Study guide ifolio 2013.2014
Download as DOC, PDF1 like653 views
This document provides information on the Anaesthesiology module for medical students, including: - The module heads and coordinators, as well as a directory of teaching staff. - An outline of the module content which will expose students to principles of anaesthesia, airway management, and care of critically ill patients. - The teaching methods include lectures, skills labs, tutorials, clinical exposure in operating theatres and ICUs, and a basic life support course. - Assessment is based on logbook, case write up, and end-of-module theory and OSCE exams. The module aims to provide students familiarity with anaesthesia techniques, airway management, and perioperative patient care.
Study guide ifolio 2013.2014
- 1. ANAESTHESIOLOGY MODULE FF4412 Head of Department: Assoc. Prof. Datin Dr. Norsidah Abdul Manap Module Heads: Dr. Azarinah Izaham Dr. Aliza Mohamad Yusof Department’s PPD Coordinator: Dr. Rufinah Teo 1.DIRECTORY OF TEACHING STAFF NO. LECTURERS EXT. E-MAIL ADDRESS 1 Assoc. Prof. Dr. Adnan Dan 5786 adnan@ppukm.ukm.my 2 Assoc. Prof. Datin Dr. Norsidah A. Manap 5788 nmanap@ppukm.ukm.my 3 Prof. Dr. Lee Choon Yee 5789 lee@ppukm.ukm.my 4 Prof. Dr. Jaafar Md. Zain 5790 jaafar@ppukm.ukm.my 5 Assoc. Prof. Dr. Choy Yin Choy 5791 choy@ppukm.ukm.my 6 Dr. Nurlia Yahya 5794 nurlia@ppukm.ukm.my 7 Prof. Dr. Joanna Ooi Su Min 5852 joanna@ppukm.ukm.my 8 Assoc. Prof. Dr. Raha Abdul Rahman 5849 raha@ppukm.ukm.my 9 Dr. Muhammad Maaya 5865 mm0427@gmail.com 10 Dr. Nadia Md. Nor 5621 nadiamn@ppukm.ukm.my 11 Dr. Khairulamir Zainuddin 5796 z_amir72@hotmail.com 12 Dr. Azmil Farid Zabir 5792 azmil@ppukm.ukm.my 13 Dr. Wan Rahiza Wan Mat 5785 docaweng@yahoo.com 14 Dr. Azarinah Izaham 5797 azaizaham@yahoo.com 15 Dr. Esa Kamaruzaman 6751 ek4776@hotmail.com 16 Dr. Liu Chian Yong 5865 chianyong@yahoo.com 17 Dr. Kamal Bashar Abu Bakar tengku_k@hotmail.com 18 Dr. Aliza Mohamad Yusof synctium_x@yahoo.com 19 Dr. Rufinah Teo finah77@yahoo.com 20 Dr. Shereen Tang Suet Ping shereen_tang@yahoo.com 21 Dr. Azlina Masdar 5864 azlinamasdar@yahoo.com SYNOPSIS: In this 2- week posting students will be exposed to the basic principles of general and regional anaesthesia, skills of airway maintenance and basic life support. They will be introduced to the management of the critically ill. Prerequisites to this module include sound knowledge in the clinical and biomedical sciences. The teaching learning methodology includes lectures, skill lab, computer assisted learning, pre-operative assessment, practical procedures in the operation theatre, small group tutorials and discussion, and basic life support hands-on and exam sessions. Assessment is based on the continuous assessment and end-of-semester theory and OSCE examination.
