’s physiology while being in various positions during surgery
  • How various patient positions can influence the plan of anesthesia

Substance Abuse

By the end of the Residency, the FPA Resident will be able to demonstrate appropriate knowledge of:

  • The various types of drugs used in substance abuse
  • The physiological changes to oranges from the effects of chronic substance abuse
  • How a patient with an acute substance abuse can influence a plan of anesthesia
  • How a patient with a history of chronic substance abuse can influence a plan of anesthesia

Procedural Sedation

By the end of the Residency, the FPA Resident will be able to: 

  • Define procedural sedation
  • Demonstrate knowledge of the various procedures where procedural sedation is used
  • Select the most appropriate types of drugs used for procedural sedation
  • Demonstrate the ability to assess a patient’s level of sedation objectively

As well as acquiring all of the above knowledge, the FP Anesthesia Resident will be expected to fulfill the following proficiencies in order to become a Medical Expert in Family Medicine Anesthesia:

  • Demonstrate skills in data gathering by taking a relevant history and performing an appropriate physical exam
  • Use appropriate diagnostic tests 
  • Utilize evidence-based medicine and cost/benefit analysis to select therapeutic agents for ethical, effective patient management
  • Demonstrate effective technical skills in the following areas:
    • Airway management – routine and difficult
    • Postoperative care and Emergency/Critical care o Obstetrical Anesthesia
    • Acute Pain Management
    • Regional Anesthesia

Communicator

During the Residency, the FP Anesthesia Resident will demonstrate the necessary knowledge and skills in the following areas in order to fulfill the CanMEDS-FM role as Communicator in Family Practice Anesthesia:

  • Demonstrate effective communication skills with patients, families, colleagues, and hospital staff. Good communication will display sensitivity and will show consideration of ethical, gender, and cultural issues.
  • Display skills as a consultant to concisely discuss patients with colleagues, organizing and expressing thoughts clearly.
  • Demonstrate effective presentation skills in teaching colleagues, residents, students, and other health science professionals.
  • Demonstrate effective record keeping and documentation

Collaborator

During the Residency, the FP Anesthesia Resident will demonstrate the necessary knowledge and skills in the following areas in order to fulfill the CanMEDS-FM role as Collaborator in Family Practice Anesthesia:

Consult effectively with other physicians and health care professionals to assure optimal medical management of patients

Work effectively in multi-disciplinary teams for the optimal management of patients in the operating room, intensive care unit, obstetrical suite, consultation clinic, and wherever else anaesthetic expertise is required.

Communicate effectively with the members of an interdisciplinary team in the resolution of conflicts, provision of feedback, and where appropriate, be able to assume a leadership role.

Delegate appropriately and demonstrates the ability to plan for appropriate referral and treatment to a tertiary center.

Manager

During the Residency, the FP Anesthesia Resident will demonstrate the necessary knowledge and skills in the following areas in order to fulfill the CanMEDS-FM role as Manager in Family Practice Anesthesia:

  • Use available resources effectively and considers alternate management options
  • Display organization of the workload effectively and efficiently. Ability to prioritize, delegate and manage simultaneous tasks
  • Function effectively in emergency situations. Shows leadership and the ability to quickly adapt to changing situations
  • Display knowledge of the principles of quality assurance and outcome measures

Health Advocate

During the Residency, the FP Anesthesia Resident will demonstrate the necessary knowledge and skills in the following areas in order to fulfill the CanMEDS-FM role as Health Advocate in Family Practice Anesthesia:

  • Provide advice and information to hospital administrators regarding compliance with National Practice Guidelines and Equipment Standards for Anaesthesia
  • Advocate for resources for improved patient care and patient safety: 
    • Through emerging medical technologies
    • In acute pain management
    • For improved anaesthesia patient safety

Scholar

During the Residency, the FP Anesthesia Resident will demonstrate the necessary knowledge and skills in the following areas in order to fulfill the CanMEDS-FM role as Scholar in Family Practice Anesthesia:

  • Develop and maintains a personal program for life-long continuing education
  • Demonstrate skill in critical appraisal of the literature and evaluation of new information and evidence.
  • Contribute whenever possible to the development, distribution and/or application of new knowledge.
  • Contribute to the learning of patients, students, and other health professionals.

