CURRICULUM / STATUTES & REGULATIONS

FOR
5 YEARS DEGREE PROGRAMME
IN
ANAESTHESIOLOGY
(MS Anaesthesiology)
 UNIVERSITY OF HEALTH SCIENCES,
LAHORE

STATUTES

Nomenclature Of The Proposed Course

The name of degree programme shall be MS Anaesthesiology. This name is well
recognized and established for the last many decades worldwide.
Course Title:
MS Anaesthesiology
Training Centers
Department of Anaesthesiology (accredited by UHS) in affiliated instates of
University of Health sciences Lahore.
Duration of Course
The duration of MS Anaesthesiology course shall be five (5) years with
structured training in a recognized department under the guidance of an app
roved supervisor.
Year 1 & 2:
After admission in MS Anaesthesiology Programme the first two years will offer:
a. Introduction and orientation to anesthesiology during the 1 st 6 months.
b. Mandatory workshops (Appendix E).
c. The research project will be designed and the synopsis be prepared during
this period and submitted for aproval by the AS&RB of the university.
d. Core training in Anesthesia and the basic principles of Surgery and Medicine
related to anesthesia. The training in the basic principles of General Surgery and
Internal Medicine will be carried out in the department of Anaesthesia by the
faculty of Anaesthesia.
At the end of 2nd Calender year the candidate shall take up Intermediate
Examination.
Year 3, 4 & 5:
During Year 3 & 4 of the Program, there shall be focus on subspecialty
anesthesia training. Year 5 will allow the resident to focus on subspecialty of
interest and submit the final thesis before the final MS examination.
The candidate will undergo clinical training in the discipline to achieve t he
educational objectives (knowledge & Skills) along with rotation in all the

subspecialties of Anaesthesiology during the 3rd, 4th & 5th years of the
programme. The clinical training shall be competency based. There shall generic
and specialty competencies and shall be assessed by continuous Internal
Assessment. (Appendix F&G).

The Research & thesis Component shall be completed over the five years
duration of the course. Research can be done as one block or it can be done as
regular periodic rotation over five years.

Admission Criteria
Applications for admission to MS Training Programs of will be invited through
advertisement in print and electronic media mentioning closing date of
applications and date of Entry Examination.
Eligibility: The applicant on the last date of submission of applications for
admission must possess the:

i) Basic Medical Qualification of MBBS or equivalent medical qualification

recognized by Pakistan Medical & Dental Council.

ii) Certificate of one year's House Job experience in institutions recognized by

Pakistan Medical & Dental Council Is essential at the time of interview. The
applicant is required to submit Hope Certificate from the concerned Medical
Superintendent that the House Job shall be completed before the Interview.

iii) Valid certificate of permanent or provisional registration with Pakistan

Medical & Dental Council.

Admission will be made through Central Induction policy of the Government of

the Punjab in all PG Institutions.
 Registration and Enrollment

 Total number of students enrolled for the course must not exceed 2 per
supervisor/year.
 The maximum number of trainees that can be attached with a supervisor at a
given point of time (inclusive of trainees in all years/phases of MS training),
must not exceed 6.
 Beds to trainee ratio at the approved teaching site shall be at least 5 beds per
trainee.
 The University will approve supervisors for MS courses.

 Candidates selected for the courses after their enrollment at the relevant
institutions shall be registered with UHS as per prescribed Registration
Regulation.
 Once a resident has joined an Anaesthesia training program, he will not be
allowed to switch from Anaesthesia to another specialty as a result of
upgradation.

Accreditation Related Issues of The Institution

A. Faculty
Properly qualified teaching staff in accordance with the requirements of
Pakistan Medical and Dental Council (PMDC)

B. Adequate Space
Including class-rooms (with audiovisual aids), demonstration rooms, computer lab
and clinical pathology lab etc.

C. Library
Departmental library should have latest editions of recommended books, reference
books and latest journals (National and International).

 Accreditation of Anaesthesiology training program can be suspended on

temporary or permanent basis by the University, if the program does not comply
with requirements for residents training as laid out in this curriculum.
 Program should be presented to the University along with a plan for
implementation of curriculum for training of residents.
 Programs should have documentation of residents training activities and
evaluation on monthly basis.
 To ensure a uniform and standardized quality of training and availability of the
training facilities, the University reserves the right to make surprise vi sits of
the training program for monitoring purposes and may take appropriate action
if deemed necessary.
 AIMS AND OBJECTIVES OF THE COURSE
AIM
The aim of five years MS program in Anaesthesiology is to produce a
trainee/ resident that demonstrate competencies in all six areas:

A. Patient Care and Procedural Skills

Trainee must be able to provide patient care that is compassionate,

appropriate, and effective for the treatment of health problems and the
promotion of health.

Trainee:

Must demonstrate competence in fundamental clinical skills of medicine,

including:

Obtaining a comprehensive medical history;

Performing a comprehensive physical examination;

Assessing a patient’s medical conditions;

Making appropriate use of diagnostic studies and tests;

Integrating information to develop a differential diagnosis; and,

Implementing a treatment plan.

Must demonstrate competence in anesthetic management, including care

for:

Patients younger than 12 years of age undergoing surgery or other

procedures requiring anesthetics;

This experience must involve care for 100 patients younger than 12 years of
age.

Within this patient group, 20 children must be younger than three years of
age, including five younger than three months of age.
Patients who are evaluated for management of acute, chronic, or cancer-
related pain disorders;

This experience must involve care for 20 patients presenting for initial
evaluation of pain.

Trainee must be familiar with the breadth of pain management, including

clinical experience with interventional pain procedures.

Patients scheduled for evaluation prior to elective surgical procedures;

Patients immediately after anesthesia, including direct care of patients in the

post- anesthesia-care unit, and responsibilities for management of pain,
hemodynamic changes, and emergencies related to the post-anesthesia care
unit; and, critically-ill patients.

Trainee must be able to competently perform all medical, diagnostic,

and surgical procedures considered essential for the area of practice.

Trainee:

Must achieve competence in the delivery of anesthetic care to:

Patients undergoing vaginal delivery; this experience must involve care for
40 patients.

Patients undergoing cesarean sections; this experience must involve care for
20 patients.

Patients undergoing cardiac surgery; this experience must involve care for
20 patients. The care provided to 10 of these patients must involve the use
of cardiopulmonary bypass.

Patients undergoing non-cardiac intrathoracic surgery, including pulmonary

surgery and surgery of the great vessels, esophagus, and the mediastinum
and its structures; this experience must involve care for 20 patients.

Patients undergoing intracerebral procedures, including those undergoing

intracerebral endovascular procedures; this experience must involve care for
20 patients, the majority of which must involve an open cranium.
Patients for whom epidural anesthetics are used as part of the anesthetic
technique or epidural catheters are placed for peri-operative analgesia; this
experience must involve care for 10 patients.

Patients undergoing procedures for complex, immediate life-threatening

pathology; this experience must involve care for 20 patients.

Patients undergoing surgical procedures, including cesarean sections, with

spinal anesthetics; this experience must involve care for 40 patients.

Patients undergoing surgical procedures in whom regional/peripheral nerve

blocks are used as part of the anesthetic technique or peri -operative
analgesic management; this experience must involve care for 10 patients.