- 2. OBJECTIVES: On completion of this module students should be familiar with various airway equipment, anaesthesia techniques and common drugs; be able to maintain an airway and perform basic life support, manage patients perioperatively, and communicate well with patients, their families and the multidisciplinary team. PREREQUISITES The students should have the following relevant knowledge and skills: 1. Good knowledge of clinical sciences 2. Good knowledge of biomedical sciences II. MODULE LEARNING OUTCOMES On completion of this module, the student should be able to: 1. identify and use different airway equipment and adjuncts. 2. perform different modes of maintaining an airway. 3. perform basic life support (BLS). 4. know the assessment and preoperative preparation of patients. 5. recognize various techniques of anaesthesia. 6. identify and describe common drugs used for anaesthesia and resuscitation. 7. identify the various methods of post operative pain management 8. demonstrate skills in breaking bad news with regards to anaesthetic related complications, and death and dying. 9. discuss the consequences of their clinical decision upon the patient, patient’s relatives, and other medical personnel. 10. understand the importance of team work and communication. III. COURSE CONTENTS Subjects Topics Airway • Airway assessment • Airway maintenance • Intubation/Airway devices Anaesthesia • Peri-operative management • General anaesthesia • Regional anaesthesia • Emergency anaesthesia Drugs in anaesthesia • Drugs for premedication • Intravenous anaesthetic agents • Inhalational anaesthetic agents • Muscle relaxants and reversal agents • Opioids and non-opioids • Local anaesthetic agents • Resuscitation drugs Resuscitation • Basic Life Support
- 4. IV. TEACHING LEARNING METHODOLOGY 1. Lectures a. Four one-hour sessions are given in the beginning of this module i. Airway management and airway adjuncts. • The methods of maintaining an airway during anaesthesia o head tilt, chin lift o the correct technique of intubation • Various airway adjuncts ii. Types of anaesthesia. • The operative management of general anaesthesia • The operative management of regional anaesthesia o spinal and epidural o indications, side-effects and contra-indications o peripheral nerve block • The conduct of emergency anaesthesia iii. Preoperative preparation of patient and postoperative pain relief. • Pre-operative patient assessment and management • Methods of post-operative pain relief o simple oral analgesics o opioids o patient-controlled analgesia o regional anaesthesia • Acute pain service • Anaesthetic clinic iv. Key elements of intensive care and related issues. • Overview of intensive care management • Organization • Admission criteria • Organ support • Sedation • Monitoring b. Common Lecture- Breaking Bad News • 1 hour lecture presented once a year and attended by all the fourth year students • proper method of communicating with relatives regarding patient’s poor prognosis and death 2. Skill lab and computer-assisted learning (CAL) The students are divided into groups for these two three hour sessions. a. In the Anaesthetic Skill Lab, a demonstration on airway management by a lecturer is followed by the students’ practical session. • Managing a mannequin’s airway with various airway adjuncts • Intubating a mannequin
- 5. • Introduction to spinal, epidural and combined spinal-epidural needles • Simulation – central and peripheral venous cannulation b. In the Computer Lab, the students undergo computer-assisted learning, where they are guided through a scenario whereby they ‘manage’ an anaesthetised patient via simulation. 3. Pre-operative assessment in the ward The students follow a lecturer or medical officer on a pre-operative assessment in the ward, where they learn the process of preparing a patient prior to anaesthesia and surgery. The students are shown • how to conduct an anaesthetic assessment • how to examine a patient’s airway • how to manage common and simple medical problems prior to anaesthesia and surgery During this session, the students also select a patient each to follow through, for a case write-up. 4. Practical In the operating theatre (OT), the students are divided into small groups, and allocated to various operating sessions, where they are shown how general and regional anaesthesia are conducted. The medical students are required to perform certain procedures which are recorded in a logbook. These are 1. Intravenous cannulation 2. Applying monitors on a patient 3. Managing a patient’s airway with a face-mask and oropharyngeal airway 4. Intubating a patient 5. Certifying the correct placement of endotracheal tube 5. Understanding the conduct of anaesthesia 5. Small group tutorial This takes place in the operating theatre to discuss topics that are covered and not covered in the lectures. Special attention is given to: 1. Drugs used in general anesthesia. • Intravenous anaesthetic agents • Inhalational anaesthetic agents • Muscle relaxants • Opioids and non-opioids • Resuscitation drugs • Reversal agents 2. Monitoring of patients in OT. 3. General anaesthesia. 4. Regional anaesthesia