Professional

During the Residency, the FP Anesthesia Resident will demonstrate the necessary knowledge and skills in the following areas in order to fulfill the CanMEDS-FM role as Professional in Family Practice Anesthesia:

  • Establish effective relationships with patients and relatives
  • Demonstrate recognition of personal limits by appropriate consultation with others when caring for the patient.
  • Exhibit appropriate professional interpersonal behaviours.
  • Demonstrate consideration of the ethical and legal aspects of patient care including respect to patient diversity (gender, religion)
  • Deal effectively with conflicts in value systems.
  • Demonstrate knowledge of chemical dependence and demonstrate ways to deal with it in self and in colleagues
  • Deliver the highest quality of care with integrity, honesty and compassion.
  • Display punctuality, reliability and preparedness
  • Demonstrate an understanding of the principles of bioethics and applies these principles in clinical situations

FP Anesthesia: Curriculum

In order for the FP Anesthesia Resident to fulfill the goals and the objectives of completing all the CanMEDS-FM roles, the FP Anesthesia Residency Program has designed a curriculum to meet these goals and objectives.

During the 52-week residency program in FP Anesthesia at the University of Toronto, the FP Anesthesia resident is required to attend didactic lectures at the site hospital. The lecture series at each site hospital is designed to meet the goals and the objectives of the FP Anesthesia resident. At Michael Garron Hospital, the lecture series is taught at 0700 Tuesdays, Thursdays and Fridays, while Wednesdays AM are Anesthesia Grand Rounds. At Mount Sinai, the lecture series are taught at 0700 Mondays to Thursdays while Fridays are Anesthesia Grand Rounds. At the Hospital for Sick Children, the lecture series are taught at 0700 Mondays to Thursdays with Fridays being Anesthesia Grand Rounds.

Michael Garron Hospital:

The lecture series is designed to ensure that each FP Anesthesia resident receives education in all of the following topics. During the resident’s three (3) month block at Michael Garron Hospital, the following lecture series is taught in order to fulfill the FP Anesthesia resident’s goals and objectives:

Anesthesia Drugs Parts 1, 2, 3
Difficult Airway
Rapid Sequence Induction
Ventilators
Diabetes and Anesthesia
Obstetrical Anesthesia
Paediatric Anesthesia
Pacemakers and Anesthesia
Cardiovascular Diseases and Anesthesia
COPD/Asthma and Anesthesia
Peri-operative Pain Management
Intraoperative Crises
Obesity and Anesthesia
Thoracic Anesthesia
Renal Diseases and Anesthesia
OR positioning
Blood Components
Liver Diseases and Anesthesia
Malignant Hyperthermia
CO2 and Anesthesia
Substance Abuse and Anesthesia
Valvular Heart Disease and Anesthesia
Anesthesia & Aortic Vascular Surgery
Congenital Heart Diseases and Anesthesia
Diseases in Pregnancy
Myotonias and Anesthesia
Procedural Sedation
Monitoring of Neuromuscular Blockade
Thyroid diseases and Anesthesia
TURP and Anesthesia
Blood Dyscrasias
Pulmonary Hypertension
PACU problems
Anesthesia and Rheumatoid Arthritis/ MSK diseases
Non-Obstetric Surgery in the Pregnant
Patient Anesthesia & Bowel Surgery
Anesthesia & Airway Surgery
Anesthesia Gas Machine
Anesthesia & Laser Surgery

Mount Sinai Hospital:

The lecture series is designed to ensure that each FP Anesthesia resident receives education in all of the following topics. During the resident’s three (3) month block at Mount Sinai Hospital, the following lecture series is taught in order to fulfill the FP Anesthesia resident’s goals and objectives:

Airway cart and equipment
Physiologic changes of pregnancy
Aseptic technique
Epidural contraindications and complications
Practical epidural anatomy
Ultrasound-guided epidurals
Cardiac arrests
Thoracic epidurals
Fluid Management
Blood Products
Anesthesia for elective
Anesthesia for emergency C/S
Epidural management
Epidural trouble-shooting
CSE – combined spinal/epidural analgesia and anesthesia
Post dural puncture headache (PDPH) and Epidural blood patch (EBP)
Unintentional dural puncture and postpartum follow-up
Postoperative pain management for C/S
Pharmacologic principles of pregnancy
Intravenous labor analgesia
Neurologic complications in obstetric anesthesia
Obstetric airway
Physiology of neuraxial anesthesia
APS/Pain management
Cardiac disease
Antepartum hemorrhage and postpartum hemorrhage
Oxytocin and related drugs
Opioids
Local anesthetics
IV hypnotics and sedatives
Inhalational agents
Neuromuscular blockers
Surgical airway
Regional anesthesia and anticoagulation
O2/CO2 physics
Pregnancy Induced Hypertension
Pregnancy and non-obstetric surgery
OR Safety
Maternal resuscitation
Malignant Hyperthermia
Amniotic fluid embolism
Morbid obesity
Myopathies

