The Generic Anesthesia Curriculum Graduates Competencies

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The Generic Anesthesia Curriculum Graduates Competencies
After critical review of existing local and international documents on learning outcomes & scope of practices, the core (essential) competencies Anesthesia students must demonstrate at the point of graduation are defined. The core competencies are organized in six domains or thematic areas:

  1. Social, epidemiologic and cultural context of Surgery & Anesthesia
  2. Anesthesia clinical care provision /Medical expert
  3. Interpersonal relationship and communication
  4. Organizational management & leadership
  5. Research, educational & professional development
  6. Professional, legal & ethical practice
  •  Social, epidemiologic & cultural context of Surgery & Anesthesia

Competency: Post Basic Anesthesia professionals apply the knowledge and skills from Basic science, the so 2. Anesthesia clinical care provision/ Anesthesia professional

Competency: Post basic Anesthesia professional applied direct interaction with patients, families and groups of patients to promote health or well-being and improve quality of life. These interactions are characterized by a holistic perspective in the anesthesia management of different surgical cases, illness and disease states. The post basic anesthesia professional demonstrates competence in the domain of the anesthesia clinical care provision when s/he:

  1. Preparation and optimization of patients for theatre & patient safety;cial sciences, public health and ethics that form the basis of high quality anesthesia clinical care. 
  2. Care of anesthetic machine, monitoring, related equipment & drugs
  3. Post-Anesthesia Care
  4. Emergency and  Critical Care
  5. Provision of obstetric anesthesia
  6. Provision of ENT & Maxillofacial surgery anesthesia
  7. Provision of Neurosurgery anesthesia
  8. Provision of Paediatrics and neonatal anaesthesia
  9. Provision of trauma and orthopedic anesthesia
  10. Pain management and regional anesthesia
  11. Provision of general surgery and urology anesthesia
  • Interpersonal relationship and communication

Competency: The post basic anesthetist collaborates at an advanced level by committing to authentic engagement and constructive patient, family, system, and population-focused problem-solving.

  • Organizational management & leadership

Competency: The post basic anesthesia graduate manages change and empowers others to influence anesthesia clinical practice and political processes both within and across systems.

  • Research, educational & professional development

Competency: The post basic anaesthesia professional must actively engage in searching for, interpretation,and use of evidence in anaesthesia clinical practice and quality improvement, as well as active participation in the conduct of research.

  • Professional, legal & ethical practice

Competency: Anaesthesia professionals practice within legal requirements, demonstrate professional integrity and act to uphold professional standards of practice and codes of ethics.

Curricular Model, Approach, and Delivery strategy

The design and development of this curriculum is competency (outcomes)-based and followed the Following key steps.

  1. Formulation of graduate profile /core competencies which are directly linked to the key occupational tasks and are integrated cluster of domain-specific andgeneric competencies.
  2. Elaborating competency descriptions: the core competencies were elaborated in terms of description of the competency, the outcome of the behavior that requires the competency.
  3. Knowledge and skills (contents) linked to the core competencies were listed
  4. Cluster existing contents into modules: integrates contents of related nature into an organized and structured unified whole (Module) to offer complete andblended knowledge, skills and values to learners that are transferable into practical work life. Within the framework, the following innovative educationalstrategies are used in the development of the curriculum.

Student-centered
In this curriculum, students are given greater responsibility for their own learning by integrating a more learner-centered teaching and learning and assessment methods such as self-initiated case base discussions, personal research and reflection exercise and portfolio-based learning, Problem based learning and assessment. This has the advantage of putting the emphasis on the student, increasing students’ motivation and preparing them to become lifelong learners.

