Department of Anesthesiology & Perioperative Care: School of Medicine: University of California, Irvine

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The "4U" Didactic Program

UCI Anesthesiology Residency POCUS session

The UCI Anesthesiology & Perioperative Care Residency Program provides residents an innovative and comprehensive educational curriculum called “4U”. Each “U”, or “University”, represents one of the four years of anesthesiology training. Residents will progress from acquiring the fundamental knowledge needed to be a perioperative physician beginning in the fundamental clinical skills year to preparing for independent practice in the senior year.

Our interactive program provides each class a protected education day every four-week period, where residents are relieved from clinical duties in order to attend. These “4U Days” are tailored to each specific resident class and include a variety of activities including case conferences, simulation sessions, hands-on workshops and interactive didactics that are led by faculty with expertise in different anesthesia subspecialties. The 4U Days are guided by the content of the American Board of Anesthesiology (ABA), ACGME training requirements, program evaluations and milestones. The didactic days also supplement intraoperative and clinical rotation specific teaching that occurs daily. The CA-1 sessions focus on basic anesthesia, while CA-2 and CA-3 sessions focus on advanced topics with an emphasis on clinical subspecialties.

Didactic Sessions

Our residency program diversified didactic formats to not heavily rely on the traditional lectures. Each session includes a diverse platform of learning modalities which help residents prepare for the ABA Staged Exams. An annual mock Objective Structure Clinical Examination (OSCE) session has been developed to prepare CA-2 and CA-3 residents for a new component of their board certification process. Simulation sessions and workshops are an important role in resident education at UCI and have been fully integrated into the 4U Day.

Each didactic session includes:

  • Written board review
  • Oral board review
  • Objective Structure Clinical Examination (OSCE) review
  • Problem-based learning discussion
  • Point-of-Care Ultrasound (POCUS)
  • Simulation sessions and/or workshops

Additional specialty topics are included throughout the four-year training program. These include:

  • Wellness Program
  • Airway Management Series
  • Quality and patient safety
  • Leadership and diversity
  • Professional Development Series (personal finance and career building tools)

Grand Rounds

Our grand rounds presentations contain lectures that cover a wide spectrum of topics, including clinical, leadership and research expertise, that is presented by our own faculty, residents, fellows, experts from UCI Health and experts from our Visiting Professor Program. The visiting professors frequently gives an interactive lecture to residents the day before grand rounds and allows for an opportunity for residents to gain further education and networking for future career plans. A fellowship panel during the CA-2 year will give insight on how to navigate the decision for post graduate training and the fellowship application process.

Evaluations

Residents have the opportunity to provide anonymous feedback for each didactic session. Evaluations are regularly reviewed by our Curriculum Committee to ensure quality of didactic sessions and the needs of the learners are met.

Fundamental Clinical Skills of Education (PGY-1)

Residents in their first year of training have education days every fourth Thursday of the month. Areas of focus include anatomy, monitors, equipment, physiology, pharmacology and pathophysiology of disease states as it relates to anesthesia. Reading assignments from Basics of Anesthesia by Ronald D. Miller, corresponds to session topics. Case discussions that integrate basic knowledge into clinical context aim to make learning engaging and interactive. Incorporating a structured learning program in the PGY-1 year also gives residents an opportunity to bond with fellow residents and faculty early on during training.

As part of the Anesthesia Clinical Essentials program, PGY-1 residents are immersed in a paradigm that allows them to have one day per month in the operating room with a subsequent structured didactic curriculum. PGY-1 residents rotate as a class onto anesthesiology for a four-week rotation of Anesthesia Bootcamp. This provides a smooth transition to clinical anesthesia by emphasizing the basics of anesthesia, patient safety and system-based practice. PGY-1 residents are paired one-on-one with a faculty or senior resident for the first week of anesthesiology.

Clinical Anesthesia Years (CA-1, CA-2, CA-3)

Residents in their clinical anesthesia years have education days on the second through fourth Wednesday of each month, alternating between each resident class. Each session is devoted to a specific specialty and is tailored to the class level. Every resident is assigned a faculty mentor to provide guidance throughout the residency training program.