Patients with acute post-operative pain, including those with patient-

controlled intravenous techniques, neuraxial blockade, and other pain-
control modalities;

Patients whose peri-operative care requires specialized techniques,

including:

A broad spectrum of airway management techniques, to include laryngeal

masks, fiberoptic intubation, and lung isolation techniques, such as double
lumen endotracheal tube placement and endobronchial blockers;

Central vein access; this experience must involve care for 20 patients.

Arterial line access; this experience must involve care for 20 patients.

Patients undergoing a variety of diagnostic or therapeutic procedures outside

the surgical suite.

B. Medical Knowledge

Trainee must demonstrate knowledge of established and evolving

biomedical, clinical, epidemiological and social- behavioral sciences, as well
as the application of this knowledge to patient care.
Trainee:

Must demonstrate appropriate medical knowledge in the topics related to the

anesthetic care of patients, including:

Practice management to address issues such as:

Operating room management;

Evaluation of types of practice;

Contract negotiations;

Billing arrangements;

Legislative and regulatory issues; and, fiscal stewardship of health services

delivery.

Management of the specific needs of patients undergoing diagnostic or

therapeutic procedures outside of the surgical suite.

C. Practice-based Learning and Improvement

Trainee must demonstrate the ability to investigate and

Evaluate their care of patients, to appraise and assimilate

Scientific evidence, and to continuously improve patient care

Based on constant self-evaluation and life-long learning.

Trainee are expected to develop skills and habits to be able to meet

the following goals:

Identify strengths, deficiencies, and limits in one’s knowledge and expertise;

Set learning and improvement goals;

identify and perform appropriate learning activities;
Systematically analyze practice using quality improvement methods, and
implement changes with the goal of practice improvement;

Incorporate formative evaluation feedback into daily practice;

Locate, appraise, and assimilate evidence from scientific studies related to

their patients’ health problems;

Use information technology to optimize learning; and,

Participate in the education of patients, families, students, residents and

other health professionals.

D. Interpersonal and Communication Skills

Trainee must demonstrate interpersonal and communication skills that result

in the effective exchange of information and collaboration with patients, their
families, and health professionals.

Trainee are expected to:

Communicate effectively with patients, families, and the public, as

appropriate, across a broad range of socioeconomic and cultural
backgrounds;

Communicate effectively with physicians, other health professionals, and

health related agencies;

Work effectively as a member or leader of a health care team or other

professional group;

Act in a consultative role to other physicians and health professionals; and,

maintain comprehensive, timely, and legible medical records, if applicable.

Maintain a comprehensive anesthesia record for each patient, including

evidence of pre- and post-operative anesthesia assessment, the drugs
administered, the monitoring employed, the techniques used, the physiologic
variations observed, the therapy provided, and the fluids administered; and,
create and sustain a therapeutic relationship with patients, engage in active
listening, provide information using appropriate language, ask clear
questions, provide an opportunity for comments and questions.

E. Professionalism

Trainee must demonstrate a commitment to carrying out professional

responsibilities and an adherence to ethical principles.

Trainee are expected to demonstrate:

compassion, integrity, and respect for others;

Responsiveness to patient needs that supersedes self- interest;

Respect for patient privacy and autonomy;

Accountability to patients, society and the profession;

Sensitivity and responsiveness to a diverse patient population,

F. Systems-based Practice

Trainee must demonstrate an awareness of and responsiveness to the larger

context and system of health care, as well as the ability to call effectively on
other resources in the system to provide optimal health care.

Trainee is expected to:

Work effectively in various health care delivery settings and systems

relevant to their clinical specialty;

Coordinate patient care within the health care system relevant to their
clinical specialty;

Incorporate considerations of cost awareness and risk-benefit analysis in

patient and/or population- based care as appropriate;

Advocate for quality patient care and optimal patient care systems;

Work in interprofessional teams to enhance patient safety and improve

patient care quality; and,
Participate in identifying system errors and implementing potential systems
solutions.

Curriculum Organization & Rotations

Anesthesia training in Year 1 & 2 will focus on the basic principles and skills,
followed by Year 3&4 with subspecialty training and Year 5 will offer further
subspecialty training. The training in basic principles of Surgery and Medicine
related to Anaesthesia will be carried out in the Department of Anaesthesia
by the faculty of Anaesthesia.

Core training in Anesthesia and Basic Principles of Surgery and

Medicine :(First 2 years)

A. Introduction to Anesthesia (6 months):

1 Preoperative assessment
2. Premedication
3. Post-operative and recovery room care
4. Perioperative management of emergency patients
5. Induction of general anaesthesia
6. Intraoperative care
7. Infection control
8. Management of cardiac arrest in adults and children.
9. Mandatory workshops
10. Synopsis preparation.

B. Core Anaesthesia (18 months):

Basics of Surgery:

1. Basic Airway management & Critical incident management- 2week

2. Day surgery - 2 weeks
3. General Surgery & Trauma - 6 months
4. Urological Surgery- 1 month
5. Gynaecological surgery- 1 month
6. Head, neck, maxillo-facial and dental surgery - 2 weeks
7. Orthopaedic surgery -1 month

Basics of Medicine

1. Intensive care medicine - 2 months

2. Outside theatre - 2 weeks
3. Obstetrics - 3 months
4. Paediatrics- 2 months

Specialty training (Year 3 & 4) - Focus on Subspecialty training (24

months)

Essential units:

1. Anaesthesia for neurosurgery, neuroradiology and neurocritical

care - 1 month
2. Cardiothoracic, Vascular & Thoracic Anaesthesia - 2 months

3. Intensive care medicine - 2 months

4. Day surgery- 2 weeks

5. General Surgery & Trauma and stabilisation - 5 months

6. Urological Surgery - 1 month

7. Gynaecological surgery - 1 month

8. Head, neck, maxillo-facial and dental surgery- 2 weeks

9. Outside theatre - 2week

10. Orthopaedic surgery - 1 month

11. Regional - 1 month

12. Sedation - 2 weeks

13. Obstetrics - 3 months

14. Paediatric - 3 months

15. Pain medicine - 1 month

Minor Rotations:

16. Ophthalmic - 2 weeks

17. Plastics/burns - 2 weeks

Year 5 - Focused Advanced training

May elect to do up to 6 months in two of the following subspecialties:

1. Anaesthesia for Neurosurgery, Neuroradiology and Neurocritical care

2. Cardiothoracic anaesthesia and cardiothoracic critical care

3. Regional

4. Intensive care medicine

5. Obstetrics

6. Paediatric

7. Pain medicine

8. Plastics/burns.

Essential units throughout training:

Domain 1 – Clinical practice

Domain 2 – Team working

Domain 3 – Leadership

Domain 4 – Innovation

Domain 5 – Management

Domain 6 – Education

Non-clinical – Academic and Research, Improvement Science, Safe and

Reliable Systems, Teaching and Learning, Management
 REGULATIONS

Scheme of the Course

A summary of five years course in MS Anaesthesiology is presented as under:

Course Components Examination
Structure

Basic Principal of Surgery & Medicine related Intermediate examination at the

to core Anaesthesia (as outlined in the end of 2nd year of MS
End of curriculum Anaesthesiology programme.
2nd Year  Written Paper
of the MCQs= 100questions
Progra SEQs = 10 questions
mme
 Clinical, TOACS/OSCE & ORAL
 Clinical Examination (Long case,
Short cases
 TOACS/OSCE & ORAL

Clinical component of M.S. Aaesthesiology Final examination in specialized

components of Anaesthesiology at
 Professional Education in Anaesthesiology the end of 5th year of MS
Anaesthesiology programme.
Training in Anaesthesiology during 3rd, 4th &
5th year of MS Anaesthesiology programme,  Written:
with compulsory & optional rotations in relevant Papers 1 & 2: Problem-based
fields questions in the subject
MCQs = 200
SEQs = 10
Paper 1
100 = MCQs
End of
5 = SEQs
5th Year
of the
Paper 2
Progra
100 = MCQs
mme
5 = SEQs

 Clinical, TOACS/OSCE & ORAL

Clinical Examination (Long case,
Short cases )
 Oral Exam

Research component of M.S. Aaesthesiology  Continuous Internal Assessment

Research work/Thesis writing project must Thesis examination with defense at

be completed and thesis be submitted the end of fifth (5th) year of MS
atPleast 6 months before the end of training. Anaesthesiology programme.
 Intermediate Examination M .S. Anaesthesiaology

All candidates admitted in M.S. Anaesthesiaology course shall appear in

Intermediate Examination at the end of 2nd calendar year.

