Residency Program Curriculum

PGY-1 residents will have an early opportunity to gain foundational medical knowledge and skills in preparation for their transitions to the clinical anesthesia training years. PGY-1 residents are immersed in a paradigm that allows them to have one day per month in the operating room with a subsequent structured didactic curriculum. This will provide for a smooth transition with decreased distress into the operating rooms in the clinical anesthesia years by emphasizing the basics of anesthesia, patient safety and system-based practice while maintaining engagement and promoting a stronger clinical foundation.

The sessions will provide exposure to fundamental skills such as:

• Preoperative assessment
• Operating Room (OR) set up
• Communications in the OR
• Drug administration
• Airway management
• IV insertion
• Physiologic monitoring
• Critical event recognition
• Sedation
• Pain management

Residents will participate in a hands-on 10-part interactive and multipart airway management series that is integrated into the 4U Didactic Program. Basic and advanced airway management components will provide residents with the background of medical knowledge, skills and hands-on dexterity needed to confidently manage diverse and challenging scenarios of airway management.

Our grand rounds presentations contain vetted quality lectures that cover a wide spectrum of topics, including clinical, leadership and research expertise, that is presented by department faculty, residents, fellows, experts from UCI Health and experts from our Visiting Professor Program. The visiting professors frequently give an interactive lecture to residents the day before grand rounds and allows for an opportunity for residents to gain further education and networking for future career plans.

The leadership development series will help residents learn the fundamental skills and knowledge to become an effective leader, learn about conflict management styles, emotional intelligence, principles of teamwork and performance improvement. Through assigned reading, self-reflection and small group discussions, residents will understand their strengths and weaknesses as a leader.

An annual mock Objective Structured Clinical Examination (OSCE) session has been developed to prepare CA-2 and CA-3 residents for a new component of their board certification. A comprehensive review of the mock OSCE examination is provided after every session.

Residents cycle through seven, eight-minute testing stations that focus on any of these skill sets:

• Informed consent
• Treatment options
• Peri-procedural complications
• Ethical issues
• Communication with other professionals
• Practice-based learning and improvement
• Interpretation of monitors
• Interpretation of echocardiograms
• Application of ultrasonography

The mock OSCEs are based on the ABA Content Outline and include standardized patients, ultrasound models, simulated exam rooms and monitors. Standardized checklists are used to evaluate residents on communication and professionalism, as well as understanding and application of medical knowledge.

Point-of-Care Ultrasound (POCUS) has been an expanding part of perioperative care and has become a large focus in anesthesia residency training. Residents learn through lectures as well as hands-on scanning of live models during POCUS sessions to maximize knowledge and skills retention. Residents will gain more exposure and experience with this technique and apply POCUS in their daily practice.

PGY-1s have a two-week ultrasound rotation with the focus on the basics of POCUS which allows for early exposure to the ultrasound curriculum to form the basis for workshops in the clinical anesthesia years.

Simulation education provides an immersive learning environment where residents will practice the management of common critical events and rare anesthetic crises in a controlled setting and supportive learning environment. A particular emphasis is placed on developing skills in leadership, communication and critical decision-making in a variety of clinical situations, including multidisciplinary team-based sessions in the hospital itself. Simulation sessions are often led by simulation trained faculty and staff where residents will have a paramount, supportive and open learning experience.

First year residents will participate in an Anesthesia Crisis Resource Management simulation. For CA-1, CA-2 and CA-3 residents, simulation sessions are scheduled throughout the year, covering a wide variety of topics and subspecialty scenarios for each clinical anesthesia year.

During the first month of orientation, CA-1s participate in an introductory series of simulation which includes:

• Anesthesia machine, monitors and equipment
• Induction and airway management
• Hemodynamic changes during anesthesia
• Emergence from anesthesia and immediate post-anesthetic care issues
• Hypoxia, hypercarbia and increased peak airway pressure
• Hands-on workshops

CA-1 residents are introduced to TEE using the HeartWorks TEE Simulator. A series of TEE simulation workshops for CA-2 and CA-3 residents includes practical examination and demonstration of general competency with the TEE examination.

In recognition of the stressors and demands associated with residency training, our goal on wellness is to support residents by fostering a culture that harnesses strength and support from peers, concern for others as colleagues, self-care and understanding one’s emotions. This is important particularly in a medical specialty that has been known for the focus on attention to detail, procedures skills, independence and maintaining composure during stressful situations.

Modeled after Jon Kabat-Zinn’s work on mindfulness-based stress reduction, our wellness program is incorporated throughout the curriculum and utilizes different experiential exercises and didactics to provide a safe place for residents to receive confidential and peer-support during what can be a challenging time in their medical education.

Active learning is far more effective than passive, stand and deliver lecture formats. Our curriculum incorporates multiple hands-on workshops that are led by faculty throughout the residency program. Topics covered in workshops will review and reinforce the knowledge and skills acquired during clinical rotations.

PGY-1 workshops topics include:

• Arterial line
• EKG
• Basic and advanced monitors
• Airway management
• Research (opportunities, IRB application process, evidence-based medicine and basic statistics)

CA-1 workshops topics include:

• Adult and pediatric airway management
• Central and arterial lines
• Spinals, epidurals and ultrasound-guided regional nerve blocks

CA-2 workshops topics include:

• Cardiovascular anesthesia
• Neuraxial anesthesia
• Regional anesthesia
• Pediatric airway
• Advanced monitors and airways

Airway workshops include instruction and practice with fast track LMA, glidescopes, adult and pediatric fiberoptic scopes, double lumen tube and bronchial blocker, retrograde intubation, cricothyrotomy and transtracheal jet ventilation, combitube and exchange catheters.

A specialty cardiovascular workshop designed for CA-3 residents as a review session focuses on TEE, CCO, SVV and Goal-Directed Therapy, Swan-Ganz monitors, interpreting pressure waveforms and common cardiac diseases.