The Hospital for Sick Children:

The lecture series is designed to ensure that each FP Anesthesia resident receives education in all of the following topics. During the resident’s three (3) month block at The Hospital for Sick Children, the following lecture series is taught (either in didactic AM lectures or in the operating room) in order to fulfill the FP Anesthesia resident’s goals and objectives:

Tonsillectomies and Adenoidectomies
Obstructive Sleep Apnea
Airway/ Respiratory

  • “Nuts and bolts” - basic airway Foreign body
  • Mediastinal mass
  • URTi

Cardiac

  • Patients with congenital heart disease

Neuromuscular

  • Myopathies/ Scoliosis
  • MMR/ MH
  • Neuromonitoring
  • Cerebral Palsy

Neuro

  • ICP/ VP shunts
  • Head injury/ ICU

Neonatal

  • Premature infant
  • Ex-premature infant
  • Neonatal physiology & pharmacology
  • Neonatal abdominal emergencies
  • Cyanotic infants
  • Pyloric stenosis
  • ICU - neonate/ CDH

Pain

  • Paediatric pain service
  • Regional anesthesia

Equipment

  • Circuits
  • Difficult airway cart

Electrical Safety

  • Electric shocks: types, effects
  • Leakages and grounding
  • Isolated power
  • Electrical Diagrams Interpretation/ Flow

Gas Supplies

  • Cylinder Markings/ Construction/Reading Cylinder Safety
  • Cylinder Mixtures
  • Colour Codes
  • PISS/DISS
  • Wall Gas Supply Network

Regulators and Gauges

  • Flow
  • Pressure
  • Single/Dual Stage
  • Troubleshooting

Flowmeters and Flow Measuring Devices

  • Pressure (Bourdon tube, Diaphragm)
  • Flow (Bourdon tube, Thorpe)
  • Compensated VS Uncompensated
  • Reading Floats
  • Current Electronic Flow Transducers (Pros/Cons)

O2 Measurement Devices

  • Thermal
  • Paramagnetic
  • Servomex
  • Clark Electrode
  • Transcutaneous

Humidification

  • Vapourizeration
  • Humidification
  • Nebulization
  • Devices that Deliver Humidity

Blenders

  • Construction and Design Parameters
  • Sechrist and Bird
  • Current Dual Solenoid Control (Draeger/Siemens)

Ventilators

  • Sechrist IV 100B
  • Servo 900
  • Ventimeter

Anaesthetic Gas Machine

  • Vapourizers

Mechanical Gas Machines (Datex Ohmeda)
Others

  • Approach to difficult patient
  • Preop clinic - practical tips
  • Paediatric burns
  • Sickle cell disease
  • PALS
  • Fluids I/ II/ III
  • Paediatric sedation
  • Anesthesia resources
  • Down’s syndrome
  • Ethical dilemmas

Other topics:

Laryngospasm, Anaphylaxis, Hyperkalemia, Local anesthetic toxicity, Postop delirium, Post heart transplant, Myotonic dystrophy, Specific cardiac conditions (TOF, shunts, Fontan), Blood conservation

Patient Simulator:

During the course of the 52-week FP Anesthesia Residency, the FP Anesthesia Resident will obtain training and teaching through the Patient-Simulator. The Patient-Simulator is designed to expose the FP Anesthesia Resident to rare but life-threatening events that can occur in the peri-operative period. The Patient-Simulator will provide the opportunity for the FP Anesthesia Resident to learn some of the CanMEDS-FM roles of: Collaborator, Communicator, Manager, Medical Expert and Professional that are necessary in life- threatening situations that can occur in the peri-operative period.

Resident Projects:

During each 3-month hospital rotation (MGH, MSH and HSC), the FP Anesthesia Resident is to submit a one-page document to the Resident Coordinator/Program Director, reflecting on his/her experiences that fulfills the goals learned in the role(s) in CanMEDS-FM:

  • Communicator
  • Collaborator
  • Manager
  • Health Advocate

The one-page document is reviewed with the Resident Coordinator/Program Director in order to ensure that the FP Anesthesia Resident has fulfilled his learning of the role(s) in CanMEDS-FM.