Eligibility Criteria: The candidate of M.S. Anaesthesiaology appearing in

Intermediate Examination of the Programme are required.

a) To have submitted certificate of completion of mandatory workshops.

b) To have submitted certificate of completion of first two years of
training from the supervisor/ Supervisors of rotations.
c) To have submitted CIS assessment proforma from his/her own
supervisor on 03 monthly basis and also from his/her supervisors
during rotation, achieving a cumulative score of 75%.
d) To have submitted certificate of approval of synopsis or undertaking /
affidavit that if synopsis not approved with 30 days of submission of
application for the Intermediate Examination, the candidate will not be
allowed to take the examinations and shall be removed from the
training programme.
e) To have submitted evidence of payment of examination fee.

Intermediate Examination Schedule and Fee

a) Intermediate Examination at completion of two years training, will be

held twice a year.
b) There will be a minimum period of 30 days between submission of
application for the examination and the conduction of examination.
 c) Examination fee will be determined periodically by the University.
d) The examination fee once deposited cannot be refunded / carried over
to the next examination under any circumstances.
e) The Controller of Examinations will issue Roll Number Slips on receipt of
prescribed application form, documents satisfying eligibility criteria and
evidence of payment of examination fee.

Written Part of Intermediate Examination

MCQs = 100 questions

SEQs = 10 questions
50% Principals of Internal Medicine
50% Principals of General Surgery
Total Marks = 300
Clinical, TOACS/OSCE & ORAL

4 Short Courses = 100 Marks

1 Long Course = 50 Marks
TOACS/OSCE & ORAL = 50 Marks

Total = 200

Declaration of Results
The Candidate will have to score 50% marks in written, clinical and
Toacs/OSCE & Oral components and a cumulative score of 60% to be
declared successful in the Intermediate Examination.

A maximum of four consecutive attempts (availed or unavailed) will be

allowed in the Intermediate Examination during which the candidate will be
allowed to continue his training program. If the candidate fails to pass his
Intermediate Examination within the above mentioned limit of four attempts,
the candidate shall be removed from the training program, and the seat
would fall vacant, stipend/ scholarship if any would be stopped.

Final Examination M.S. Anaesthesiology

(at the end of 5th year of the Programme)

Eligibility Criteria:

To appear in the Final Examination the candidate shall be required:

 i) To have submitted the result of passing Intermediate Examination .

ii) To have submitted the certificate of completion of training, issued

by the Supervisor which will be mandatory.

iii) To have achieved a cumulative score of 75% in Continuous Internal

assessments of all training years .

iv) To have got the thesis accepted and will then be eligible to appear in
Final Examination.

v) To have submitted no dues certificate from all relevant departments

including library, hostel, cashier etc.

vi) To have submitted evidence of submission of examination fee .

Final Examination Schedule and Fee

a) Final examination will be held twice a year.

b) The candidates have to satisfy eligibility criteria before permission is

granted to take the examination.

c) Examination fee will be determined and varied at periodic intervals by

the University.

d) The examination fee once deposited cannot be refunded / carried over

to the next examination under any circumstances .

e) The Controller of Examinations will issue an Admittance Card with a

photograph of the candidate on receipt of prescribed application form,
 documents satisfying eligibility criteria and evidence of payment of
examination fee. This card will also show the Roll Number, date / time
and venue of examination.

Components of Final Examination

Written Part of Final Examination Total marks 500

Clinical & Toacs/OSCE & Oral Total marks 500
Contribution of CIS to the Final Examination Total marks 100
Thesis Evaluation Total marks 400

Written Part of Final Examination

a) There will be two written papers which will cover the whole syllabus of
the specialty of training with total marks of 500 .

b) The written examination will consist of 200 single best answer type
Multiple Choice Questions (MCQs) and 10 Short Essay Questions
(SEQs). Each correct answer in the Multiple Choice Question paper will
carry 02 marks, but an incorrect response will result in deduction of
0.5 marks. Each Short Essay Question will carry 10 marks .

c) The Total Marks of the Written Examination will be 500 to be divided

as follows :

 Multiple Choice Question paper Total Marks = 400

 Short Essay Question paper Total Marks = 100

d) The candidates scoring 50% marks in multiple choice question paper

and short essay question paper will pass the written part of the final
 examination and will become eligible to appear in the clinical and oral
examination.

e) The written part result will be valid for three consecutive attempts for
appearing in the Clinical and Oral Part of the Final Examination. After
that the candidate shall have to re-sit the written part of the Final
Examination.

Clinical and Toacs/OSCE & Oral

a) The Clinical and Oral Examination will consist of 04 short cases, 01 long case
and Oral Examination with 01 station for a pair of Internal and External
Examiner Each short case will be of 07 minutes duration, 05 minutes will be
for examining the patient and 02 minutes for discussion. The Oral
Examination will consist of laboratory data assessment, interpretation of
Radiology images, ECG and others.

b) The Total Marks of Clinical & Oral Examination will be 500 and to be divided
as follows:

Short Cases Total Marks = 200

Long Case Total Marks = 100
TOACS/OSCE & ORAL Total Marks = 200

c) A panel of four examiners will be appointed by the Vice Chancellor and of

these two will be from UHS whilst the other two will be the external
examiners. Internal examiner will act as a coordinator. In case of difficulty
in finding an Internal Examiner in a given subject, the Vice Chancellor
would, in consultation with the concerned Deans, appoint any relevant
person with appropriate qualification and experience, outside the
University as an examiner.
 d) The internal examiners will not examine the candidates for whom they
have acted as Supervisor and will be substituted by other internal
examiner.

e) The candidates scoring 50% marks in each component of the Clinical & Oral
Examination will pass this part of the Final Examination.

f) The candidates will have two attempts to pass the final examination with
normal fee. A special administration fee of Rs.10,000 in addition to normal
fee or the amount determined by the University from time to time shall be
charged for further attempts.
Declaration of Result

For the declaration of result

I. The candidate must get his/her Thesis accepted.
II. The candidate must have passed the final written examination with
50% marks and the clinical & oral examination securing 50% marks.
The cumulative passing score from the written and clinical/ oral
examination shall be 60%. Cumulative score of 60% marks to be
calculated by adding up secured marks of each component of the
examination i.e written and clinical/ oral and then calculating its
percentage.
III. The MS degree shall be awarded after acceptance of thesis and
success in the final examination.
IV. On completion of stipulated training period, irrespective of the result
(pass or fail) the training slot of the candidate shall be declared
vacant.
 Submission / Evaluation of Synopsis

1. The candidates shall prepare their synopsis as per guidelines provided by

the Advanced Studies & Research Board, available on university website.
2. The research topic in clinical subject should have 30% component related
to basic sciences and 70% component related to applied clinical sciences.
The research topic must consist of a reasonable sample size and sufficient
numbers of variables to give training to the candidate to conduct
research, to collect & analyze the data.
3. Synopsis of research project shall be submitted by the end of the 2nd year
of MS program. The synopsis after review by an Institutional Review
Committee, shall be submitted to the University for consideration by the
Advanced Studies & Research Board, through the Principal / D0ean /Head
of the institution.