Examinations

All anesthesia residents are expected to take the American Board of Anesthesiology In-Training Exam (ABA ITE) each Spring. Clinical Anesthesia Year residents are expected to take the ABA BASIC at the end of the CA-1 year, the Anesthesia Knowledge Test (AKT) at one, six and 24 months of training and mock oral board exams throughout the year. A senior ABA Board Examiner conducts regular mock oral exams during the CA-3 sessions.

Anesthesia Clinical Essentials

The Anesthesia Clinical Essentials sessions provide PGY-1 residents with an early opportunity to gain foundational medical knowledge and skills in preparation for clinical anesthesia. PGY-1 residents are immersed in an environment that allows them to have one day per month in the operating room with a subsequent structured didactic curriculum.

The sessions will provide exposure to fundamental skills such as:

  • Preoperative assessment
  • Operating Room (OR) set up
  • Communications in the OR
  • Drug administration
  • Airway management
  • IV insertion
  • Physiologic monitoring
  • Critical event recognition
  • Sedation
  • Pain management

Traditionally, PGY-1 residents have limited exposure to the OR environment with acclimation primarily reserved for the clinical anesthesia training years. Providing an augmented OR experience in the early years, residents are able to transition to their clinical anesthesia year with ease and decrease distress. The Anesthesia Clinical Essentials curriculum will maintain intern engagement and foster a stronger clinical foundation to the clinical anesthesia years of residency.

Airway Management Series

Airway management skills are a critical competency for anesthesiologists. Adverse events associated with airway management are among the leading causes of anesthesia related mortality and morbidity and most adverse events are considered preventable.

Residents will participate in a 10-part interactive and multipart airway management series that is integrated into the 4U Didactic Program. Basic and advanced airway management components will provide residents with the background of medical knowledge, skills, and hands-on dexterity needed to confidently manage diverse and challenging scenarios of airway management.

Leadership Development

This new four-year curriculum is designed to help residents learn the fundamental skills and knowledge to become an effective leader. Through assigned reading, self-reflection and small group discussions, residents will understand their strengths and weakness as a leader. This leadership development curriculum will help residents learn about conflict management styles, emotional intelligence, principles of teamwork and performance improvement.

Mock Objective Structure Clinical Examination (OSCE)

Our residents each participate in an annual mock Objective Structure Clinical Examination (OSCE). The session has been developed to closely mirror the actual board certification exam that will occur in Raleigh, North Carolina on the same day as the Oral Board Examination. Residents cycle through nine, eight-minute testing stations that focus on any of these skill sets:

  • Informed consent
  • Treatment options
  • Peri-procedural complications
  • Ethical issues
  • Communication with other professionals
  • Practice-based learning and improvement
  • Interpretation of monitors
  • Interpretation of echocardiograms
  • Application of ultrasonography

The mock OSCEs are based on the ABA Content Outline and include standardized patients, ultrasound models, simulated exam rooms and monitors. Standardized checklists are used to evaluate residents on communication and professionalism, as well as understanding and application of medical knowledge.

Point-of-Care Ultrasound (POCUS)

Point-of-Care Ultrasound (POCUS) has been an expanding part of perioperative care and has become a large focus in anesthesia residency training. An integrated POCUS is included into the “4U” Didactic Program with six sessions per class per year. The sessions use portable Sonosite iViz ultrasound machines to gain hands-on training with live models. The goal is for residents to bring POCUS into a daily practice by gaining more exposure and experience with this technique.

PGY-1 residents have a two-week ultrasound rotation that teaches the basics of POCUS and allows for early exposure to the ultrasound curriculum to form the basis for the workshops in the clinical anesthesia years.

Simulation Curriculum

Simulation is an important part of resident education and is integrated throughout the course of residency training. It provides a unique learning environment where residents have the opportunity to practice the management of common critical events and rare anesthetic crises in a controlled setting and supportive learning environment. A particular emphasis is placed on developing skills in leadership, communication and critical decision-making in a variety of clinical situations, as the SimMan 3G is mobile, which includes multidisciplinary team-based sessions in the hospital itself. Residents may run to an airway emergency while carrying the code pager and become involved in a fully immersive simulation. At the end of each simulation session, residents have an open and supportive debrief where more learning occurs.

