POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO, SRI LANKA PROSPECTUS BOARD CERTIFICATION IN ANAESTHESIOLOGY WITH A SPECIAL INTEREST IN TRANSPLANT ANAESTHESIOLOGY AND CRITICAL CARE (To be effective from the year 2018) BOARD OF STUDY IN ANAESTHESIOLOGY Copyright © 2018 by Postgraduate Institute of Medicine, University of Colombo, 160, Prof. Nandadasa Kodagoda Mawatha, Colombo 7, Sri Lanka. All rights reserved. This course document is the intellectual property of the Postgraduate Institute of Medicine, University of Colombo. No part of this document may be copied, reproduced or transmitted in any form by any means without the prior written permission of the Postgraduate Institute of Medicine, University of Colombo. Postgraduate Institute of Medicine – University of Colombo Contents 1. BACKGROUND ................................................................................................................................. 2 2. ELIGIBILITY FOR ENTRY INTO TRAINING PROGRAMMEME ............................................................ 2 3. SELECTION PROCESS ....................................................................................................................... 2 4. NUMBER TO BE SELECTED FOR TRAINING ...................................................................................... 3 5. AIMS, LEARNING OBJECTIVES, AND CONTENT AREAS .................................................................... 3 6. STRUCTURE OF TRAINING PROGRAMME ....................................................................................... 4 7. LEARNING ACTIVITIES ..................................................................................................................... 5 8. TRAINING PORTFOLIO ..................................................................................................................... 6 9. TRAINERS AND TRAINING UNITS .................................................................................................... 6 10. MONITORING PROGRESS ................................................................................................................ 6 11. ELIGIBILITY FOR PRE-BOARD CERTIFICATION ASSESSMENT ........................................................... 7 12. FORMAT OF PRE-BOARD CERTIFICATION ASSESSMENT (PBCA) ..................................................... 7 13. BOARD CERTIFICATION ................................................................................................................... 8 14. RECOMMENDED READING – ANNEXURE 13 .................................................................................. 8 15. CURRICULUM DEVELOPMENT COMMITTEE ................................................................................... 8 ANNEXURE 1 - LEARNING OUTCOMES AND COMPETENCIES ................................................................. 9 ANNEXURE 2 - FORMAT OF DETAILED PROJECT PROPOSAL ................................................................. 17 ANNEXURE 3 - FORMAT OF RESEARCH REPORT ................................................................................... 18 ANNEXURE 4: TRAINING PORTFOLIO AND TRAINING PORTFOLIO ASSESSMENT ................................ 22 ANNEXURE 5 - ANAESTHETIC LIST MANAGEMENT ASSESSMENT TOOL ............................................... 24 ANNEXURE 6 - DIRECT OBSERVATION OF PROCEDURAL SKILLS (DOPS) ASSESSMENT FORM ............. 25 ANNEXURE 7 - CLINICAL CASE DISCUSSION – CRITICAL CARE ASSESSMENT FORM ............................. 27 ANNEXURE 8 - ANAESTHESIA CLINICAL PRACTICE ASSESSMENT FORM ............................................... 29 ANNEXURE 9 - CASE BASED DISCUSSION [CBD] ASSESSMENT FORM .................................................. 32 ANNEXURE 10 - ASSESSMENT FORM FOR TRAINERS ............................................................................ 33 ANNEXURE 11 - REFLECTIVE PRACTICE GUIDELINE .............................................................................. 35 ANNEXURE 12 - MARKING SCHEME FOR THE PRE BOARD CERTIFICATION ASSESSMENT ................... 36 ANNEXURE 13 - RECOMMENDED READING MATERIALS ...................................................................... 37 Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 1 Postgraduate Institute of Medicine – University of Colombo This prospectus is made under the provisions of the Universities Act, the Postgraduate Institute of Medicine Ordinance, and the General By-Laws: No. 1 of 2016 and By-Laws No. 2 of 2016 for Degree of Doctor of Medicine (MD) and Board Certification as a Specialist. 1. BACKGROUND A surge in the number of patients with end stage organ failure in Sri Lanka has resulted in a dramatic rise in the demand for organ transplant. Perioperative care is an important determinant of outcome for the recipient and the donor in the case of live donor transplantation. The programme leading to Board certification in Anaesthesiology with a special interest in Anaesthesia and Critical care for organ transplantation is intended to produce practitioners capable of providing care of the highest quality. Due to the complexity of perioperative issues related to ‘end stage’ organ failure, optimizing donor organs, transplant surgery, postoperative complications and immune suppression, a structured training with exposure to the ‘state of the art’ is essential. This is to be fulfilled by the establishment of an area of Special Interest in Anaesthesia and Critical care for organ transplantation. The future Specialist Anaesthesiologist with a special interest in Anaesthesia and Critical care for organ transplantation will be a key stakeholder in organ transplant programmes and will play a major role in improving outcomes. This programme is intended to allow trainees to acquire the skills, attitudes and knowledge required to function as a competent specialist Anaesthesiologist providing perioperative care of the highest quality to organ donors and recipients undergoing organ transplantation. The trainees are expected to undertake future leadership roles in managing transplant programmes and in capacity building in Transplant Anaesthesia and Critical care to ensure sustained growth of this field to meet national requirements. 