Submission of Thesis

1. Thesis shall be submitted by the candidate duly recommended by the

Supervisor.
2. The minimum duration between approval of synopsis and submissi on of
thesis shall be one year.
3. The research thesis must b0e compiled and bound in accordance with the
Thesis Format Guidelines approved by the University and available on
website.
4. The research thesis will be submitted along with the fee prescribed by the
University.
 Thesis Examination

a) The candidate will submit his/her thesis at least 06 months prior to

completion of training.

b) The Thesis along with a certificate of approval from the supervisory will be
submitted to the Registrar’s office, who would record the date / time etc.
and get received from the Controller of Examinations within 05 working
days of receiving.

c) The Controller of Examinations will submit a panel of eight examiners

within 07 days for selection of four examiners by the Vice Chancellor. The
Vice Chancellor shall return the final panel within 05 working days to the
Controller of Examinations for processing and assessment. In case of any
delay the Controller of Examinations would bring the case personally to the
Vice Chancellor.

d) The Supervisor shall not act as an examiner of the candidate and will not
take part in evaluation of thesis.
e) The Controller of Examinations will make sure that the Thesis is submitted
to examiners in appropriate fashion and a reminder is sent after every
fifteen days.

f) The thesis will be evaluated by the examiners within a period of 06 weeks.

g) In case the examiners fail to complete the task within 06 weeks with 02
fortnightly reminders by the Controller of Examinations, the Controller of
Examinations will bring it to the notice of Vice Chancellor in person.

h) In case of difficulty in find an internal examiner for thesis evaluation, the

Vice Chancellor would, in consultation with the concerned Deans, appoint
any relevant person as examiner in supersession of the relevant Clause of
the University Regulations.

i) There will be two internal and two external examiners. In case of difficulty
in finding examiners, the Vice Chancellor would, in consultation with the
concerned Deans, appoint minimum of three, one internal and two external
examiners.

j) The total marks of thesis evaluation will be 400 and 60% marks will be
required to pass the evaluation.

k) The thesis will be considered / accepted, if the cumulative score of all the
examiners is 60%.

l) The clinical training will end at completion of stipulated training period but
the candidate will become eligible to appear in the Final Examination at
completion of clinical training and after acceptance of thesis. In case clinical
training ends earlier, the slot will fall vacant after stipulated training period.
 Award of MS Anaesthesiology Degree
After successful completion of the structured courses of MS Anaesthesiology and
qualifying Intermediate and Final examinations (written, Clinical, TOACS/OSCE &
ORAL and Thesis), the degree with title MS Anaesthesiology shall be awarded.
 CURRICULUM
TABLE OF CONTENTS

For Intermediate Module

I. Basic Principles of Surgery & Medicine related to Anesthesia

A. BASIC SCIENCES

 I.A.1 Anatomy

 I.A.2 Physics, Monitoring, and Anesthesia Delivery Devices

 I.A.3 Mathematics

 I.A.4 Pharmacology

B. CLINICAL SCIENCES:

Anesthesia Procedures, Methods, and Techniques

 I.B.1 Evaluation of the Patient and Preoperative Preparation.

 I.B.2 Regional Anesthesia

 I.B.3 General Anesthesia

 I.B.4 Monitored Anesthesia Care and Sedation

 I.B.5 Intravenous Fluid Therapy During Anesthesia

 I.B.6 Complications (Etiology, Prevention, Treatment)

 I.B.7 Postoperative Period

C. ORGAN-BASED BASIC AND CLINICAL SCIENCES

 I.C.1 Central and Peripheral Nervous Systems

  I.C.2 Respiratory System

 I.C.3 Cardiovascular System

 I.C.4 Gastrointestinal / Hepatic Systems

 I.C.5 Renal and Urinary Systems/ Electrolyte Balance

 I.C.6 Hematologic System

 I.C.7 Endocrine and Metabolic Systems

 I.C.8 Neuromuscular Diseases and Disorders

D. SPECIAL PROBLEMS OR ISSUES IN ANESTHESIOLOGY

 I.D.1 Physician Impairment or Disability: Substance Abuse, Fatigue,

Aging, Visual and Auditory Impairment

 I.D.2 Ethics, Practice Management, and Medicolegal Issues

 FOR FINAL EXAMINATION

II. Advanced Topics in Anesthesiology

A. BASIC SCIENCES

 II.A.1 Physics, Monitoring, and Anesthesia Delivery Devices

 II.A.2 Pharmacology
B. CLINICAL SCIENCES: Anesthesia Procedures, Methods, and
Techniques.

 II.B.1 Regional Anesthesia

 II.B.2 Special Techniques

C. ORGAN-BASED BASIC AND CLINICAL SCIENCES.

 II.C.1 Central and Peripheral Nervous Systems

 II.C.2 Respiratory System

 II.C.3 Cardiovascular System

 II.C.4 Gastrointestinal / Hepatic Systems

 II.C.5 Renal and Urinary Systems / Electrolyte Balance: Clinical Science

 II.C.6 Hematologic System

 II.C.7 Endocrine and Metabolic Systems: Clinical Science

 II.C.8 Neuromuscular Diseases and Disorders: Clinical Science

D. CLINICAL SUBSPECIALTIES.

 II.D.1 Painful Disease States

 II.D.2 Pediatric Anesthesia

 II.D.3 Obstetric Anesthesia

 II.D.4 Otorhinolaryngology (ENT) Anesthesia: Airway Endoscopy;

Microlaryngeal Surgery; Laser Surgery, Hazards, Complications
(Airway Fires, Etc.)

