The Department of Anesthesiology

Perioperative Medicine Program Fellowship

Curriculum

PEMBA Program - UTK Haslam College of Business

A preeminent program ranked #1 most relevant Executive MBA worldwide by the 2018 Economist WhichMBA. The program features a one year curriculum (January-December) with exposure to:

• Economics & Policy in Healthcare
• Marketing
• Accounting & Finance
• Healthcare Law Environments & Ethics
• Strategy & Entrepreneurship in Healthcare
• Leadership Development
• Analytics, Information Technology, Operations, and Quality

The program combines weekly online interactive instruction with four one-week long residence periods on campus at the business school. An Organizational Action Project is included with additional details listed below. The PEMBA program is designed for immediate impact and significant return on investment (ROI). The PEMBA program champions a robust alumni network with over 650 physicians from fifty states and ten countries and is the longest running and most highly respected physician-only MBA. Twenty-five hours of CME credits are included after completion of the program. No entrance exams or business prerequisites required.

Clinical Experience and Training

The Perioperative Medicine fellow will gain experience in learning to supervise providers and move toward expertise in medical direction supervision and management at a Level I Trauma Center. The fellow will be expected to average 40-45 hours of clinical work per week, in addition to the 15-20 hours per week focused on clinical enrichment activities and requirements for the PEMBA program. The fellow will not have any weekend or night clinical responsibilities, nor will they take call during the duration of the program.

Perioperative Research and Academics

As part of the PEMBA program curriculum, the fellow will complete an Organizational Action Project (OAP). The purpose of this exercise is to design a project that will improve both patient and organizational outcomes, with deliverables scheduled throughout the year. The fellow will present the finished product to the department at the end of the training program. Additionally, the fellow will participate in other perioperative research and quality improvement initiatives as able through guidance and assistance with ongoing resident projects.

Clinical Enrichment Activities and Consultations

Perioperative Medical Management

• Gain expertise in the design, implementation, and management of clinical care pathways utilizing the Perioperative Surgical Home (PSH) and Enhanced Recovery after Surgery (ERAS) models of care
• Understand evidence-based practices and current perioperative algorithms, including standards and guidelines for operating an efficient Pre-Anesthesia Testing clinic and Post-Anesthesia Care Unit
• Understand key concepts such as perioperative management of anemia, blood transfusion, nutrition, obstructive sleep apnea (OSA), coagulation, cardiac implantable electronic devices (CIEDs), geriatric anesthesia, acute and chronic pain, smoking cessation, diabetes, mental health, prehabilitation, etc.
• Become familiar with population health management and its relation to perioperative medicine
• Understand the relationship between Preoperative Risk Management, Intraoperative Enhanced Recovery, and Postoperative Transition of Care and how they contribute to adding value to patient care

Perioperative Ultrasonography

• Gain expertise with perioperative transthoracic and transesophageal echocardiography (TTE/TEE) with opportunity for Basic Certification in Perioperative TEE
• Gain experience with Perioperative Point-of-Care Ultrasound (POCUS) with a focus on the FORESIGHT (Focused periOperative Risk Evaluation Sonography Involving Gastro-abdominal, Hemodynamic, and Transthoracic) Ultrasound protocol

OR and Practice Management

• Understand the relationship of OR to hospital and healthcare system expenditures and revenues
• Gain expertise with the use of OR efficiency metrics, OR throughput, resource management, fixed vs. variable costs, surgical block utilization, staffing ratios, coding, billing, reimbursements, OR policy and procedure making, legal issues, information technology

Hospital Services

• Understand ASA, CMS, and Joint Commission guidelines for hospitals/ORs
• Learn about the current approaches to cost containment, safe practices, and staff satisfaction at the institutional level
• Participate in organizational-level administration/committee meetings

Patient Safety and Quality Improvement

• Gain expertise in quality and safety metrics for anesthesia and patient safety
• Understand current perioperative quality assurance and safety initiatives
• Become familiar with regulatory affairs, compliance, risk assessment and management
• Participate in hospital-level quality/performance improvement and patient safety meetings
• Provide assistance and guidance with ongoing resident projects

Ambulatory and Non-Operating Room Anesthesia (NORA)

• Gain expertise with standards and infrastructure needed for creating and designing an ambulatory surgery center and/or a NORA procedural site
• Understand special anesthetic considerations with NORA
• Become familiar with cost, accounting, finance, and resource management of ASCs/NORA sites

Multimodal Pain Management

• Understand federal law, state law, and society recommendations regarding pain management, with focus on opioids and opioid-sparing regimens and their incorporation into clinical care pathways
• Understand Joint Commission standards for pain assessment and management
• Gain expertise with novel regional anesthetic techniques
• Become familiar with the design and management of a pain service

Leadership Development and Advocacy Training

• Participate in the Physician Leadership Development Program and attend various leadership development activities
• Understand different leadership styles and strategies with focus on The Theory of Situational Leadership
• Become familiar with current legislative issues surrounding medicine and anesthesiology
• Gain experience with physician advocacy and learn how to be an effective physician advocate
• Attend relevant physician advocacy events at the state and national level as scheduling permits

Advanced Medical Simulation

• Understand the role of simulation in today's practice environment
• Supervise residents/students in interactive simulations and participate in simulations for educational purposes
• Focus on Perioperative POCUS, TTE/TEE, and ACLS/ATLS simulations
• Apply leadership and management skills in a dynamic setting

Didactics and Teaching

The fellow is expected to attend the department's weekly grand rounds conference, and is also encouraged to attend additional resident lectures as scheduling permits. Additionally, the fellow is expected to engage in intraoperative teaching of residents, medical students, and student nurse anesthetists utilizing the Socratic Method of teaching. Also, the fellow will be expected to provide at minimum one resident lecture per academic year on Perioperative Medicine.

National and Regional Conference

The Department of Anesthesiology will support travel to The Washington Campus' Health Care Policy course, or an equivalent conference, during the fellowship program. Additionally, the fellow is encouraged to present their Organizational Action Project (OAP) at any relevant national/regional conference where accepted.