Curriculum
ACGME Residency Review
The Residency Review Committee for Anesthesiology (RRC), operating with accreditation authority delegated to it by the Accreditation Council for Graduate Medical Education reviewed the performance of the Anesthesiology Residency at The University of Tennessee Medical Center at Knoxville in 2004. After completion of the review, the RRC granted Continued Full Accreditation with the next review scheduled in 2014.
Chairman
Jerry L. Epps, M.D. became Chairman of the Department of Anesthesiology in December 2003. He had served as Vice-Chairman of the UTMCK Department of Anesthesiology for the previous fourteen years. Dr. Epps served as Chief of Staff for the University of Tennessee Medical Center at Knoxville from January 1 through December 31, 2006. In addition to his duties as Departmental Chairman, Dr. Epps is also a Senior Oral Board Examiner for the American Board of Anesthesiology, Member of the ACGME Appeals Panel for Anesthesiology, Residency Program Director, Member of the American Board of Anesthesiology Review Panel and Medical Director of Operating Services.
The Clinical Base-Year
The Anesthesiology Residency at the University of Tennessee Graduate School of Medicine (UTGSM) has officially been designated a Categorical Program for the academic year 2011-2012.
The Planned 13 4-week rotation blocks are as follows:
Internal Medicine |
4 |
Medicine Critical Care |
1 |
Pulmonary |
1 |
Cardiology |
1 |
Surgery |
3 |
Anesthesia Surgery Critical Care |
1 |
Emergency Room |
1 |
Anesthesiology |
1 |
Our program has been "functionally" categorical for the past decade with designated internship positions in the Transitional Year and in the Surgical Preliminary year. This year marks a change in designation from Advanced to Categorical.
The interview for the anesthesiology residency is also the interview for the internship positions. No separate interview is necessary.
Affiliated Rotation in Pediatric Anesthesia at Vanderbilt University
In order to expand and improve the educational experience in pediatric anesthesia, residents in anesthesiology have a mandatory two-month rotation at Children's Hospital at Vanderbilt University . As a result of the combined pediatric experience at the University of Tennessee Medical Center in Knoxville as well as the rotation at Children's Hospital, our graduates have no difficulty in meeting the expected numbers and exceeding national percentile rankings in all pediatric age case categories. Housing at a local condominium complex is provided by the UTGSM Department of Anesthesiology at no cost to the resident.
Didactic Program
The Department of Anesthesiology at the University of Tennessee Graduate School of Medicine has had great measure of academic success over the last several years as reflected by the performance of our residents on the In-Training Examination of the American Board of Anesthesiology/American Society of Anesthesiologists as well as the Written Examination (now ABA Part 1) of the ABA.
While much of our success in this area is directly related to the quality of our residents, the average USMLE Part I and II scores have clustered near the median score for their respective class. Our didactic program has made several changes for the past years which help account for our didactic success. These changes include an introductory reading program for our CA-1 residents, an annual lecture series for each year-level of training, year-long oral board examination preparation, problem-based learning discussions, and a weekly preparatory course for Part 1 of the American Board of Anesthesiology Certification examination.
Introductory Reading Program
The Clinical Anesthesia-1 (CA-1) year presents many challenges for anesthesiology residents as they are asked to acquire, assimilate and apply large amounts of new information. In order to facilitate this process for residents at our institution, specific changes were made to the CA-1 curriculum. A structured introductory reading program was initiated utilizing the textbook, Basics of Anesthesiology. This reading program occurs over, approximately, the first ten weeks of the CA-1 year. The program consists of independent reading coupled with weekly faculty-led sessions to assess and encourage completion of the assignment. Additionally, the board review program at our institution was changed and expanded to include CA-1 residents. This program utilizes the textbook, Anesthesiology Review, as a primary reference and consists of weekly one-hour sessions. Each session includes both practice board questions and a faculty-led presentation of the assigned topics. To evaluate the efficacy of our decisions, In-training Examination scores were compared prior to and after these changes. Significant improvement in ITE-1 scores resulted from the addition of an introductory reading program and a board review series to the CA-1 educational curriculum. Because of the improved CA-1 performance, as well as strongly-positive resident feedback, we have established the introductory reading program and the board review series as permanent parts of the CA-1 educational program.
