CURRICULUM / STATUTES & REGULATIONS FOR 5 YEARS DEGREE PROGRAMME IN ANAESTHESIOLOGY (MS Anaesthesiology) UNIVERSITY OF HEALTH SCIENCES, LAHORE Curriculum/Statutes & Regulations -MS Anaesthesiology STATUTES 1. Nomenclature Of The Proposed Course The name of degree programme shall be MS Anaesthesiology. This name is well recognized and established for the last many decades worldwide. 2. Course Title: MS Anaesthesiology 3. Training Centers Departments of Anaesthesiology (accredited by UHS) in affiliated institutes of University of Health Sciences Lahore. 4. Duration of Course The duration of MS Anaesthesiology course shall be five (5) years (first year in Part I, first two years in Part II and next three years in Part III) with structured training in a recognized department under the guidance of an approved supervisor. The course is structured in three parts: Part I is structured for the 1st calendar year. The candidate shall undertake didactic training in Basic Medical Sciences, Physics & Equipment, Behavioural Sciences and Biostatistics & Research Methodology. At the end of first year the examination shall be held in above mentioned disciplines. The clinical training in fundamental concepts of Surgery shall start from the 1st day of enrollment. Part II is structured for the 1st and 2nd calendar year. The candidate shall undertake clinical training in fundamental concepts of Surgery. At the end of 2nd year, the examination shall be held in fundamental concepts of Surgery. The clinical training in Anaesthesiology shall start from 3rd year onwards in the in recognized institutions. Part III is structured for 3rd, 4th and 5th calendar years in MS Anaesthesiology. It has two components; Clinical and Research. The candidate shall undergo clinical training to achieve educational objectives of MS Anaesthesiology (knowledge & skills) along with rotation in relevant fields. Over the five years 2 Curriculum/Statutes & Regulations -MS Anaesthesiology duration of the course, candidate will spend total time equivalent to one calendar year for research during the training. Research can be done as one block in 5th year of training or it can be done in the form of regular periodic rotations over five years as long as total research time is equivalent to one calendar year. 5. Admission Criteria I. For admission in MS Anaesthesiology course, the candidate shall be required to have: • MBBS degree • Completed one year House Job • One year experience in Anaesthesiology / General surgery /Allied surgical discipline in the given order of preference • Registration with PMDC • Passed Entry Test conducted by the University & aptitude interview by the Institute concerned • Having up to the mark credentials as per UHS rules (no. of attempts in each professional, any gold medals or distinctions, relevant work experience, Rural/ Army services, research experience in a recognized institution, any research article published in a National or International Journal) may also be considered on case to case basis. II. Exemptions: A candidate holding FCPS/MRCS/Diplomate/equivalent qualification in General Surgery shall be exempted from Part-I & Part-II Examinations and shall be directly admitted to Part-III Examinations, subject to fulfillment of requirements for the examination. 6. Registration And Enrollment • Total number of students enrolled for the course must not exceed 2 per supervisor/year. • The maximum number of trainees that can be attached with a supervisor at a given point of time (inclusive of trainees in all years/phases of MS training), must not exceed 6. 3 Curriculum/Statutes & Regulations -MS Anaesthesiology • Beds to trainee ratio at the approved teaching site shall be at least 5 beds per trainee. • The University will approve supervisors for MS courses. • Candidates selected for the courses after their enrollment at the relevant institutions shall be registered with UHS as per prescribed Registration Regulation. 7. Accreditation Related Issues of The Institution A. Faculty Properly qualified teaching staff in accordance with the requirements of Pakistan Medical and Dental Council (PMDC) B. Adequate Space Including class-rooms (with audiovisual aids), demonstration rooms, computer lab and clinical pathology lab etc. C. Library Departmental library should have latest editions of recommended books, reference books and latest journals (National and International). (cid:131) Accreditation of Anaesthesiology training program can be suspended on temporary or permanent basis by the University, if the program does not comply with requirements for residents training as laid out in this curriculum. (cid:131) Program should be presented to the University along with a plan for implementation of curriculum for training of residents. (cid:131) Programs should have documentation of residents training activities and evaluation on monthly basis. (cid:131) To ensure a uniform and standardized quality of training and availability of the training facilities, the University reserves the right to make surprise visits of the training program for monitoring purposes and may take appropriate action if deemed necessary. 