- 6. • spinal • epidural • combined spinal-epidural • Peripheral nerve block 6. Basic Life Support Upon starting this module, the students are given a Basic Life Support Course Manual which has been prepared by the Department of Anaesthesiology and Intensive Care. The BLS session is a one-day course which takes place during the second week of the module to give ample time for the students to thoroughly read the manual. The components of the session are 1. Demonstration and practical stations. • an overview lecture on the basics of BLS • how to correctly perform a one-person and two-person rescue on an adult • how to correctly treat a conscious and unconscious adult choking patient • how to correctly perform a one-person BLS on an infant • how to correctly treat a choking infant 2. Examination. • 40 objective questions (one best answer format) on the basics of BLS, which takes place the afternoon before the course • 5 rotating practical stations assessing the skills mentioned above, which takes place in the afternoon of the course. Those who fail the objective paper can resit the exam the following afternoon. The students who fail the practical assessment can retake the test immediately afterwards. The students have to repeat the whole exam if they fail either component of the repeat exam. The students are awarded with a BLS Course Certificate after passing the exams. Lecturers & Medical Officers in charge: Various Lectures and Medical Officers, i.e. a rolling roster of Lectures and Medical Officers 7. Small Group Discussion (SGD) The students are divided into small groups, and each group is allocated a topic to research for discussion during the second week. The four topics to be discussed are: 1. Dealing with death and dying patients 2. Dealing with brain dead patients and the issue of organ donation 3. Consent in Anaesthesia 4. Breaking bad news: Anaesthesia related complications All groups are also required to demonstrate breaking bad news with regards to simple clinical circumstances..
- 8. V. ASSESSMENT Prerequisites A student is considered to have satisfactorily completed this module, and allowed to sit for the end-of-semester exam, when he/she 1. has submitted a completed and signed logbook 2. has submitted an original case write-up 3. has a good record of attendance (at least 80%) Breakdown of marks Continuous assessment 30% End-of-semester theory examination 35% End-of-semester OSCE 35% 1. Continuous assessment (30%) The components of the continuous assessment are Logbook 10% Case write-up 20% 2. End-of-semester theory examination (35%) 10 Questions (mixture of one best answer and extended matching item) 3. End-of-semester OSCE (35%) • 4 OSCE stations (1 manned and 3 unmanned) • 2 PPD stations (rotated between the 3 minor postings each end-of-semester exam, i.e. Ophthalmology & Otorhinolaryngology, Otorhinolaryngology & Anaesthesiology, Anaesthesiology & Ophthalmology) Both the theory and OSCE examinations take place in combination of the 3 minor postings. PPD The components of the continuous assessment are • Reflective writhing 10% • Small group discussion 10% • PPD component of case write-up 30% Theory consisting KFQ and OSCE 50%
- 9. Continuous assessment 1. Logbook (30%/3 =10%) ATTENDANCE (10%) Lectures Date & Signature 1. Airway management & airway adjuncts 2. Preop preparation and postop pain relief 3. Types of anaesthesia 4. Introduction to care of critically ill patient Skill lab Computer assisted learning (CAL) Pre-operative assessment Small group discussion (SGD) On call (5-9pm) BLS Pass / Fail TUTORIAL (5%) OT Signature Date & Operation 1. Introduction to a. induction agents b. opioids c. muscle relaxants d. reversal 2. Monitoring in anaesthesia 3. General anaesthesia 4. Regional anaesthesia a. spinal b. epidural c. peripheral nerve block 5. Pre and postoperative Management
- 10. PROCEDURES (15%) Date & Signature Observed Performed Apply monitors on patient IV cannulations (minimum performed 3) Intubation: patient (minimum performed 1) Intubation: mannequin (minimum performed 1) Hold mask on patient (minimum performed 1) Insert an oropharyngeal airway Certify correct placement of ETT Spinal Not required Epidural Not required Combined spinal-epidural Not required Central venous line cannulation Not required Arterial line cannulation Not required Hold mask on patient (1 mark/performed procedure) Max. 3% Intubation (1 mark/performed procedure) Max. 3% Intravenous cannulation (1 mark/performed procedure) Max. 5% Others (1 mark/observed or performed procedures) Max. 5% 2. Case write-up (20%) The student chooses a patient scheduled for an operative procedure and writes an anaesthetic peri-operative follow-up • Pre-operative assessment and management • The conduct of anaesthesia • Immediate post-operative management • Discussion which should emphasise the anaesthetic element 3. PPD specific assignment (20%) - refer PPD Guideline Passing criteria In order to pass this module, the student must 1. pass the BLS assessment, and 2. accumulate at least 50% from the continuous assessment and end-of- semester examinations.
