Anesthesiology,critical care and pain medicine specialty training program

GRADUATE PROFILES
Medical Expert: As Medical Experts who provide high-quality, safe, patient-centered care, anesthesiologists draw upon an evolving body of knowledge,their clinical skills, and their professional attitudes. They collect and interpret information, make clinical decisions, and carry out diagnostic and therapeutic interventions. They do so within their scope of practice and with an understanding of the limits of their expertise. Their decision-making is informed by best practices and research evidence, and takes into account the patient’s circumstances and preferences as well as the availability of resources. Their clinical practice is up-to-date, ethical, and resource-efficient, and is conducted in collaboration with patients and their families, other health care professionals, and the community. The Medical Expert Role is central to the function of an anesthesiologist and draws on the competencies included in the Intrinsic Roles (Communicator, Collaborator, Leader, Health Advocate,Scholar, and Professional).
Communicator: Anesthesiologists enable patient-centered therapeutic communication by exploring the patient’s symptoms, which may be suggestive of disease, and by actively listening to the patient’s experience of his or her illness. Anesthesiologists explore the patient’s perspective, including his or her fears, ideas and feelings about the impact of the illness and Anesthesia, and expectations of health care and health care professionals.
The physician integrates this knowledge with an understanding of the patient’s context, including socio-economic status, medical history, family history, stage of life, living situation, work or school setting, and other relevant psychological and social issues. Central to a patient-centered approach is shared decision-making: finding common ground with the patient in developing a plan to address his or her medical problems and health goals in a manner that reflects the patient’s needs, values, and preferences. This plan should be informed by evidence and guidelines. Because illness affects not only patients but also their families, anesthesiologists must be able to communicate effectively with everyone involved in the patient’s care.
Collaborator: Collaboration is essential for safe, high-quality, patient- centered care, and involves patients and their families, anesthesiologists and other colleagues in the health care professions, community partners, and health system stakeholders. Collaboration requires relationships based in trust, respect, and shared decision-making among a variety of individuals with complementary skills in multiple settings across the continuum of care. It involves sharing knowledge, perspectives, and responsibilities, and a willingness to learn together. This requires understanding the roles of others, pursuing common goals and outcomes, and managing differences.
Collaboration skills are broadly applicable to activities beyond clinical care, such as administration, education, advocacy, and scholarship.
Leader and Manager: As Leaders, anesthesiologists develop a vision of a high-quality health care system and, in collaboration with other health care leaders, take responsibility for effecting change to move the system toward the achievement of that vision. Leadership and management abilities as core requirements for the practice of medicine. Anesthesiologists and othersexercise collaborative leadership within the complex health care systems that form their specific work environments. At a systems level, anesthesiologists contribute to the development and delivery of continuously improving health care and engage others to work with them toward this vision.
Anesthesiologists must balance their personal lives with their responsibilities as leaders and managers in their everyday clinical, administrative, research, and teaching activities. They function as individual care providers, as members of teams or groups, and as participants and leaders in the health care system locally, regionally, nationally, and globally. The Leader Role describes the active engagement of all anesthesiologists as leaders and managers in decision making in the operation and ongoing evolution of the health care system.
Health Advocate: As Health Advocates, anesthesiologists contribute their expertise and influence as they work and be role models for communities or patient populations to improve health. They work with those they serve to determine and understand needs, speak on behalf of others when needed, and support the mobilization of resources to effect change. Anesthesiologists take the cultural context of the community whenever they engage in health advocacy and promotion. Anesthesiologists recognize their duty to participate in efforts to improve the health and well-being of their patients, their communities, and the broader populations they serve. Anesthesiologists possess medical knowledge and abilities that provide unique perspectives on health. Anesthesiologists also have privileged access to patients’ accounts of their experience with illness and the health care system. Improving health also includes promoting health equity, whereby individuals and populations reach their full health potential without being disadvantaged by, for example, race, ethnicity, religion, gender, age, social class, economic status, or level of education. Anesthesiologists leverage their position to support patients in navigating the health care system and to advocate with them to access appropriate resources in a timely manner. Anesthesiologists seek to improve the quality of both their clinical practice and associated organizations by addressing the health needs of the patients, communities, or populations they serve. Anesthesiologists promote healthy communities and populations by influencing the system (or by supporting others who influence the system), both within and outside of their work environments. Advocacy requires action. Taking steps to maintain their own physical and mental health, using coping strategies and seeking appropriate assistance as needed, by this they serve as role models by advocating for and promoting healthy life styles. They support or lead the mobilization of resources (e.g., financial, material, or human resources) on small or large scales.
Scholar: As Scholars, anesthesiologists demonstrate a lifelong commitment to excellence in practice through continuous learning, the teaching of others, the evaluation of evidence, and contributions to scholarship. Anesthesiologists acquire scholarly abilities to enhance practice and advance health care.
Anesthesiologists pursue excellence by continually evaluating the processes and outcomes of their daily work, sharing and comparing their work with that of others, and actively seeking feedback in the interest of quality and patient safety. Using multiple ways of learning, they strive to meet the needs of individual patients and their families and of the health care system.
Anesthesiologists strive to master their domains of expertise and to share their knowledge. As lifelong learners, they implement a planned approach to learning in order to improve in each role. They recognize the need to continually learn and to model the practice of lifelong learning for others. As teachers they facilitate, individually and through teams, the education of students and residents, colleagues, co-workers, the public, and others.
Anesthesiologists are able to identify pertinent evidence, evaluate it using specific criteria, and apply it in their scholarly activities and practice. Through their engagement in evidence-informed and shared decision-making, they recognize uncertainty in practice and formulate questions to address knowledge gaps. Using skills in navigating information resources, they identify evidence syntheses that are relevant to these questions and arrive at clinical decisions that are informed by evidence while taking patient values and preferences into account. Finally, Anesthesiologists’ scholarly abilities allow them to contribute to the application, dissemination, translation, and creation of knowledge and practices applicable to health and health care.
Professional: As Professionals, anesthesiologists are committed to the health and well-being of individual patients and society through ethical practice, high personal standards of behavior, dedication to the profession, profession-led regulation, and maintenance of personal health. Anesthesiologists serve an essential role as professionals dedicated to the health and care of others. Their work requires mastery of the art, science, and practice of medicine. The professional identity of anesthesiologists has developed over millennia, and the Professional Role reflects contemporary society’s expectations of anesthesiologists, which include clinical competence, a commitment to ongoing professional development, promotion of the public good, and adherence to ethical standards and values, such as integrity, honesty, altruism, respect for diversity, and transparency with respect to potential conflicts of interest.
It is also recognized that, to provide optimal patient care, anesthesiologists must take responsibility for their own health and well-being and that of their colleagues. The professionalism of anesthesiologists is the basis of the implicit contract between society and the medical profession, by which anesthesiologists are granted the privilege of profession-led regulation with the understanding that they are accountable to those served, to society, to their profession, and to themselves.
Graduate Competencies in terms of Knowledge, Attitudes, and Skills
Knowledge