Group |
ITE-1 Score Mean |
ITE-1 Score S.D. |
Unpaired T-Test P Value |
Baseline Group 1 Pre-Curriculum |
18.9 |
5.7 |
|
Baseline Group 2 Post-Curriculum |
20.3 |
17.0 |
0.309 |
CA-1 Group 1 Pre-Curriculum |
26.0 |
12.5 |
|
CA-1 Group-2 Post-Curriculum |
30.2 |
16.8 |
0.009 |
In addition, members of our department shared these ideas at the national meetings of both the Society for Education in Anesthesiology as well as the American Society of Anesthesiology.
Annual Lecture Series for Each Year Level of Training
The lecture series in the Department of Anesthesiology at the University of Tennessee Medical Center at Knoxville differs from most training programs. In contrast to other centers which have a series of lectures which repeat on a two or three-year cycle, each year level (CA-1, CA-2 and CA-3) have separate lecture series which repeat annually with each new class. All of these hour-long lectures occur on Monday at 0600. This time was deliberately chosen so that all residents could attend their individual lectures and virtually eliminated the problems associated with insuring regularly relief from operating room assignments to attend conferences during elective operating schedule time. As an additional benefit, retention of information has been shown to improve when lectures are given in the morning hours as opposed to late afternoon. Also, residents who are on-call the previous night do not have to return for lecture since the residents going “off-call” and those starting call are both physically present.
Each year level lecture series is specifically tailored to the needs and experiences of the residents. The CA-1 lectures series focuses upon the scientific principles and fundamental knowledge base upon which the practice of anesthesiology practice is founded whereas the CA-2 lecture series concentrates on the various subspecialties of cardiac, obstetrical, neurosurgical, pediatric and regional anesthesia. As a result, each year's lecture series helps focus the resident's attention to the types of anesthesia that he is actually administering. CA-3 residents are required to attend either the CA-1 lecture or the CA-2 lecture as a matter of review unless the individual obtains a scaled score of 34 or higher on the ITE examination after two years of training. Past performance as indicated by a scaled score of 34 or higher on the ITE examination has virtually assured the resident of a “passing” score on Written Examination of the ABA (now Part 1). In addition, this incentive of ‘testing out' has proven to be a powerful incentive. In 2007 86% of our CA-2 residents scored 34 or higher on the ITE. In addition, the CA-3 residents attend a mandatory “Transition to Practice” Seminar Series throughout the year. This is a highly regarded series of lectures and question-and-answer sessions about such diverse topics such as billing and coding, job evaluations, and personal finance.
Oral Board Preparation
Every resident in our anesthesiology residency program practices a “mock” oral examination at least once or twice per year. At the beginning of each academic year, each resident receives a schedule listing the oral examination date, examiner and the case vignette. Because the oral board examination is a test of judgment, adaptability, application of knowledge and organization/presentation as opposed to knowledge per se , prior familiarity with the clinical scenario enables first and second year residents to prepare prior to the examination in order to obtain the understanding needed to participate in the examination in order to assess the above listed competencies. In general, five minutes are devoted to pre-operative assessment and then followed by fifteen minutes of questioning regarding intra-operative anesthetic decision-making and management of complications. Ten minutes are left for debriefing and immediate feedback to the resident by the attending anesthesiologist administering the examination. Since this is a mandatory conference for all residents, every resident can participate ‘silently' in the examination and are able to ask questions during the debriefing session. In addition, all CA-3 residents undergo their final mock oral examination without prior knowledge of the clinical scenario to be discussed. This examination is administered by a senior oral board examiner for the American Board of Anesthesiology. In this situation, the examinee receives the clinical scenario ten minutes prior to the start of the examination. Afterwards the examination follows the exact format of the ABA oral board examination and often uses sample questions provided by the ABA . After the conclusion of this thirty-five minute examination, a debriefing session with immediate feedback regarding performance is given. All residents attend this session as well and are encouraged to ask questions about the examinee's responses regarding content as well as style.