 II.D.5 Anesthesia for Plastic Surgery, Liposuction

  II.D.6 Anesthesia for Laparoscopic Surgery; Cholecystectomy;
Gynecologic Surgery; Gastric Stapling; Hiatus Hernia Repair;
Anesthetic Management; Complications

 II.D.7 Ophthalmologic Anesthesia, Retrobulbar and Peribulbar Blocks;

Open Eye Injuries

 II.D.8 Orthopedic Anesthesia; Tourniquet Management,

Complications, Regional vs. General Anesthesia

 II.D.9 Trauma Anesthesia

 II.D.10 Anesthesia for Ambulatory Surgery

 II.D.11 Geriatric Anesthesia/Aging

 II.D.12 Critical Care

E. SPECIAL PROBLEMS OR ISSUES IN ANESTHESIOLOGY

 II.E.1 Electroconvulsive Therapy

 II.E.2 Organ Donors: Pathophysiology and Clinical Management

 II.E.3 Radiologic Procedures; CT Scan; MRI-Anesthetic

Implications/Management, Anesthesia in Locations Outside the
Operating Rooms

 II.E.4 Ethics, Practice Management, and Medicolegal Issues

Basic Topics in Anesthesiology

A. Basic Sciences

1. Anatomy

a. Topographical Anatomy as Landmarks

1) Neck: Cricothyroid Membrane, Internal and External Jugular Veins,
Thoracic Duct, Carotid and Vertebral Arteries, Stellate Ganglion, Cervical
Spine Landmarks (Vertebra Prominens, Chassaignac’s Tubercle)

2) Chest: Pulmonary Lobes, Cardiac Landmarks, Subclavian Vein

3) Pelvis and Back: Vertebral Level of Topographical Landmarks, Caudal
Space 4) Extremities: Relationship of Bones, Nerves, and Arteries
5) Dermatome Anatomy: Sensory and Motor

b. Radiological Anatomy
1) Chest (Including CT and MRI)
2) Brain and Skull (Including CT and MRI)
3) Spine (Cervical, Thoracic, Lumbar), Including CT and MRI
4) Neck (Including Doppler Ultrasound for Central Venous Access)

c. Clinical Anatomy

1) Upper Extremity

a) Bones
b) Vasculature c) Innervation

2) Lower Extremity a) Bones

b) Vasculature

c) Innervation
2. Physics, Monitoring, and Anesthesia Delivery Devices

a. Mechanics
1) Pressure Measurement of Gases, Liquids

2) Transducers, Regulators, Medical Gas Cylinders

3) Principles of Ultrasound: Obtaining an Image, Resolution, Depth,
Frequency, Resonance b. Flow Velocity

1) Viscosity-Density; Laminar-Turbulent Flow 2) Flowmeters: Rotameter

3) Principles of Doppler Ultrasound

I.A.2

c. Properties of Liquids, Gases, and Vapors

1) Diffusion of Gases
2) Solubility Coefficients
3) Relative and Absolute Humidity

4) Critical Temperature, Critical Pressure d. Gas Laws

e. Vaporizers

1) Vapor Pressure and Calculation of Anesthetic Concentrations 2) Vaporizer

Types and Safety Features

f. Uptake and Distribution of Inhalation Agents

1) Uptake and Elimination Curves; Effect of Ventilation, Circulation,

Anesthetic Systems 2) Concentration Effect
3) Second Gas Effect
4) Nitrous Oxide and Closed Spaces

g. Physics of Anesthesia Machine/ Breathing System

1) Principles: Resistance, Turbulent Flow, Mechanical Deadspace,

Rebreathing, Dilution, Leaks, Gas Mixtures, Humidity, Heat

2) Components: Connectors, Adaptors, Mask, Endotracheal Tube, Reservoir

Bag Unidirectional Valves, Corrugated Breathing Tubes, Laryngeal Mask
Airways, Airway Pressure Relief Valve

3) Characteristics

a) Circle Systems: Closed and Semi-Closed; Adult; Pediatric

b) Non-Circle Systems: Insufflation; Open; Semi-Open

c) Portable Ventilation Devices (Self-Reinflating, Non-Self-Reinflating), Non-

Rebreathing Valves

d) CO2 Absorption: Principles, Canisters, Efficiency

e) Toxicity: Compound A, Carbon Monoxide

4) Oxygen Supply Systems: FiO2
5) Waste Gas Evacuation Systems
6) Safety Features (Proportioning Devices, Rotameter Configuration,
Pressure Fail-Safe)

h. Monitoring Methods
1) Neuromuscular Function: Nerve Stimulators, Electromyography (Emg)
2) Ventilation: Respirometers, Inspiratory Force, Spirometry, Flow-Volume
Loops 3) Gas Concentrations: O2, CO2, Nitrogen, Anesthetic Gases and
Vapors
4) Temperature
5) Oxygen: Oximetry, Co-Oximetry, Pulse Oximetry

I.A.2.h

6) Blood Pressure - Noninvasive, Invasive

7) Heart Function: Heart Tones, Electrocardiogram i. Instrumentation

1) Arterial and Venous Blood Gases: Electrodes for pH, PO2, PCO2,
Calibration, Temperature Corrections, Errors

2) Gas Concentrations: Infrared Absorption, Mass Spectrometry, Raman

Scatter Analysis

3) Pressure Transducers: Resonance, Damping

4) Non-Invasive Blood Pressure (BP) Measurement: Doppler, Oscillometry,

Korotkoff Sounds, Palpation
5) Blood Warmers, Autotransfusion Devices

6) Body Warming Devices: Forced Air, Heating Lamps, Insulation Devices,

Warming Blankets, Water-Flow “Second Skin” Devices

j. Ventilators

1) Classifications: Flow Generation vs. Pressure Generation

2) Principles of Action: Assistors, Controllers, Assist-Control; Pressure-

Limited, Volume-Limited; FiO2 Control; Periodic Sigh, Inverse Ratio, High
Frequency Ventilation, Intermittent Mandatory Ventilation (IMV),
Synchronized IMV, Pressure Support, Airway Pressure Release Ventilation
(APRV), Pediatric Adaptation, Non-Invasive Techniques: Biphasic Positive
Airway Pressure (BIPAP), Others

3) Monitors; Pressure (Plateau, Peak), Oxygen, Apnea,

Inspiratory/Expiratory Ratio, Dynamic Compliance, Static Compliance

k. Alarms and Safety Features: Operating Room, Electrical, Anesthesia

Machine, Ventilators, Capnometer, Oxygen, Hemodynamic Monitors

l. Defibrillators: Automatic Internal, External, Implantable; Energy,

Cardioversion, Types of Waveforms (Monophasic, Biphasic); Paddle Size and
Position; Automated External Defibrillators (AEDs)

m. Electrical; Fire and Explosion Hazards; Basic Electronics

1) Source of Ignition; Static

2) Prevention: Grounding, Isolation Transformers
3) Macro and Micro Current Hazards
4) Safety Regulations; National Fire Protection Association (NFPA) Standards
5) Risk Factors for Intraoperative Fire 3. Mathematics

a. Simple Math: Logarithms; Graph of Simple Equations; Exponential

Function, Analysis of Biologic Curves

b. Statistics: Sample and Population; Probability; Mean, Median, and Mode;

Standard Deviation and Error; T-Test; Chi-Square; Regression
Analysis/Correlation; Analysis of Variance, Power Analysis, Meta-Analysis,
Confidence Intervals, Odds Ratio, Risk Ratio, Bland-Altman Plot

I.A

4. Pharmacology
a. General Concepts

1) Pharmacokinetics and Pharmacodynamics, Protein Binding; Partition

Coefficients; PKA; Ionization; Tissue Uptake; Compartmentalization and
Exponential Models

a) Pharmacokinetics of Neuraxial Drug Administration: Epidural and

Subarachnoid

b) Tolerance and Tachyphylaxis 2) Termination of Action

a) Elimination; Biotransformation; Context-Sensitive Half-Time

b) Impact of Renal Disease

c) Impact of Hepatic Disease

3) Drug Interactions
a) Enzyme Induction and Inhibition
b) Hepatic Blood Flow
c) Drug-Drug Binding
d) Alternative and Herbal Medicines: Perioperative Implications