Demonstrate knowledge of the basic sciences as applicable to anesthesia, and critical care including anatomy, physiology, pharmacology, biochemistry, and physics.
Demonstrate knowledge of medicine with particular reference to the cardiovascular, respiratory, renal, hepatic, endocrine, hematologic, and neurologic functions systems.
Demonstrate knowledge of age-related variables in medicine as they apply to neonatal, pediatric, adult, and geriatric patient care.
Demonstrate knowledge of the principles and practice of anesthesia and critical care as it applies to patient support during surgery, obstetrics, and ICU.
Demonstrate knowledge of the principles of management of patients with acute and chronic pain.
Demonstrate knowledge of the role of the consultant anesthesiologist in the provision of safe anesthetic services within both community and teaching facilities
Demonstrate knowledge in all technical procedures commonly employed in anesthetic practice, and critical care setting; including airway management, cardiovascular resuscitation, patient invasive and non-invasive monitoring and life support, general and regional anesthetic and analgesic techniques, and perioperative care
Demonstrate knowledge of principles of sedation and anesthesia care outside the operation theater.
Demonstrate knowledge in the safe application of equipment, careful monitoring, judicious use of drugs, and the coordinated provision of interdisciplinary care for effective organ system support.
Demonstrate an ability to recognize, resuscitate, and stabilize patients sustaining, or at risk of, cardiopulmonary arrest or other life-threatening disturbance.
Demonstrate knowledge and ability to prevent, recognize, and treat single or multiple organ failure.