Integration
Recognizing the short falls of the subject-based organization of the traditional curriculum, related contents of subjects and learning experiences are integrated throughout this curriculum. There is both horizontal and vertical integration. Integration is done using surgical practice specialty approach as thematic areas to organizing framework. Regarding basic and clinical sciences, emphasis is given through integration of their contents in to specialties while clinical sciences take the upper hand in later times of each module. Clinical exposure starts in year one with progressive increase in intensity, complexity and student responsibility over the years. On early phases of the 3 years training, basic Anesthesia modules will provide context and relevance to the learning of basic sciences & basic principles of anesthesia clinical practice. Social and population health modules are organized around competency functions and run as a longitudinal thread throughout the curriculum. The advantages of integration are reducing fragmentation of anesthesia professional courses and demonstrating unity of courses, motivating students and shaping their attitude towards anesthesia profession, improving educational effectiveness of teaching and learning, encouraging development of higher level objectives, longitudinal coverage of all domains of competencies, promoting staff communication and collaboration and bringing about rationalization of teachingresources. The clinical attachments for every professional module will be delivered following & together with the theoretical (classroom) and skill lab based sessions.
Community Based Education
To prepare anesthesia professional who are able and willing to address priority health needs of their communities, community-based learning is added to complement the hospital-based learning. In this curriculum, students are scheduled to have a 4-weeks in the mid of their education to identify and prioritize problems in the community and a 4-weeks long team training program (TTP) during final semester to intervene the identified problems. Advantages of community-based learning include providing community-orientation to the curriculum, providing useful learning experiences for competencies that may not be adequately developed in a hospital setting, making use of untapped resources, encouraging active learning, exposing students to patients that have not been seen by healthcare providers and introduction to the healthcare system.