- 11. APPENDIX I. TWO-WEEK TIMETABLE FOR THE MODULE Week 1 0800-1000 1000-1300 1300- 1400 1400-1700 Mon 0800-0830 Introduction lecture from the Module Head 0830-0930 Lecture: Airway management and airway adjuncts 0930-1030 Lecture: Types of anaesthesia The students are divided into 8 groups Operating Theatre according to groups Break 1400-1500 Lecture: Preoperative preparation of patient and postoperative pain relief 1500-1600 Lecture: Introduction to the care of the critically ill patient 1600-1700 Pre-operative assessment Tue 0800-0900 Departmental CME 0900-1000 All groups Operating Theatre/ICU/APS according to groups Groups 1-4 Operating Theatre/ICU Groups 5&6 Skill Lab Groups 7&8 Computer assisted learning (CAL) Break 1400-1600 All groups Operating Theatre according to groups 1600-1700 Pre-operative assessment Wed 0800-0900 CPC 0900-1000 All groups Operating Theatre/ICU/APS according to groups Groups 1-4 Operating Theatre/ICU Groups 5&6 CAL Groups 7&8 Skill Lab Break 1400-1600 All groups Operating Theatre according to groups 1600-1700 Pre-operative assessment Thu All groups Operating Theatre/ICU/APS according to groups Groups 1&2 Skill Lab Groups 3&4 CAL Groups 5-8 Operating Theatre/ICU Break 1400-1700 Special Study Module Fri All groups Operating Theatre/ICU/APS according to groups Groups 1&2 CAL Groups 3&4 Skill Lab Groups 5-8 Operating Theatre/ICU Break 1500-1700 Concept lecture
- 12. Week 2 0800-1300 1300-1400 1400-1700 Mon 0800-0900 Departmental CME 0900-1300 Groups 1-4 BLS Demonstration & Practice Groups 5-8 Operating Theatre/ICU/APS according to groups Break Groups 1-4 BLS MCQ/Practical Exam Groups 5-8 Small Group Discussion Tue 0800-0900 Departmental CME 0900-1300 Groups 1-4 Operating Theatre/ICU/APS according to groups Groups 5-8 BLS Demonstration & Practice Break Groups 1-4 Small Group Discussion Groups 5-8 BLS MCQ/Practical Exam Wed 0800-0900 CPC 0900-1300 All groups Operating Theatre/ICU/APS according to groups Break 1400-1600 All groups Operating Theatre according to groups 1600-1700 Pre-operative assessment Thu All groups Operating Theatre/ICU/APS according to groups Break 1400-1700 Special Study Module Fri All groups Operating Theatre/ICU/APS according to groups Break 1500-1700 Concept lecture This two weeks timetable is subject to change in the event • the module coinciding with public holidays or departmental activities, e.g. Masters Students’ Examination • increasing or decreasing student group size
- 13. APPENDIX II. RESOURCE MATERIALS Textbook Gwinnutt, Carl. 2004. Clinical Anaesthesia (Lecture Notes). 2nd Edition. Blackwell Publishing Limited. Manual Basic Life Support Course Manual (2010) An Introduction to Cardiopulmonary Resuscitation, Basic Airway Management and Defibrillation (2nd Edition 2011) UKMMC