Attitudes

Demonstrate respect and dedication to the specialty and to colleagues
Critically appraise the ethical and medico-legal requirements and responsibilities of the specialty of anesthesia, critical care, and pain medicine
Demonstrate good communication with colleagues, patients, and their family
Demonstrate ability to function as a leader of the anesthesia, ICU, and pain management care team
Critically appraise the importance and obligation of continuing self-directed education and teaching others
Describe the proper use of the resources in the operation theater, critical care unit, and pain clinic with full responsibility and care.
Demonstrate a respect to patients’ autonomy and have a caring and compassionate attitude for patients
Demonstrate appreciation of the role of research in the critical analysis of scientific developments related to the specialty
Demonstrate a skill to Communicate effectively with patients and colleagues in a medical context
Demonstrate to act according to ethical and legal principles
Demonstrate a behavior to be polite, considerate, trustworthy, and honest, act with integrity, maintain confidentiality, respect patients’ dignity and privacy, and understand the importance of appropriate consent

Skills
Trainees must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Should be able to demonstrate competency in the following skills:

Assessment and maintenance of the airway
Tracheal intubation
Difficult airway management
Replacement of a preexisting tracheotomy tube
Cricothyrotomy and other emergency surgical airway access
Perform fiberoptic intubation and lung isolation
Awake intubation
Cardiopulmonary resuscitation and life support
Patient non-invasive and invasive monitoring
Interventional pain management during perioperative period, in the ICU, at the pain clinic and for diagnostic procedure
Demonstrate skills of ventilation by bag and mask, invasive and non-invasive ventilation
Demonstrate skills to establish arterial lines, central venous lines, automated external defibrillation (AED), cardioversion, transcutaneous pacemaker, and pericardiocentesis.
Demonstrate skills of inserting and management of spinals, epidural catheter and Swan-Ganz catheter
Demonstrate skill to conduct central and peripheral regional blocks for acute and chronic pain management
Demonstrate skill conduct diagnostic and therapeutic procedures for critical patients in the ICU
Develop skills on invasive and non-invasive critical patients in respiratory, cardiovascular, and other systems management
Demonstrate skills for supervision of intracranial pressure (ICP) monitoring, cerebral spinal fluid (CSF) drainage for raised ICP
Monitor and maintain homeostasis during perioperative period including for critically ill, injured, or otherwise diseased patient
Evaluate respiratory function and apply respiratory therapy
Be well-versed on performing Advanced Cardiovascular Life Support (ACLS),Advanced Trauma Life Support (ATLS), and Pediatric Advanced Life Support (PALS)
Diagnose and treat acute and chronic pain syndrome
Demonstrate the ability to administer, organize, and lead the department of anesthesia, operating theater, ICU, and pain clinic
Demonstrate the clinical skill to diagnose, investigate, and manage underlying illness and critically ill patients, influencing the patients’ surgical and medical outcomes
Demonstrate skills to perform ultrasound and ultrasound-guided procedures such as nerve blocks, central line placement, and quick evaluation of CV function
Demonstrate the clinical skill to interpret diagnostic results
Apply the scientific method and approaches to medical research
Conduct clinical research to explain and improve the care of patients
Establish the foundations for lifelong learning and continuing professional development, including a professional development portfolio containing reflections, achievements, and learning needs
Demonstrate the ability of teaching skills in basic and clinical anesthesiology
Demonstrate skills and understanding of Quality Improvement projects which involve monitoring and evaluation

ADMISSION REQUIREMENT

The candidate should have MD degree from a recognized institution
Satisfactory completion of internship at least in the four major clinical departments
Pass the written and oral entrance examinations

Non-Academic Requirements

Should be registered and licensed to practice medicine in Ethiopia
The candidate should be in good mental and physical health
Should have letter of support / sponsoring institution
Recommendation letters (two)

Transfer

Trainees can be transferred from another institute if their previous training curriculum is the same. If curriculums are different the course/module covered should be comparable

DURATION OF THE PROGRAM

The entire residency program will take place over the course of three years (36 months).

TEACHING/LEARNING METHODS

To conduct the training program, the following modes of delivery will be employed:

Interactive lectures
Seminars
Supervised clinical practice
Journal reviews and reflection
Short rounds and grand rounds
Interdepartmental conferences
Morning sessions and patient clinical reports
Mentored research projects
Demonstration and coaching in simulation settings
Video lectures and interactive seminars
Video conferences
Self-study
Morbidity and mortality reviews and reflections
Case-based discussions
Group discussions

Assessment Methods, Activities, and Weight

Assessment of student performance includes:

Student performance assessment includes both formative and continuous summative assessment
Summative assessment mainly includes:

Written cognitive knowledge assessment using multiple-choice questions (MCQ) and essays
Performance assessment

Observed performance in workplace setting using directly observed procedures (DOPs), Clinical Evaluation Exercise (MINI-CEX), and other works completed by students.
Observed performance in simulated setting using objective structured clinical exam (OSCE)