Problem-based Learning Discussion
Every resident in our anesthesiology residency program leads an evidenced-based review of a clinical scenario based on the American Society of Anesthesiologists Problem-Based Learning Discussions presented at the ASA's Annual Meeting. Interesting and unusual case scenarios which broaden the educational experience of our residents are chosen by the Chairman of the Education Committee from the PBLD series and assigned to two residents and a faculty mentor. As a requirement for the presentation, the residents are expected to use information technology to find, evaluate and incorporate data from scientific studies for this presentation. The faculty mentor assists the residents by reviewing the results of the literature search and its application to the presentation. This affords the residents an excellent opportunity to gain experience and obtain learning opportunities in all of the ACGME competencies but particularly in practice-based medicine, communication skills and residents as teachers.
Part 1 of the American Board of Anesthesiology Review
A one-hour review session for the Part 1 of the ABA Examination in which all residents participate occurs weekly. The schedule for the topic of discussion for each session is published and the appropriate review material listed at the beginning of the academic year. At the start of each session, questions to test medical knowledge are answered by the residents and the answers graded and returned as part of the resident portfolio. More important than the actual answers, however, is the ensuing discussion led by a member of the anesthesiology faculty regarding the key points and the anesthetic implications of the review material.
Pre-Anesthesia Evaluation and Planning Rotation
This one-month rotation was instituted in the University of Tennessee Medical Center Pre-Anesthesia Clinic in July 2003 in order to prepare residents physicians for the practice of pre-anesthesia evaluation and planning while also serving as a model for full implementation of the ACGME Outcome/Competencies Project into our program. The value of this rotation has been clearly established in the minds of both the anesthesiology residents and our faculty. Hence, our Department of Anesthesiology was pleased to see that the RRC for Anesthesiology has now required this rotation for all residencies and also validating our decision made five years earlier. Resident responsibilities include pre-anesthesia planning, risk assessment, and chart review as well as participating in patient interview and evaluation. The Pre-Anesthesia Clinic is composed of an interdisciplinary team, including the supervising staff anesthesiologist, the resident, nurses, lab technicians, and clerical staff. The Chair of the Education Committee serves as the both the rotation director and a cadre of select members of our department are assigned daily as the supervising anesthesiologist. This rotation was chosen as an example of the complete integration of the competencies into the anesthesiology residency program at the time of our last review because all six competencies are taught and assessed. In addition, a wide spectrum of learning opportunities and assessment methods can be utilized.
Patient Care requirements during this rotation include effective interviewing; caring, respectful counseling of patients and families; education of patients and families; and informed perioperative planning. Within anesthesiology training, this rotation demands a unique spectrum of patient care skills (as outlined by the ACGME). These skills and attitudes are learned through daily clinical experience, teaching from faculty anesthesiologists, and performance feedback from faculty members on a case-by-case basis. Competency evaluation by the rotation director incorporates checklist evaluation of global performance, chart stimulated recall, patient surveys and nursing staff surveys.
Medical Knowledge required for complete pre-anesthesia evaluation encompasses the breadth of medicine. Application of this knowledge is essential for effective pre-anesthesia planning. This knowledge is acquired through guided independent study, formal didactic lectures, and weekly departmental conferences. Literally the entire departmental education program provides learning opportunity. Besides global evaluation by periodic written examinations (AKT series and ABA in-service), competency in this area is also assessed by chart stimulated recall and record review.
Practice-Based Learning and Improvement is readily taught and assessed, as the learning curve for proper pre-anesthetic evaluation and planning is quite steep. Expectations include improvement of patient care through evaluation of personal practice experience and clinical studies, as well as knowledge of study designs and use of information technology. Learning opportunities include daily clinical teaching and performance feedback from anesthesia faculty, monthly departmental journal club and M&M conferences, ready access to online information, and a reading list of evidence-based articles. Competency in this area is assessed by staff evaluation that utilizes chart stimulated recall, check list evaluation of live performance, and global evaluation of live performance during clinical teaching.