Fundamental Clinical Skills of Education (PGY-1)

  • Anesthesia Crisis Resource Management

Clinical Anesthesia Years (CA-1, CA-2, CA-3)

Simulation sessions are scheduled throughout the year, covering a wide variety of topics and subspecialty scenarios for each clinical anesthesia year. Four simulation sessions are led by a simulation trained faculty as well as a content expert.

The First Month Orientation for the CA-1 year includes afternoon didactics following mornings in the operating room. There are a number of simulation sessions and topics emphasized during this introductory series, which includes:

  • Anesthesia machine, monitors and equipment
  • Induction and airway management
  • Hemodynamic changes during anesthesia
  • Emergence from anesthesia and immediate post-anesthetic care issues
  • Hypoxia, hypercarbia and increased peak airway pressure
  • Hands-on workshops (airway management, central and arterial lines, spinals, epidurals and ultrasound-guided regional nerve blocks)

Additionally, the CA-1 year are exposed to TEE using the HeartWorks TEE Simulator. During the CA-2 and CA-3 year, residents participate in a series of TEE simulation workshops ending in a practical examination where each resident must demonstrate general competency with the TEE examination.

Wellness Program

Mindfulness-Based Stress Reduction (MBSR) and Peer Support Program

In recognition of the stressors and demands associated with residency training, our goal on wellness for the UCI Anesthesiology Residency Program is to support residents by fostering a culture that harnesses strength and support from peers, concern for others as colleagues, self-care and understanding one’s emotions. This is important particularly in a medical specialty that has been known for the focus on attention to detail, procedures skills, independence and maintaining composure during stressful situations.

Modeled after Jon Kabat-Zinn’s work on mindfulness-based stress reduction, our wellness program is incorporated throughout the Clinical Anesthesia Years and utilizes a curriculum of experiential exercises and didactics to provide a safe place for residents to receive support during what can be a challenging time in their medical education.

Workshops

Active learning is far more effective than passive, stand and delivers lecture formats. For that reason, we incorporate multiple hands-on workshops into the curriculum.

Fundamental Clinical Skills of Education Year (PGY-1)

  • Arterial line workshop
  • EKG workshop
  • Research workshop
  • Basic monitors and basic airway workshop
  • Advanced monitors workshop

CA-1 Year

  • Adult airway workshop
  • Pediatric airway workshop

CA-2 Year

  • Cardiovascular workshop
  • Neuraxial (epidural/spinal) workshop
  • Pediatric airway workshop
  • Regional anesthesia workshop
  • Advanced monitors workshop
  • Advanced airway workshop

Cardiovascular Workshops

The cardiovascular workshop is a review session designed for CA-3 residents preparing to take their Boards. The workshop focuses on TEE, CCO, SVV and Goal-Directed Therapy, as well as Swan-Ganz monitors, interpreting pressure waveforms and common cardiac diseases.

Airway Workshops

The airway workshops include instruction and practice with the following:

  • Fast track LMA
  • Glidescope
  • Adult and pediatric fiberoptic scope
  • Double lumen tube and bronchial blocker
  • Retrograde intubation
  • Cricothyrotomy and transtracheal jet ventilation
  • Combitube
  • Exchange catheters

Research Workshop

The research workshop will give residents formal education from the medical sciences librarian, research support staff and Vice Chair for Research on effective literature searches, evidence-based medicine, basic statistics, IRB applications process and current basic and clinical research opportunities. Residents also receive a scheduled tour of the basic science labs on the UCI Campus.

Regional Workshop

The regional workshop is lead by faculty to give hands-on training to residents on common regional anesthesia techniques. Using patient models, landmark and ultrasound-guided techniques are reviewed during this workshop. The workshop will help reinforce the knowledge and skills acquired during the regional anesthesia rotation.