4) Drug Reactions (Anaphylactoid, Anaphylaxis, Idiosyncratic)

b. Anesthetics-Gases and Vapors

1) Physical Properties
2) Mechanism of Action
3) Effects on Central Nervous System (CNS)
4) Effects on Cardiovascular System
5) Effects on Respiration
6) Effects on Neuromuscular Function
7) Effects on Renal Function
8) Effects on Hepatic Function
9) Effects on Hematologic and Immune Systems
10) Biotransformation and Toxicity
11) Minimum Alveolar Concentration (MAC), Factors Affecting Mac
12) Trace Concentrations, OR Pollution, Personnel Hazards
13) Comparative Pharmacodynamics

c. Anesthetics-Intravenous (Opioid and Non-Opioid Induction and Anesthetic

Agents)

1) Opioids

a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics

(1) Intravenous

I.A.4.c.1.b

(2) Epidural and Intrathecal

a) Metabolism and Excretion

b) Effect on Circulation
c) Effect on Respiration
d) Effect on Other Organs
e) Side Effects and Toxicity
f ) Indications and Contraindications

2) Barbiturates

a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics
c) Metabolism and Excretion
d) Effect on Circulation
e) Effect on Respiration
f) Effect on Other Organs
g) Side Effects and Toxicity
h) Indications and Contraindications

3) Propofol

a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics
c) Metabolism and Excretion
d) Effect on Circulation
e) Effect on Respiration
f) Effect on Other Organs
g) Side Effects and Toxicity
h) Indications and Contraindications

4) Etomidate

a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics
c) Metabolism and Excretion
d) Effect on Circulation
e) Effect on Respiration
f) Effect on Other Organs
g) Side Effects and Toxicity
h) Indications and Contraindications

I.A.4.c

5) Benzodiazepines

a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics
c) Metabolism and Excretion
d) Effect on Circulation
e) Effect on Respiration
f) Effect on Other Organs
g) Side Effects and Toxicity
h) Indications and Contraindications
i) Antagonism

6) Ketamine

a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics
c) Metabolism and Excretion
d) Effect on Circulation
e) Effect on Respiration
f) Effect on Other Organs
g) Side Effects and Toxicity
h) Indications and Contraindications

7) Dexmedetomidine

a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics
c) Metabolism and Excretion
d) Effect on Circulation
e) Effect on Respiration
f) Effect on Other Organs
g) Side Effects and Toxicity
h) Indications and Contraindications

d. Anesthetics - Local
1) Uptake, Mechanism of Action
2) Biotransformation and Excretion
3) Comparison of Drugs and Chemical Groups
4) Prolongation of Action
5) Local Anesthetic Side Effects
a) CNS: Seizures, Cauda Equina Syndrome, Transient Neurological Symptom

I.A.4.d.5
b) Cardiac
c) Allergy
d) Preservatives/Additives
e) Methemoglobinemia
f) Local Anesthetic Systemic Toxicity

i. American Society for Regional Anesthesia Checklist for Local Anesthetic

Systemic

Toxicity
ii. Intravenous Lipid Emulsion for Local Anesthetic Systemic Toxicity

e. Muscle Relaxants (Depolarizing, Non-Depolarizing)

1) Mechanism of Action
2) Pharmacokinetics and Pharmacodynamics, Abnormal Responses
3) Prolongation of Action; Synergism
4) Metabolism and Excretion
5) Side Effects and Toxicity
6) Indications and Contraindications
7) Antagonism of Blockade
8) Drug Interactions (Antibiotics, Antiepileptics, Lithium, Magnesium,
Inhalational Anesthetics)

B. Clinical Sciences: Anesthesia Procedures, Methods, and Techniques

1. Evaluation of the Patient and Preoperative Preparation

a. Physical Examination Including Airway Evaluation b. Laboratory Evaluation

1) American Society of Anesthesiologists (ASA) Preoperative Testing

Guidelines

2) American College of Cardiology/American Heart Association Guidelines for

Perioperative Cardiovascular Evaluation
c. ASA Physical Status Classification
d. Preparation for Anesthesia/Premedication

1) Interaction with Chronic Drug Therapy; Interaction with Anesthetic Agents

2) Adverse Reactions to Premedications; Patient Variability, Dose Response

Curves, Side Effects

3) Specific Problems in Disease States: Hyperthyroidism and

Hypothyroidism, Drug Abuse, Glaucoma, Uremia, Increased CSF Pressure,
Chronic Steroid Ingestion, Obesity, Obstructive Sleep Apnea, Depression,
COPD, Hypertension

4) Pediatric and Geriatric Doses, Routes of Administration

5) Role in Patients with Allergies

6) NPO and Full Stomach Status; Implications for Airway Management,

Choice of Anesthesia Technique and Induction of Anesthesia; Gastric
Emptying Time; Preoperative; Full Stomach and Induction of Anesthesia;
Practice Guidelines for Preoperative Fasting

a) Alteration of Gastric Fluid Volume and pH, Sphincter Tone

I.B.1.d

7) Continuation vs. Discontinuation of Chronic Medications:

Antihypertensives, Anti-Anginal, Antihyperglycemics, Antidepressants,
Platelet Inhibitors, Etc.

8) Prophylactic Cardiac Risk Reduction: Beta-Adrenergic Blockers, Etc.

9) Prophylactic Antibiotics

a) Indications
b) Risks of Administration
c) Drug Interactions
2. Regional Anesthesia
a. General Topics: Premedication, Patient Position, Equipment, Monitoring
and Sedation
b. Spinal, Epidural, Caudal, Combined Spinal/Epidural

1) Indications, Contraindications
2) Sites of Actions
3) Factors Influencing Onset, Duration, and Termination of Action
4) Systemic Toxicity, Test Dose
5) Complications; Precipitating Factors, Prevention, Therapy, Implications of
Anticoagulants and Platelet Inhibitors: American Society of Regional
Anesthesia and Pain Medicine (ASRA) Guidelines
6) Physiologic Effects (GI, Pulmonary, Cardiac, Renal)

c. IV Regional: Mechanism, Agents, Indications, Contraindications,

Techniques, Complications
d. Transversus Abdominis Plane Blocks: Indications, Risks, Side Effects

3. General Anesthesia
a. Stages and Signs of Anesthesia; Awareness Under Anesthesia
b. Techniques: Inhalational, Total Intravenous, Combined
Inhalational/Intravenous
c. Airway Management

1) Assessment/Identification of Difficult Airway: Anatomic Correlates,

Mallampati Classification, Range of Motion

2) Techniques for Managing Airway: Awake vs. Asleep, Use vs. Avoidance of
Muscle Relaxants, Drug Selection, Retrograde Intubation Techniques, ASA
Difficult Airway Algorithm

3) Devices: Flexible Fiberoptic, Rigid Fiberoptic, Transillumination,

Laryngoscope Blades, Alternative Intubating Devices, Video Laryngoscopes

4) Alternatives and Adjuncts: Laryngeal Mask Airway (Traditional and

Modified), Esophageal Obturator Airways, Occlusive Pharyngeal Airways
5) Transcutaneous Or Surgical Airway: Tracheostomy, Cricothyroidotomy,
Translaryngeal Or Transtracheal Jet Ventilation

6) Endobronchial Intubation: Double-Lumen Endobronchial Tubes; Bronchial

Blockers, Placement and Positioning Considerations, Postoperative
Considerations

7) Intubation and Tube Change Adjuncts: Bougies, Jet Stylettes, Soft and
Rigid Tube Change Devices; Complications