FP Anesthesia: Wednesday Afternoon Teaching Series

From September to June each year, the FP Anesthesia resident is expected to attend the Wednesday afternoon seminar series in order to fulfill the FP Anesthesia resident’s goals and objectives:

Airway

  • Assessment of the airway
  • Management Techniques
  • Extubation and complications

Pediatric Anesthesia

  • Pre-op. Pharmacology, Physiology
  • Cardiac
  • Pain Management
  • Trauma
  • PALS

Obstetrical Anesthesia

  • Physiologic changes of pregnancy
  • Anesthesia considerations for non-obstetrical surgery in the pregnant patient
  • Pain relief in labour, Complications of pregnancy
  • Obstetrical Emergencies
  • Operative deliveries
  • Fetus and the newborn
  • Obstetrics Simulation

Pain

  • Acute and Chronic Pain Management

Central Lines

  • Practical Skills

ICU

  • Care of the critically ill patient

Regional Anesthesia

  • Neuraxial blocks
  • Perpherial nerve blocks
  • Local anesthetics – pharmaocology and choice

Trauma

  • ABCs, Securing the airway, Hypotension
  • Neck trauma, C-spine precautions, cord injury, penetrating trauma
  • Chest trauma, blunt & penetrating, aortic injuries
  • Abdominal & Pelvic trauma, compartment syndrome

POCUS Bootcamp

 

During the course of 52 weeks, residents in the FP Anesthesia Program at the University of Toronto will be exposed to a myriad of clinical operating room cases. The goal of the Program is to ensure exposure to the following anesthesia cases that are typical for a FP Anesthetist in independent practice:

  • General Surgery: such as laparoscopic cholecystectomies, bowel surgeries, breast surgeries, hernia repairs
  • Ear, Nose and Throat Surgery: such as tonsillectomies, adenoidectomies, myringotomies, thyroidectomies, sinus surgeries, middle ear surgeries
  • Gynecologic Surgery: such as D&Cs, laparoscopic pelvic surgeries, hysterectomies
  • Non-operative deliveries and Obstetrical Surgery: such as Caesarian Sections o Orthopedic Surgery: such as arthroscopies, spine surgeries, major joint replacement surgeries, fracture repair surgeries
  • Urologic Surgery: such as cystoscopies, TURP, TURBT, radical prostate surgeries, renal stone surgeries, kidney cancer surgeries
  • Plastic Surgery: such as breast reduction surgeries, carpal tunnel release surgeries, hand surgeries
  • Paediatric Surgery: such as dental surgery for caries and extractions, circumcisions, tonsillectomies, adenoidectomies, myringotomies, fracture reduction surgeries, hernia repairs
  • Procedural Sedation: such as DC Cardioversions, ECTs, colonoscopies, gastroscopies, bronchoscopies
  • Anesthesia Consultations: assessment of patients (inpatients and outpatients) with respect to optimization and/or initiating treatment and investigations if needed prior to surgery

Residents will be able to utilize the skills acquired as family physicians in communicating effectively with patients in all phases of the peri-operative period. These skills include the pre-operative work-up, intra-operative management and post-operative care. Residents will become effective patient advocates in assessing, advising and optimizing patients in anticipation of anesthesia for surgical and non-surgical procedures. Residents will be expected to continually respect boundaries that may exist. Residents will be expected to respect the different societal, religious and ethnic differences that may appear throughout their patient interactions.

Supervisors

The Program Director will be responsible for the distribution of residents to appropriate sites to ensure that the relevant knowledge, skill and experience are acquired during their 12 months of FP Anesthesia training. There will be a resident supervisor at each site who is responsible to evaluate the residents as well as ensuring that these goals and objectives are achieved. The resident supervisor will meet with the residents at the mid-term and at the end of the rotation in order to discuss the residents’ evaluations based on the CanMEDS-FM roles (Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional).

Clinical Duties and On-Call expectations

Residents will rotate through at least 4 different hospital sites. Call will vary by site and will not exceed the guidelines indicated by PAIRO. At present, call will not exceed 1 in 4. Residents in the Royal College Anesthesia Program will share call duties when both types of trainees are present. At present, PAIRO states that residents are entitled to 4 weeks of holiday per 12 months of training.

Funding & Evaluations

At present, funding for the FP Anesthesia Program at the University of Toronto will be through the Department of Family and Community Medicine or the re-entry program of the Ministry of Health and Long Term Care of Ontario.

There will be a formal written exam at the 6-month mark of training as well as an oral exam at the end of the 12 months of training. Mid-term and end of rotation evaluations will be completed by the resident supervisors using the POWER system at the University of Toronto.