4 Curriculum/Statutes & Regulations -MS Anaesthesiology AIMS AND OBJECTIVES OF THE COURSE AIM The aim of five years MS programme in Anaesthesiology is to train residents to acquire the competency of a specialist in the field so that they can become good teachers, researchers and clinicians in their specialty after completion of their training. GENERAL OBJECTIVES MS Anaesthesiology training should enable a student to: 1. Access and apply relevant knowledge to clinical practice: (cid:131) Maintain currency of knowledge (cid:131) Apply scientific knowledge in practice (cid:131) Appropriate to patient need and context (cid:131) Critically evaluate new technology 2. Safely and effectively performs appropriate surgical procedures: (cid:131) Consistently demonstrate sound surgical skills (cid:131) Demonstrate procedural knowledge and technical skill at a level appropriate to the level of training (cid:131) Demonstrate manual dexterity required to carry out procedures (cid:131) Adapt their skills in the context of each patient and procedure (cid:131) Maintain and acquire new skills (cid:131) Approach and carries out procedures with due attention to safety of patient, self and others (cid:131) Critically analyze their own clinical performance for continuous improvement 3. Design and implement effective management plans: (cid:131) Recognize the clinical features, accurately diagnose and manage anaesthesia related problems (cid:131) Formulate a well-reasoned provisional diagnosis and management plan based on a thorough history and examination (cid:131) Formulate a differential diagnosis based on investigative findings 5 Curriculum/Statutes & Regulations -MS Anaesthesiology (cid:131) Manage patients in ways that demonstrate sensitivity to their physical, social, cultural and psychological needs (cid:131) Recognize disorders of the human body and differentiate those amenable to surgical treatment (cid:131) Effectively manage the care of patients with trauma including multiple system trauma (cid:131) Effectively recognize and manage complications (cid:131) Accurately identify the benefits, risks and mechanisms of action of current and evolving treatment modalities (cid:131) Indicate alternatives in the process of interpreting investigations and in decision-making (cid:131) Manage complexity and uncertainty (cid:131) Consider all issues relevant to the patient (cid:131) Identify risk (cid:131) Assess and implement a risk management plan (cid:131) Critically evaluate and integrate new technologies and techniques. 4. Organize diagnostic testing, imaging and consultation as needed: (cid:131) Select medically appropriate investigative tools and monitoring techniques in a cost-effective and useful manner (cid:131) Appraise and interpret appropriate diagnostic imaging and investigations according to patients' needs (cid:131) Critically evaluates the advantages and disadvantages of different investigative modalities 5. Communicate effectively: (cid:131) Communicate appropriate information to patients (and their family) about procedures, potentialities and risks associated with different anaesthesias in ways that encourage their participation in informed decision making (cid:131) Communicate with the patient (and their family) the treatment options including benefits and risks of each (cid:131) Communicate with and co-ordinate health management teams to achieve an optimal surgical environment (cid:131) Initiate the resolution of misunderstandings or disputes 6 Curriculum/Statutes & Regulations -MS Anaesthesiology (cid:131) Modify communication to accommodate cultural and linguistic sensitivities of the patient 6. Recognize the value of knowledge and research and its application to clinical practice: (cid:131) Assume responsibility for self-directed learning (cid:131) Critically appraise new trends in Anaesthesiology (cid:131) Facilitate the learning of others. 7. Appreciate ethical issues associated with Anaesthesiology: (cid:131) Consistently apply ethical principles (cid:131) Identify ethical expectations that impact on medico-legal issues (cid:131) Recognize the current legal aspects of informed consent and confidentiality (cid:131) Be accountable for the management of their patients. 