I.B.3.c

8) Endotracheal Tube Types: Tube Material (Polyvinyl Chloride, Silicone,

Laser-Resistant, Silver Impregnated, Other), Tube Tip Design (Murphy Eyes,
Flexible Tip, Moveable Tip, Short- Bevel), Cuff Design (High vs. Low
Volume/Pressure, Cuffed Vs Uncuffed, Cuff Shape), Cuff Pressure
Management (Lanz Valves, Active Management, Pilot Balloon, Inflation
Valve), Specific Tube Types (Wire-Reinforced, Nasal and Oral Rae®,
Microlaryngeal, Supraglottic Secretion Suctioning, Other),
Microlaryngoscopy; Laser Safe

d. ASA Monitoring Standards

4. Monitored Anesthesia Care and Sedation

a. Techniques
b. Risks and Complications
c. ASA Guidelines for Sedation, Sedation Guidelines for Non-
Anesthesiologists d. Indications/Contraindications

5. Intravenous Fluid Therapy During Anesthesia

a. Water, Electrolyte, Glucose Requirements and Disposition

b. Crystalloid vs. Colloid

c. Fluid Requirements and Fluid Deficit Calculations
d. Normal Saline vs. Lactated Ringers' vs. Plasmalyte vs. D5W e. Enhanced
Recovery After Surgery Protocol for Fluid Therapy

6. Complications (Etiology, Prevention, Treatment) a. Trauma

1) Upper Airway, Epistaxis
2) Larynx, Trachea, and Esophagus
3) Eyes: Corneal Abrasions, Blindness, Post-op visual loss
4) Vascular; Arterial and Venous Thrombosis; Thrombophlebitis; Sheared
Catheter, Intra- Arterial Injections, Air Embolism, Cardiac/Vascular
Perforations, Pulmonary Artery Rupture

5) Neurological: Pressure Injuries of Mask, Tourniquet, Body Position,

Intraneural Injections, Retractors, Peripheral Neuropathies

6) Burns
b. Chronic Environmental Exposure; Fertility, Teratogenicity, Carcinogenicity,
Scavenging c. Temperature

1) Hypothermia: Etiology, Prevention, Treatment, Complications (Shivering,

O2 Consumption), Prognosis

2) Nonmalignant Hyperthermia; Complications, Treatment d. Bronchospasm

e. Anaphylaxis

1) Latex Allergy 2) Other

I.B.6

f. Laryngospasm
g. Postobstructive Pulmonary Edema h. Aspiration of Gastric Contents
i. Malignant Hyperthermia

1) Genetics

2) Pathophysiology 7. Postoperative Period

a. Pain Relief
1) Pharmacologic

a) Drugs: Opioids, Agonist-Antagonists, Local Anesthetics, Alpha-2 Agonists,

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), N-Methyl-D-Aspartate
(NMDA) Receptor Blockers, tricyclic antidepressants (TCA), selective
serotonin reuptake inhibitor (SSRI)
b) Routes: Oral, Subcutaneous (SC), Transcutaneous, Transmucosal,
Intramuscular (IM), Intravenous (IV), Including Patient-Controlled Analgesia
(PCA), Epidural, Spinal, Interpleural, Other Regional Techniques

2) Other Techniques; Transcutaneous Electrical Nerve Stimulation (TENS);

Cryotherapy; Acupuncture, Hypnosis

b. Respiratory Consequences of Anesthesia and of Surgical Incisions

c. Cardiovascular Consequences of General and Regional Anesthesia:

Differential Diagnosis and Treatment of Postoperative Hypertension and
Hypotension

d. Nausea and Vomiting

1) Physiology; Etiology; Risk Factors, Preventive Strategies

2) Use of Antacids, Histamine-2 (H2) Blockers, Metoclopramide, Transdermal

Scopolamine, Droperidol, Serotonin Antagonists, Proton Pump Inhibitors,
Dexamethasone, Multimodal Therapy, Acupressure/Acupuncture

e. Neuromuscular Consequences: Residual Paralysis, Muscle Soreness,

Recovery of Airway Reflexes

f. Neurologic Consequences of Anesthesia: Confusion, Delirium, Cognitive

Dysfunction, Failure to emerge from anesthesia

C. Organ-Based Basic and Clinical Sciences

1. Central and Peripheral Nervous Systems

a. Physiology 1) Brain

a) Cerebral Cortex; Functional Organization

b) Subcortical Areas: Basal Ganglia, Hippocampus, Internal Capsule,

Cerebellum, Brain Stem, Reticular Activating System

c) Cerebral Blood Flow

(1) Effect of Perfusion Pressure, Ph, PaCO2, PaO2, and Cerebral Metabolic
Rate for O2 (CMRO2); Inverse Steal; Gray vs. White Matter

I.C.1.a.1.c

(2) Autoregulation: Normal, Altered, and Abolished

(3) Pathophysiology of Ischemia/Hypoxia: Global vs. Focal, Glucose Effects,

Effects of Brain Trauma or Tumors

d) Cerebrospinal Fluid

(1) Formation, Volume, Composition, Flow and Pressure

(2) Blood-Brain Barrier, Active and Passive Molecular Transport Across,

Causes of Disruption

(3) Relation to Blood Chemistry and Acid-Base Balance e) Cerebral

Protection

(1) Hypothermia

(2) Anesthetic and Adjuvant Drugs 2) Spinal Cord

a) General Organization b) Spinal Reflexes

c) Spinal Cord Tracts
d) Evoked Potentials

3) Neuromuscular and Synaptic Transmission

a) Morphology; Receptors, Receptor Density

b) Membrane Potential; Mechanism

c) Action Potential; Characteristics, Ion Flux

d) Synapse; Transmitters, Precursors, Ions, Termination of Action,

Transmission Characteristics, Presynaptic and Postsynaptic Functions

4) Skeletal Muscle Contractions; Depolarization, Role of Calcium,

Actin/Myosin; Energy Source and Release
5) Pain Mechanisms and Pathways
a) Nociceptors and Nociceptive Afferent Neurons, Wind-Up Phenomenon
b) Dorsal Horn Transmission and Modulation
c) Spinal and Supraspinal Neurotransmission and Modulation; Opioid
Receptors d) Autonomic Contributions to Pain; Visceral Pain Perception and
Transmission e) Social, Vocational and Psychological Influences on Pain
Perception
f) Gender and Age Differences in Pain Perception

6) Autonomic Nervous System

a) Sympathetic: Receptors; Transmitters, Synthesis; Storage; Release;

Responses; Termination of Action

b) Parasympathetic: Receptors; Transmitters; Synthesis; Releas e;

Responses; Termination of Action

c) Ganglionic Transmission

I.C.1.a.6

d) Reflexes: Afferent and Efferent Limbs 7) Temperature Regulation

a) Temperature Sensing; Central, Peripheral

b) Temperature Regulating Centers; Concept of Set Point

c) Heat Production and Conservation

d) Heat Loss; Mechanisms
e) Body Temperature Measurement; Sites; Gradients
f) Effect of Drugs/Anesthesia on Temperature Regulation

b. Anatomy 1) Brain

a) Cerebral Cortex
(1) Cerebellum, Basal Ganglia, Major Nuclei and Pathways

(2) Brain Stem

(a) Respiratory Centers

(b) Reticular Activating System
(3) Cerebral Circulation; Circle of Willis, Venous Sinuses and Drainage