Progressive Assessment
The responsible staff and/or department where the residents attach for the particular module assess each trainee regularly and periodically and complete the assessment paper accordingly (Progressive assessment form, Workplace-based assessment tool).
The assessment will be compiled at the end of every month or after the end of the rotation time. Trainees not performing to the standard will get feedback and be advised to improve their performance. Following every attachment or completion of the module, the resident will collect signed logs and assessment forms filled and present to resident program director so that it will be compiled and/or filled in the computer database.
Formal Examination and Proportional Contributions
Examination for module 1 will be finished at the end of the module. For the other modules and rotations, progressive assessments will be completed following every rotation and the result will be compiled. Formal examinations will have specific season because of the different clinical rotations that will not finish modules at the same time.
Hence the formal examination seasons will be the following:
YEAR I:
Examination period: Introduction to anesthesia and equipment, Critical care I and introduction to regional anesthesia and pain management will be conducted at the end of year one.
Exam types: in addition to the progressive assessment there will be written exam (MCQ and Essay), OSCE, long and short case practical exams.
Proportional Contributions: Progressive assessment contributes 40% in all modules, from written (15%), oral (10%), and OSCE (20%); Module I result 15%
YEAR II:
Exam period: At the end of the second year an exam for all modules will be given. Exam proportional composition: Progressive assessment contributing to 60% of the work while the rest is composed from written exam 40%.
YEAR III:
All modules in year III are computed 100% from progressive assessment except the Final Qualifying Exam (FQE).
Final qualifying examination (FQE) will be given in the end of third year after one month of reading period.
Prerequisites: Pass Year III progressive assessment; Successful defense of their research; Trainee should pass all modules with B (70%) to be eligible for FQE.
A resident has to present his/her research project and achieve a minimum evaluation of ‘satisfactory’, which is a prerequisite for sitting for qualifying examination and for graduation. A research project that is ranked ‘fail’ must be revised and re-defended. The re-defense will be done based on the recommendation of the thesis examining board. If trainee fails to fulfill the requirement to take FQE, he/she can only take the exam after a year has passed.
The examination will be comprised of clinical practical exam, OSCE, VIVA and written. The progressive work from all years will contribute to 40% in the FQE. The rest (60%) is derived from written exam (15%), OSCE (15%), Viva/External examination (30%).
Promotion Requirements
For One Module to the Next Module and from One Year to the Next Year
Year I and II:
Rules and regulations for graduate programs will be used to promote a trainee within a program. A trainee that fails in the examination (grade less than 70%) will have a chance to take supplemental exam within four weeks. If trainee fails twice on the supplemental exam, then the module has to be repeated. If the trainee passes the supplementary exam, he/she will be promoted to the next year (Year II or III).
Year III:
The promotion regulation of all modules is similar to year I and II, but in addition there is the FQE. Trainee should pass all modules with B (70%) to be in good standing for the FQE. The regulation of the FQE is also similar to other years in that a student should score B (70%) or higher. If a student fails to achieve this grade, he/she will take supplemental exam after six months. Supplemental exams can be conducted in the presence of other groups of internal examiners. No study leaves within the six months are permitted.
DISMISSAL FROM THE PROGRAM
Disciplinary Dismissal
The college regulations on disciplinary dismissal will be applied.
Academic Dismissal
•Based on the University Senate Legislation.
Grading System
Letter grades shall be given at the end of each module based on the points earned out of 100. The letter grading system has a fixed scale as described in the table below:

Raw mark interval [100%]	Corresponding fixed number grade	Corresponding letter grade	Status Description	Class description
[90, 100]	4.0	A+	Excellent	First class with great distinction
[85, 89]	4.0	A	Excellent	First class with great distinction
[80, 84]	3.75	A^–	Excellent	First class with great distinction
[75, 79]	3.5	B+	Very good	First class with distinction
[70, 74]	3.0	B	Very good	First class with distinction
[65, 69]	2.75	B^–	Good	First class
[60, 64]	2.5	C+	Good	Second class
[50, 59]	2.0	C	Satisfactory	Second class
[45, 54]	1.75	C^–	Unsatisfactory	Lower class
[40, 44]	1.0	D	Very poor	Lower class
[<40]	0	F	Fail	Lowest class

GRADUATION REQUIREMENTS

The candidate should successfully complete all of the modules for three years
The candidate should pass the final examination and obtain a minimum of 70% or B grade.
A resident has to present his/her research project and achieve a minimum evaluation of ‘satisfactory’, which is a prerequisite for sitting for qualifying examination and for graduation. A research project that is ranked ‘fail’ must be revised and re-defended. The re-defense will be done based on the recommendation of the thesis examining board.

NOMENCLATURE OF THE CERTIFICATE
Degree Nomenclature
A candidate who satisfies the requirements will be recommended by the Council of Graduate Studies to the University Senate for approval of the award of:
Certificate of Specialty in Anesthesiology, Critical Care and Pain Medicine In Amharic……………….