The duration of the Generic anesthesia education is four and half years with the following components:
Assessment Methods
Assessment plays a central role in education process: it determines much of the work students undertake affects their approach to learning and is an indication of which aspects of the course are valued most highly. The purposes of assessment are to motivate students to learn, create learning opportunities, to give Feedback to students and teachers, grading and quality assurance. There is a distinction between a formative assessment, which is mainly intended to help the student learn and a summative assessment, which is intended to identify how much has been learned. Formative assessment is most useful part way through the module and will involve giving students feedback which they can use to improve future performance. Faculty should conduct at least two formative assessments of each student during a given module or rotation. Summative assessment is used to make a pass/fail or, promotion decision; findings of formative assessment are not used to make pass/fail decisions, however. That being said both formative and summative assessments are equally important; however, psychometric rigor is required more from summative assessment strategies. The following principles1,2 are considered in selection of assessment strategies and faculty should keep in mind these principles in appraising and revising assessment methods during implementation. Validity and reliability are of utmost importance but it is also recommended to consider feasibility and cost.
Reliability: Reliability is the reproducibility or consistency or generalizability of assessment scores. An assessment result is said to be reliable if students will get the same score if they re-take the exam. Similarly, for essay type and performance assessment, assessment scores are reliable, if the same results are obtained with different raters. Reliability of assessments can be improved by increasing the number of questions (or cases in clinical performance examination), aiming for middle difficulty questions, writing clear and unambiguous questions and increasing the number of raters.
Validity: Validity is the ability of an assessment to measure what it is supposed to measure. Validity is not about the method refers to the evidence presented to support or refute the meaning or interpretation assigned to assessment results. Simply put, assessment results are valid if they accurately distinguish competent from incompetent students and if the student who gets “A” grade is actually an “A” student, a student who gets a “B” grade is actually a “B” student, a student who gets an “F” grade is actually an “F” student, etc. Examples of factors that affect validity in written assessment are too few written questions to sample the content adequately, preparing questions from some chapters, mismatch of assessment questions with content covered in the curriculum, poorly constructed questions, too difficult or too easy questions, rater subjectivity and cheating. For performance (clinical) assessment, too few cases or observations to generalize performance, unrepresentative cases, rater bias, flawed rating scales/checklists and indefensible pass/fail cut off points are threats to validity. Note that reliability is a necessary but not sufficient condition for validity.
These are the descriptions of the major assessment methods including when and where they would be used in the curriculum.
1. Direct observation of Practice (DOP)
The purpose of DOPs or mini-clinical evaluation exercise3 is to assess clinical skills while a student interacts with patients in different settings. Typically it takes 15- 20 minutes and the assessor follows the student with a checklist and gives feedback at the end. The DOPs offers students immediate and ongoing feedback about their observed clinical skill and performance (interviewing skills, physical examination skills, and professionalism, clinical judgment, counseling skills, organization/efficiency and overall clinical competence). This method will be used in all years of the training and there will be at least two DOPs to be performed by a student in each module. This assessment method enables one to follow the progress of the student and will be used for formative assessment.
2. Objective structured examination
Objective structured clinical examination (OSCE) is a performance-based exam. During the exam, students are observed and evaluated as they go through a series of 8 or more stations. It allows assessment of multiple competencies. It is Objective, because examiners use a checklist for evaluating the trainees; structured , because every student sees the same problem and performs the same tasks in the same time frame; Clinical , because the tasks are representative of those faced in real clinical situations. These increase the reliability and validity of the assessment. OSCE1 is a standardized means to assess history taking, physical examination skill, communication skills, ability to summarize and document findings, ability to make a differential diagnosis or plan and execute different anesthesia management options/ techniques, clinical judgment based on patient ‘s note and procedural skills. OSCE may use manikins and simulators, standardized patients and real patients. Standardized patients are healthy persons trained to simulate a medical condition in a standardized way. Health science students, health facility staff and faculty may serve as standardized patients. Objective structured practical exam (OSPE) is a variant of OSCE to assess students’ knowledge and skill in a non-clinical setting. Both OSCE/OSPE will be part of the summative assessment and will be implemented from year 1-3 in the post-basic anesthesia program.
3. Practical Clinical Examination (PCE)
Practical Clinical Examinations assessment presents the student with a complete and realistic clinical challenge thereby enabling the evaluator to see the complete picture of the student’s ability in addressing the challenges. The use of multiple cases improves reliability of the examination, which is a major weakness in the traditional long case. Additional improvements to the traditional long case that would improve reliability are observing the student-patient interaction and using checklist and increasing the number of examiners.
4. Standardized oral exam
The standardized oral examination2 is a type of performance assessment using realistic patient cases for questioning the examinee. The examiner begins by presenting to the examinee a clinical problem in the form of a patient case scenario and asks the examinee to manage the case. Questions probe the reasoning for requesting clinical findings, interpretation of findings, and treatment plans. In efficiently designed exams each case scenario takes three to five minutes. One or two faculty serve as examiners and students can be tested on several different clinical cases. Oral exam will be part of the summative assessment in final year comprehensive examination.
5. Written exam
Written assessments may include different item formats such as multiple choice questions, matching, true false, essay and short answer. Written assessment methods will help to evaluate knowledge and understanding of basic, clinical, public health and psychosocial sciences and professionalism and ethics. Important point to remember is to ensure written exams assess higher order knowledge in addition to recall and comprehension. Written assessments would be parts of both as formative and summative assessment in all years of the post-basic anesthesia program.
6. Logbook
Logbook documentation serves as evidence of scope of patient care and community experience to meet requirements or specific learning outcomes. Maintaining logbook will encourage students to make use of all possible learning opportunities for clinical/procedural skills and community skills to fulfill minimum requirement.
Regular review of logbook can be used to help the student track what procedures or experiences must be sought to meet requirements. The logbook document should be counter signed by faculty. The number reported in a logbook may not necessarily indicate competence. Logbook will be part of the formative assessment throughout the post-basic anesthesia curriculum.
7. Portfolio
Portfolio1 is collection of papers and other forms of evidence that learning has taken place. It provides evidence for learning and progress towards learning objectives. Reflecting upon what has been learned is an important part of constructing portfolio. In addition to products of learning, the portfolio can include statement about what has been learnt, its application, remaining learning need, how they can be met. Portfolio helps to assess learning outcomes including those that are not easy to assess with other methods like personal growth, self-directed learning, reflective ability, self-assessment of personal growth and professionalism. Portfolio allows assessment of progress towards learning outcomes by using chronological work samples collected at different points in time. Portfolio will be part of the formative assessment throughout the duration of the post-basic anesthesia training and can be used as a summative assessment during professional anesthesia practice.
8. Global Rating
Global Rating is assessment of general categories of ability (e.g. patient care skill, medical knowledge, interpersonal and communication skills, professionalism, etc.) retrospectively based on general impression over a period of time and derived from multiple source of information. The purpose is to evaluate knowledge, skill and attitude over a period of time during and at the end of specialty clinical attachment thereby helping the evaluation of the student’s effort across time. Global rating will be main part of both formative and summative assessment of students throughout the duration of the post-basic anesthesia Curriculum. Some of the simple but critical assessments will be either passed or failed, whilst the others will be marked out of 4 points. 4 is considered excellent, 3.5 good, 3.0 satisfactory, 2.0 “needs to improve” and   1.0 is poor. A grade point average of 3.0 or more in each Module is required to successfully complete the module.

