3rd Year Anesthesiology Experience
during Surgical Clerkship 

Goal: To experience and learn about the preoperative, intraoperative and postoperative care of the adult and pediatric surgical patient

Relevance: Primary care physicians are often consulted regarding the medical preparation of their patients for surgery. However, this area is not traditionally covered in medical, pediatric or surgical rotations either for medical students or residents. While there is some exposure to perioperative consultation on such medical specialties as cardiology, these individuals may not possess a specific knowledge of the perioperative concerns represented in these consultations. Furthermore, as primary care physicians become the gatekeepers to (and against) surgical interventions, it is critically important that they are familiar with the entire perioperative period.

Students planning a career in one of the surgical specialties may benefit from an approach to the patient that is a bit different from that usually taken on a surgical rotation. This rotation emphasizes the physiological and pharmacological basis of clinical care in this area. You may find yourselves reviewing your old first and second year texts and lecture notes with a new awareness of how these basic science areas relate to actual patient care. The rotation will also add to the non-operative skills required of surgical specialists.

Given the universal relevance as described above, all medical students are required to take the 3-day rotation in Anesthesiology.

Objectives:

1. Preanesthetic patient evaluation and anesthetic planning

    A.The medical student will understand how patient  momorbidities can affect the anesthetic plan. 

    B.     The medical student will be able to understand potential anesthetic options for a given surgical procedure.

    C.     The medical student will be able to plan an anesthetic for a basic surgical procedure

2. Management of the airway, use of equipment to ensure airway patency, and patient ventilation.

    A.     The medical student will be able to state the signs of the non-patent airway and state steps to be taken to manage the obstructed airway.

    B.     The medical student will be able to demonstrate the proper use of the bag-mask on the patient as well as choose the proper size equipment to be used both for ventilation and intubation.

    C.     The medical student will be able to assess the patient during ventilation to determine that ventilation is adequate both by physical criteria and use of capnography and pulse oximetry.

    D.     The medical student will observe and/or understand alternative procedures for airway management

3. Intraoperative anesthetic management and anesthetic pharmacology

    A.     The medical student will understand basic pharmacologic principles regarding the utilization of intravenous induction agents, neuromuscular blockers, local anesthetics, volatile anesthetic agents, and vasoactive medications.

    B.     The medical student will be able to list and understand the basic ASA-required patient monitors.

    C.     The medical student will observe and learn to treat some of the most common intraoperative complications.

    D.     The medical student will develop technical skills for peripheral vascular access.

    E.     The medical student will be exposed to the principles of invasive monitoring.

4.  Postoperative anesthetic management and pain control

    A.     The medical student will understand some of the most common postoperative complications and their potential etiologies.

B.    The medical student will be able to list possible analgesic modalities and their respective advantages and disadvantages.

Expectations and Instructions:

1. On the first day, meet with Ashley Shilling (PIC# 3302) or her designee for orientation.

2. MUST attend 7AM-8AM surgery lectures Monday and Tuesday. Not all anesthesia residents/attendings will know this - just tell them that Dr. Shilling said you had to go.

3. Attend Anesthesia Grand Rounds from 7AM-9AM on Weds AM. May alternatively attend surgery grand rounds if there is a particular topic of interest to you - let Dr. Shilling know.

4. Attend anesthesia resident conference Monday 4:00PM in OR classroom (pizza/soda provided) if possible. If the OR classroom is unavailable, ask your resident where the conference is held.

5. Anytime during the elective period let Dr. Shilling know if you're interested in any subspecialty experience- eg OB anesthesia, pediatric anesthesia, neuroanesthesia, cardiovascular anesthesia, acute or chronic pain management, ICU.

6.   Lectures and other educational activities will occasionally occur during the day, if such activity is a required part of your surgical clerkship, you are excused from your anesthesiology duties.  Please return to your surgical teams at 2 PM.

7.   Complete Anesthesiology Procedure Log.

Director:  Ashley Shilling, M.D. - Assistant Professor of Anesthesiology