8. Professionalism by: (cid:131) Employing a critically reflective approach to Anaesthesiology (cid:131) Adhering with current regulations concerning workplace harassment (cid:131) Regularly carrying out self and peer reviewed audit (cid:131) Acknowledging and have insight into their own limitations (cid:131) Acknowledging and learning from mistakes 9. Work in collaboration with members of an interdisciplinary team where appropriate: (cid:131) Collaborate with other professionals in the selection and use of various types of treatments assessing and weighing the indications and contraindications associated with each type (cid:131) Develop a care plan for a patient in collaboration with members of an interdisciplinary team (cid:131) Employ a consultative approach with colleagues and other professionals (cid:131) Recognize the need to refer patients to other professionals. 10. Management and Leadership (cid:131) Effective use of resources to balance patient care and system resources (cid:131) Identify and differentiate between system resources and patient needs 7 Curriculum/Statutes & Regulations -MS Anaesthesiology (cid:131) Prioritize needs and demands dealing with limited system resources. (cid:131) Manage and lead clinical teams (cid:131) Recognize the importance of different types of expertise which contribute to the effective functioning of clinical team. (cid:131) Maintain clinically relevant and accurate contemporaneous records 11. Health advocacy: (cid:131) Promote health maintenance of patients (cid:131) Advocate for appropriate health resource allocation (cid:131) Promote health maintenance of colleagues and self scholar and teacher 8 Curriculum/Statutes & Regulations -MS Anaesthesiology SPECIFIC LEARNING OUTCOMES On completion of the training programme, Anaesthesiology trainees pursuing an academic pathway will be expected to have demonstrated competence in all aspects of the published syllabus. The specific training component would be targeted for establishing clearly defined standards of knowledge and skills required to practice Anaesthesiology at secondary and tertiary care level with proficiency in the Basic and applied clinical sciences, Basic anaesthesiological care, intensive care units, Emergency (A&E) medicine and Complementary surgical disciplines. Anaesthetic equipment and safety (cid:131) Physical principles underlying the function of the anaesthetic machine, pressure regulators, flow meters, vaporizers, breathing systems. (cid:131) Absorption of carbon dioxide (cid:131) Principles of lung ventilators, disconnection monitors (cid:131) Manufacture and storage of oxygen, nitrous oxide, carbon dioxide, compressed air. (cid:131) Pipeline and suction systems, gas cylinders (cid:131) Humidification devices (cid:131) Minimum monitoring requirements (cid:131) Environmental control of the operating theatre including scavenging systems for waste anaesthetic gases and vapours (cid:131) Pre-use checks of anaesthetic machine, breathing systems and monitoring apparatus (cid:131) Anaesthetic records and critical incidents (cid:131) Function and use of related anaesthetic and resuscitation equipment including that used for regional anaesthesia ; Airways, tracheal tubes, tracheostomy tubes, laryngeal masks, oxygen therapy equipment, self-inflating bags, spinal and epidural needles, intravenous cannulae and transfusion devices (cid:131) Sterilization and cleaning of equipment 9 Curriculum/Statutes & Regulations -MS Anaesthesiology Preoperative assessment (cid:131) Implications for anaesthesia of more common medical conditions. In particular, respiratory diseases (e.g. asthma, chronic obstructive airway disease), cardiac disease (e.g. angina pectoris, valvular disease, myocardial infarction, pacemakers, arrhythmias), vascular disease (e.g. hypertension), sickle cell disease and anaemias, rheumatoid arthritis, renal dysfunction and insufficiency, plasma electrolyte disturbance (e.g. hyper- and hypokalaemia), diabetes mellitus, liver disease (cid:131) Implications for anaesthesia of more common surgical conditions, trauma, intestinal obstruction and acute abdominal emergencies (cid:131) ASA classification and other pre-anaesthetic scoring systems such as Glasgow Coma Scale (cid:131) Interpretation of relevant preoperative investigations, plasma electrolytes, haematology, disturbances of acid/base status, ECG, X- rays, pulmonary function tests and clotting abnormalities (cid:131) Preoperative assessment of a patient of any age (excluding neonates) for elective or emergency surgery (cid:131) Restriction of food and fluid by mouth, cessation of smoking, correction of dehydration (cid:131) Assessment of difficulty of tracheal intubation (cid:131) Precautions in the management of the infective patient (e.g. hepatitis sero- positive or HIV positive) (cid:131) Anaesthetic implications of current drug therapy such as beta blockers, antihypertensive drugs, tricyclic antidepressant agents and monoamine oxidase inhibitors, insulin, anti-diabetic drugs, anticoagulants, contraceptives (cid:131) Assessment of postoperative analgesic needs Premedication (cid:131) Rationale for premedicant drugs. (cid:131) Choice of drugs, advantages and disadvantages (cid:131) Induction (cid:131) Intravenous and inhalational induction of anaesthesia; advantages and disadvantages; techniques 10