Rules, Regulations and Requirements

Admission Requirement

Candidates must fulfill the following criteria:

  1. Meet the criteria set by ministry of education for degree students.
  2. Have a background of natural sciences.
  3. Preferably those who choose to enter the profession.
  4. Applicant must be physically and mentally fit.
  5. Top scorer students in ministry of education entrance for degree program will be encouraged.

Criteria for Promotion

  • Promotion will be conducted every time when a module is completed
  • Pass mark for any module will be at least a C grade (for Professional modules) & any grade for general/ supportive modules.
  • No “less than C grade in all major supportive modules (Medicine, surgery, pediatrics Gyn& Obs and Physical Diagnosis) professional modules refer to grading system
  • If the student fail in one core/ Professional/ module (with module ECTS less than 5), He /She can repeat the assessment while continuing the next module
  • If a student has failure in more than one module or a module of greater than 5 ECTS, remedial exams will not be allowed and the student will be required to repeat the failed module(s) in the next year.
  • Any student who fails a remedial exam will repeat the modules.
  • Any student who fails in the final comprehensive qualifying examination is required to work under supervision for 5 months duration and re-examined.
  • Presnt complete , signed and approved Assessement tools (CBD,DOP,PCE,Continous assessment) at the end of each Module.

Graduation requirement will be according to each university rule and regulation. Thus, a student enrolled in the Post Basic BSc anesthesia program is eligible for graduation if and only if he/she has taken all the required Modules for the program and obtained a minimum CGPA of 2.

Student should be able to pass comprehensive exam of the school, both in theory and practice before graduation.

  • Has not scored ‘F’ grade in any module, and should not score ‘D’ grade in any professional (core) module.
  • Has carried out a student research project on a selected and agreed topic of research problem and scored a minimum of ‘C’ grade in his/her thesis report.
  • Present approved and signed log/performance book with a minimum of 250 cases of which the graduate:
  • Performs pre-anesthetic assessment for 250 clients
  • Performs 200 endotracheal intubations
  • Performs of 20 LMA insertions
  • Performs of 200 endotracheal and/or LMA extubation
  • Performs 50 intravenous cannulation
  • Major General Anesthesia for 200 cases
  • Attended 15 pediatrics &/ or Neonatal Anesthesia
  • Delivers Anesthesia for 50 Obstetrics clients
  • Handles 30 emergency cases requiring Anesthesia
  • Provided sedation (analgesia) without intubation for 20 cases
  • Performs minimum of 50 regional blocks (caudal, spinal, abdominal field blocks and peripheral nerve blocks etc.)
  • Produce thesis
  • Student must pass Final Year Comprehensive Exam
  • Internal exam 40% (written -10%, Oral (10%), OSCE (10% ) & Progressive ass’t – 10% and External examination 60% (practical & oral); this is non-credited but is Passed or failed.
  • If a student can’t pass the exam he /she will be delayed for 5 months and re-examined.
  • Examined by group senior Anesthesia professionals from different universities

Degree Nomenclature
Upon completion of the Four years program, the graduate will be awarded the degree of ‘Bachelor of Science in Anesthesia’ and in Amharic ‘የሳይንስ ባችለር ዲግሪ በአንስቴዝያ’
Medium of instruction
The medium of instruction will be English language.
Duration and total load of the study
The program will be completed in four academic years for regular post basic program.
The Total Load of the program is 250 ECTS.