Ortho-joint Competencies

The objective of the rotation is to train you in the anesthetic techniques for a variety of orthopedic surgical procedures, focusing on total joint replacements and joint revision surgery. At the end of the rotation, you should be capable of selecting and executing an appropriate anesthetic plan that is best given the patient’s comorbidities as well as the anticipated surgical issues. Unique to this MSD rotation, you will have ample opportunity to perform spinal anesthetics.

Attendance at the weekly lecture as well as Monday morning Grand Rounds is expected. It is also the expectation of the department that you will read outside of clinical work independently.

Feedback via a daily debriefing at the end of the workday is expected. At the end of the rotation, the rotation director with input from other faculty will evaluate via MedHub the resident in all 6 core competencies: Medical knowledge, Patient care, Interpersonal communication skills, Professionalism, Practiced based learning and Systems based practice.

ACGME Competency and Milestone-based Curriculum: Goals and Objectives - ACGME Milestones (Link)

Goal 1. MEDICAL KNOWLEDGE: Demonstrate knowledge of biomedical, epidemiological, and social behavior sciences as outlined in the American Board of Anesthesiology Content Outline related to patients submitted to total joint surgery. At the end of rotation residents are expected to:

Describe the proper positioning of orthopedic patients for specific procedures
Describe the indications and contraindications to spinal anesthesia
Understand the utility of peripheral nerve blocks/catheters in TKA & THA patients
Understand the risk of local anesthetic toxicity and show awareness of summative local anesthetic doses patients are receiving – including peripheral nerve blocks, LIA and IV local anesthetics
Understand the potential surgical complications associated with joint replacement, including implications of pneumatic tourniquets, methylmethacrylate, DVT, fat embolism and infection
Understand the pathophysiology of delirium and POCD in the elderly
Demonstrate knowledge of ASRA guidelines for regional anesthesia and anticoagulants
Understand factors that contribute to increased blood loss in joint replacement and revision cases
Demonstrate knowledge about methods of intraoperative blood conservation (including controlled hypotension) and understand its limitations and when it should be avoided

Goal 2: PATIENT CARE: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. At the end of rotation residents are expected to:

Demonstrate preanesthetic evaluation, assessment, and preparation in common coexisting diseases seen in joint replacement patients including rheumatoid arthritis
Design an anesthetic plan to deliver appropriate, safe anesthesia for primary and revision THA and TKA
Be able to identify chronic pain patients and manage perioperative pain for total joint surgery
Demonstrate appropriate intraoperative management of common complications in patients undergoing total joint surgery such as hypo/hypertension, hypoxemia, airway obstruction, excessive blood loss
Perform airway management in patients undergoing total joint surgery
1. - General anesthesia – intubation, LMA placement, AFOI (rheumatoid patients)
  - MAC airway management for spinal/MAC cases
Demonstrate the use and interpretation of basic monitoring and equipment
Technical skills – perform a spinal anesthetic with minimal faculty intervention

Goal 3: INTERPERSONAL AND COMMUNICATION SKILLS: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. At the end of rotation residents are expected to:

Effectively explain and consent a patient for spinal anesthesia
Communicate with and calm patients undergoing surgery under regional anesthesia
Communication with surgical colleagues and OR staff
Coordinate team-based care in orthopedic joint surgery (regional anesthesia, pain service etc)

Goal 4: SYSTEM-BASED PRACTICE: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. At the end of rotation residents are expect to:

Practice cost-effective healthcare and resource allocations without compromise of patient care
Describe Stanford Anesthesia and Pain Service guidelines for joint replacement surgery, understanding the benefits and limitations of these guidelines
Demonstrate efficiency in your workflow and anesthetic without compromise of patient care
Understand how efficiency is valued and even required in most anesthesia practices

Goal 5: PROFESSIONALISM: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. At the end of rotation residents are expected to:

Responsibility to patients, families and society
Honesty, integrity, and ethical behavior
Commitment to institution, department and colleagues
Seek feedback and incorporate suggestions into practice
Demonstrate responsibility to maintain personal emotional, physical, and mental health

Goal 6: PRACTICE BASED LEARNING AND IMPROVEMENT: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. At the end of rotation residents are expected to:

Incorporate quality improvement and safety initiatives into personal practice
Self-identify areas that the resident needs to improve his/her own practice
Demonstrate evidence of self-directed learning
Educate patients, families, students, other residents, and other health professionals