2. ELIGIBILITY FOR ENTRY INTO TRAINING PROGRAMMEME a) Passed the MD in Anaesthesiology examination conducted by the Postgraduate Institute of Medicine, University of Colombo And b) The trainee should not be board certified by the PGIM in any other specialty or subspecialty 3. SELECTION PROCESS Order of merit in the MD (Anaesthesiology) examination will be taken into consideration when selecting trainees. Due to the paucity of training opportunities, the trainees will be given the option of declaring the special interest in Transplant Anaesthesia and Critical care at any point of training up to the end of the initial six months of overseas training. Based on the above, if a trainee opts for special training after completion of 12 months of local training, the trainee will be required to complete the stipulated six-month period of local training in Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 2 Postgraduate Institute of Medicine – University of Colombo order to be eligible to apply for Board Certification in Anaesthesiology with a Special Interest in Anaesthesia and Critical care for Transplantation. 4. NUMBER TO BE SELECTED FOR TRAINING The number of candidates to be selected will be predetermined by the Board of Study in Anaesthesiology and Board of Management in consultation with the Ministry of Health. Available training opportunities will be indicated by the PGIM in the public circular for the MD Anaesthesiology examination. In case the specified number is not selected, trainees will have the option of declaring the special interest on completion of the initial six months of overseas training. The merit position and the date of declaration of interest will be considered when trainees exercise this option. 5. AIMS, LEARNING OBJECTIVES, AND CONTENT AREAS A. Aims The principal aims of the post MD Anesthesiology training programme leading to Board certification in Anaesthesiology with a Special Interest in Anaesthesia and Critical care for organ transplantation are for the trainee to: 1. Achieve mastery in this specific area of special interest of Anaesthesia and Critical care for organ transplantation 2. Be proficient in non-clinical skills needed for consultant practice B. Learning objectives In order to achieve these aims the trainee is expected to fulfill the following objectives. 1. Gain experience required to become technically competent in the practice of anaesthesia and perioperative care for organ transplantation and to master the underlying analytical and clinical principles of transplant anaesthesia and critical care 2. Achieve competence in communication and teaching skills necessary for effective practice 3. Acquire management skills to lead a center/department providing an effective service 4. Gain experience in the design and conduct of research and development projects and in critical assessment of published work 5. Develop a framework for continued professional development (CPD) including life-long habits of reading, reviewing literature, consultation with colleagues, attendance at scientific meetings and presentation of scientific work 6. Gain experience in clinical governance, benchmarking and audit through comparison of practice with established standards of care 7. Cultivate personal virtues and traits of professionalism such as honesty, integrity, responsibility, and accountability to practice as professionals in the field 8. Be conversant in the areas of law, medical ethics and human rights in relation to transplant medicine 9. Acquire the skills of leadership and management to lead teams carrying out organ transplantation 10. Experience the role of ‘clinical governance’ and “institutional accountability” and responsibility for continuously “improving the quality’ of their services and safeguarding high ‘standards of care’ by striving for excellence in clinical care Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 3 Postgraduate Institute of Medicine – University of Colombo 11. Inculcate the value of accountability, quality assurance and improvement, clinical audit, evidence-based practice, clinical standards and guidelines and risk management 12. Network, establish links and collaborate with experts in the field of organ transplantation internationally C. Content areas Trainees are expected to display a thorough knowledge and expertise in the following broad areas; a. Pathophysiology and management of end stage organ disease b. Risk stratification and optimization of recipients c. Criteria for selection of candidates for organ transplantation d. Ethics and medico-legal issues e. Anaesthesia for the organ donor and recipient f. Perioperative, multi-disciplinary care including organ support g. Immune suppression and associated issues h. End of life care i. Setting up a transplant programme j. Communication with family, transplant teams, care givers and administrators k. Continuous professional development and evidence based medicine l. Research, benchmarking and quality assurance m. Use of information technology n. Undergraduate and postgraduate teaching Details of learning objectives, content areas, and competencies are given in Annexure 1. 6. STRUCTURE OF TRAINING PROGRAMME Training period The post MD training consists of full time ‘Hands on training’ in anaesthesia and critical care for a minimum period of 12 months in Sri Lanka and 12 months at an overseas training centers accredited by the Board of study in Anaesthesiology. During the local training period, 6 months should be spent under recognized trainers in training centers where organ transplantation is carried out. During overseas training, 6 months should be spent at a training center where organ transplantation is carried out. This period of specialized training should include a minimum of 6 months each of anaesthesia and critical care. The prospectus indicates the minimum requirements of training. The trainees must proactively widen the scope of the training in line with the objectives. The 12 months of local training shall include a) Participation in multidisciplinary team meetings on perioperative care of the organ donor, harvesting of organs and transplantation. b) Attendance of at least one regional/ international meeting on transplantation annually. c) Organization of transplant related teaching programmes for junior trainees, nurses and ancillary staff Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 4 Postgraduate Institute of Medicine – University of Colombo d) An optional fellowship at a regional center of excellence in transplantation arranged in consultation with the Supervising consultant with the approval of the Board of study in Anaesthesiology. Training centers for the six months of specialized local training a) Two (2) months at North Colombo Teaching Hospital, Ragama b) Two (2) months at National Hospital of Sri Lanka c) One (1) month at Teaching Hospital, Kandy d) One (1) month at Teaching Hospital, Peradeniya With the concurrence of the trainer, the trainees should make use of training opportunities outside of the center whenever they become available. Training centers for the remaining six months of local training a) Three (3) months of Medical/ Surgical/ Paediatric surgical critical care at a teaching hospital b) Two (2) months of General Anaesthesia at a teaching hospital c) One (1) month of Medicine – including a combination of two of the following specialties: nephrology, hepatology, cardiology, pulmonology, transfusion medicine at a teaching hospital. 7. LEARNING ACTIVITIES 7.1. At the Pre-board certification assessment, the trainees are expected to produce proof of, • Certification in Advanced life support • Certification in Advanced trauma life support • Certification in ultrasound in anaesthesia and critical care • Certification in advanced airway management • Competence in transesophageal echocardiography • Competence in techniques of medical education • Competence in medical statistics • Competence in information technology • Understanding of medical ethics and professionalism • Maintenance of a training portfolio • Conduct of a research project 7.2. RESEARCH AND PUBLICATIONS: The trainee is expected to a. Initiate and complete a research project. The research should be in an area directly related to transplant anaesthesia or Critical care (See Annexure 2 and Annexure 3) b. Submit a research report c. Submit proof of at least one publication in a peer reviewed journal as the principal author of research conducted in a related field during the period of advanced training d. Submit proof of a minimum of one oral/ poster presentation in a transplant related area during the period of advanced training Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 5 Postgraduate Institute of Medicine – University of Colombo 8. TRAINING PORTFOLIO The training portfolio should encompass all of the following learning outcomes and contain evidence of achievement of these outcomes by the trainee. (Details are given in Annexure 4) i. Subject expertise ii. Teaching iii. Research and publications iv. Ethics and medico-legal issues v. Information technology vi. Life-long learning vii. Reflective practice 9. TRAINERS AND TRAINING UNITS Accredited trainer, mentor, and training units An accredited trainer is a Specialist with at least 3 years’ experience after board certification as a specialist anaesthesiologist and is a designated anaesthesiologist in a unit carrying out organ transplantation. Each trainee will be allocated to a designated trainer at a training center for a specified period of training. Each trainee will be allocated a mentor for the period of post MD training. The mentor shall be an accredited trainer in transplant anaesthesia. Training units must be accredited by the Board of Study in Anaesthesiology as suitable for training in organ transplantation based on annual audits including data on the number of transplants carried out, the conduct of clinics and provision of educational and research activities. 10. MONITORING PROGRESS Workplace based assessments a. The following workplace based assessments are used as part of the assessment process. The completed forms must be included in the training portfolio. The forms to be used are included as annexures. A minimum of 80% of workplace based assessments in each domain should be completed in order to be eligible to apply for PBCA a. Anaesthesia list management tool (ALMAT) – (Annexure 5) b. Direct observation of procedural skills (DOPS) – (Annexure 6) c. Critical care clinical evaluation exercise (I-CEX) - (Annexure 7) d. Anaesthesia clinical evaluation exercise (A-CEX) – (Annexure 8) e. Case based discussions (CBD) – a minimum of 10 case based discussions must be completed to indicate the breadth of exposure and reflective practice. (Annexure 9) f. Trainee evaluation form for trainers (Annexure 10) Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 6 Postgraduate Institute of Medicine – University of Colombo g. Acute care assessment tool (ACAT) h. Professionalism observation forms i. Multi-source feedback – forms down loaded from the PGIM website should be completed and submitted through the respective trainers to the Medical Education Resource Center (MERC). j. Reflective practice guideline for trainees (Annexure 11) 11. ELIGIBILITY FOR PRE-BOARD CERTIFICATION ASSESSMENT The following criteria must be fulfilled before a trainee is eligible for the PBCA. b. Completion of the required period of training to the satisfaction of the Board of study in Anaesthesiology c. Satisfactory progress reports to cover the entire period of training d. Submission of training portfolio and satisfactory completion of workplace based assessments. A minimum of 80% of workplace based assessments in each domain should be completed in order to be eligible to apply for PBCA e. Completion of the research project and approval of the research report by the Board of study in Anaesthesiology f. Evidence of oral/poster presentations on transplant related topics at a local/ international meeting g. A publication on a transplant related topic in a peer reviewed journal 12. FORMAT OF PRE-BOARD CERTIFICATION ASSESSMENT (PBCA) The Pre Board Certification Assessment will be based on assessment of a training portfolio maintained by the trainee during the period of post-MD training. Training portfolio assessment: The training portfolio will be reviewed at least every 6 months by the local supervisor(s), with regular feedback to the trainee on how the training portfolio may be improved. When the trainee is eligible for PBCA, 3 copies of the completed training portfolio should be submitted to the PGIM Examinations Branch. The trainee will be required to make a 10-15 minute presentation covering the post MD training including both local and overseas components at the PBCA. Pre-board certification assessment (PBCA): The PBCA will take the form of a final, summative assessment of the trainee’s training portfolio, carried out by 3 examiners appointed by the Board of Study in Anaesthesiology. The third examiner should be from outside the discipline. The viva examination will include 1. A presentation of 10-15 minutes on the post-MD training 2. Interview based on the training portfolio 3. Interview on reflective practice The overall assessment will be based on each of the main sections: presentation, training portfolio, reflective practice. Each section shall be assessed as satisfactory or unsatisfactory. Marking scheme for the Pre-Board Certification Assessment (PBCA) – (Annexure 12) Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 7 Postgraduate Institute of Medicine – University of Colombo If the examiners are of the view that the trainee’s performance is satisfactory, the Board of study will be informed as such. If the performance is unsatisfactory, the examiners must provide the trainee with written feedback on how the performance should be improved in order to reach the required standard. The trainee should then re-submit the training portfolio within a specified period of time (up to 6 months) and face another interview based on the re-submitted training portfolio. If the trainee is successful at this second attempt, the date of Board Certification should be backdated as done routinely. If unsuccessful, the date of Board Certification will be the date of passing the subsequent PBCA following further training for a minimum period of six months in a unit selected by the Board of study. 13. BOARD CERTIFICATION A trainee who has successfully completed the Pre-Board Certification Assessment is eligible for Board Certification as a Specialist in Anaesthesiology with a Special interest in Transplant Anaesthesiology and Critical care, on the recommendation of the Board of study in Anaesthesiology, Postgraduate Institute of Medicine, University of Colombo. 14. RECOMMENDED READING – ANNEXURE 13 15. CURRICULUM DEVELOPMENT COMMITTEE Professor Anuja Abayadeera – Professor in Anaesthesia, Faculty of Medicine, University of Colombo Dr Bhagya Gunetilleke – Senior Lecturer in Anaesthesia, Faculty of Medicine, University of Kelaniya Professor Vasanthi Pinto – Professor of Anaesthesia and Critical care, Faculty of Medicine, University of Peradeniya Dr Manoj Edirisooriya – Consultant Intensivist, Medical intensive care unit, National hospital, Colombo Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 8 Postgraduate Institute of Medicine – University of Colombo ANNEXURE 1 - LEARNING OUTCOMES AND COMPETENCIES 1. Learning outcomes By this stage of training, the vast majority of outcomes are generic across all areas of clinical practice in Anaesthesia and Perioperative care. They have been divided into nine generic domains and the specific domain of Transplant Anaesthesia and Critical care as follows: Domain 1: Clinical Practice Domain 2: Team work Domain 3: Leadership Domain 4: Innovation Domain 5: Management Domain 6: Education Domain 7: Airway management skills Domain 8: Haemodynamic monitoring and management Domain 9: Information technology, research and publication Domain 10: Anaesthesia & Critical care for organ transplantation Domain 11: Research & publications 2. Competencies Outcomes as assessed by competencies in the specified domains are stated below. Assessment method decode A- Anaesthesia Clinical Evaluation Exercise [A-CEX] C - Case Based Discussion [CBD] D - Direct Observation of Procedural Skills [DOPS] E - Examination I - Critical care Medicine Clinical Evaluation Exercise [I-CEX] L - Anaesthesia List Management Assessment Tool [ALMAT] M - Multi-source Feedback/ Peer team rating [MSF/PTR] S - Simulation T - Acute Care Assessment Tool [ACAT] V - Viva ( Training portfolio assessment and PBCA) Board Certification in Anaesthesiology with a Special Interest in Transplant Anaesthesiology and Critical care- 2018 9