2) Spinal Cord and Spine

a) Variations in Vertebral Configuration
b) Spinal Nerves (Level of Exit, Covering, Sensory Distribution)

c) Blood Supply
d) Sacral Nerves: Innervation of Pelvic Structures

3) Meninges: Epidural, Subdural and Subarachnoid Spaces

4) Parasympathetic Nervous System: Location of Ganglia, Vagal Reflex
Pathways
5) Sympathetic Nervous System: Ganglia, Rami Communicantes,
Sympathetic Chain

a) Cranial Nerves
b) Carotid and Aortic Bodies, Carotid Sinus
c) Ganglia, Rami Communicantes, Sympathetic Chain

d) Nociception

(1) Peripheral Nociceptors: Transduction

(2) Afferent Pathways: Neurons, Dorsal Horn, CNS Pathways

2. Respiratory System
a. Physiology: Lung Functions and Cellular Processes

1) Lung Volumes
a) Definitions; Methods of Measurement; Normal Values; Time Constants

I.C.2.a.1

b) Spirometry; Static and Dynamic Volumes; Deadspace; Nitrogen Washout,

O2 Uptake, CO2 Production, Exercise Testing

2) Lung Mechanics

a) Static and Dynamic Compliance, Pleural Pressure Gradient, Flow-Volume

Loops and Hysteresis, Surfactant, Laplace Law
b) Resistances; Principles of Gas Flow Measurement

c) Methods of Measurement
d) Work of Breathing
e) Regulation of Airway Caliber

3) Ventilation - Perfusion
a) Distribution of Ventilation
b) Distribution of Perfusion, Zones, Hypoxic Pulmonary Vasoconstriction c)
Alveolar Gas Equation

4) Diffusion
a) Definition, Pulmonary Diffusion Capacity b) Apneic Oxygenation, Diffusion
Hypoxia

5) Blood Gas

a) O2 Transport; O2 Physical Solubility; Oxyhemoglobin (Hb-O2) Saturation,

Hb-O2 Dissociation Curve; 2,3-Diphosphoglycerate (2,3-DPG), P50,
Respiratory Enzymes; Hemoglobin (Hb) As A Buffer

b) CO2 Transport; Blood CO2 Content; Carbonic Anhydrase; CO2

Dissociation Curve; Bohr Effect, Haldane Effect

c) Systemic Effects of Hypercarbia and Hypocarbia d) Systemic Effects of

Hyperoxia and Hypoxemia e) Basic Interpretation of Arterial Blood Gas

6) Control of Ventilation
a) Respiratory Center

b) Central and Peripheral Chemoreceptors; Proprioceptive Receptors;

Respiratory Muscles and Reflexes; Innervation

c) CO2 and O2 Response Curves

7) Non-Respiratory Functions of Lungs: Metabolic, Immune 8) Perioperative
Smoking

a) Physiologic effects

b) Cessation of smoking b. Anatomy

1) Nose
2) Pharynx: Subdivisions; Innervation

I.C.2.b

3) Larynx
a) Innervation; Muscles; Blood Supply; Cartilages

b) Vocal Cords, Positions with Paralysis

c) Differences Between Infant and Adult

4) Trachea
a) Structure and Relationships in Neck and Chest

5) Muscles of Respiration, Accessory Muscles c. Pharmacology

1) Bronchodilators a) β-agonists

b) Anticholinergics
2) Antiinflammatory medications

a) Steroids
b) Leukotriene modifier drugs
c) Mast cell stabilizers
d) Immunoglobulin E (IgE) blockers

3. Cardiovascular System a. Physiology

1) Cardiac Cycle
a) Control of Heart Rate
b) Synchronicity of Pressure, Flow, ECG, Sounds, Valve Action

c) Impulse Propagation
d) Normal ECG
e) Electrophysiology; Ion Channels and Currents

2) Ventricular Function
a) Frank-Starling Law; Preload and Afterload, Intracardiac Pressures
b) Force, Velocity, Length, Rate of Shortening
c) Myocardial Contractility, Measurement Limitations
d) Cardiac Output: Determinants and Regulation
e) Myocardial Oxygen Utilization
f) Systolic and Diastolic Function
g) Cardiac Output: Fick Principle

3) Venous Return
a) Vascular Compliance/Venous Capacitance; Controlling Factors

b) Muscle Action; Intrathoracic Pressure; Body Position

I.C.3.a.3

c) Blood Volume and Distribution

4) Blood Pressure

a) Systolic, Diastolic, Mean, and Perfusion Pressures

b) Intracardiac, Pulmonary, Venous
c) Systemic and Pulmonary Vascular Resistance, Viscosity

d) Baroreceptor Function

5) Microcirculation
a) Capillary Diffusion; Osmotic Pressure, Starling’s Law

b) Pre-Post

Capillary Sphincter Control

c) Viscosity; Rheology

6) Regional Blood Flow and Its Regulation a) Cerebral and Spinal Cord
b) Coronary
c) Pulmonary

d) Renal
e) Splanchnic – Hepatic f) Muscle and Skin
g) Uterine and Placental
7) Regulation of Circulation and Blood Volume
a) Central: Vasomotor Center, Hypothalamic-Pituitary-Adrenal Axis
b) Peripheral: Receptors and Reflexes
c) Hormonal Control
d) Mixed Venous Oxygen Tension and Saturation
8) Basics of Cardiopulmonary Resuscitation; Medications, Defibrillators,
Advanced Cardiac Life Support (ACLS) Algorithms

b. Anatomy
1) Normal Anatomy of Heart and Major Vessels

a) Coronary Circulation

b) Heart Conduction System c. Pharmacology

1) Digitalis; Actions and Toxicity

2) Inotropes
3) Phosphodiesterase III Inhibitors (Inodilators): Milrinone, Others

4) Antiarrhythmics
5) Antianginal Drugs

I.C.3.c

6) Vasodilators: Nitroprusside, Nitroglycerin, Hydralazine, Nesiratide,

Calcium Channel Blockers, Others

7) Angiotensin Converting Enzyme Inhibitors and Angiotensin Blockers

8) Electrolytes (Potassium, Magnesium, Phosphorus, Calcium):

Cardiovascular Effects 9) Non-Adrenergic Vasoconstrictors: Vasopressin and

Congeners

4. Gastrointestinal / Hepatic Systems a. Physiology: Hepatic Function

1) Dual Blood Supply and Its Regulation

2) Metabolic and Synthetic Functions
3) Excretory Functions
4) Mechanisms of Drug Metabolism and Excretion, Cytochrome P450
b. Enhanced Recovery After Surgery for Colorectal Surgery 5. Renal and
Urinary Systems/ Electrolyte Balance

a. Physiology
1) Blood Flow, Glomerular Filtration, Tubular Reabsorption and Secretion 2)
Renal Function Tests
3) Hormonal Regulation of Extracellular Fluid
4) Hormonal Regulation of Osmolality
5) Regulation of Acid-Base Balance
6) Drug Excretion
7) Water and Electrolytes: Distribution and Balance; Compartments
8) Renin-Angiotensin-Aldosterone System

b. Pharmacology 1) Diuretics

a) Mechanism of Action
b) Comparison of Drugs
c) Effect on Electrolytes and Acid-Base Balance d) Adverse Effects

2) Dopaminergic Drugs 6. Hematologic System

a. Pharmacology
1) Anticoagulants, Antithrombotics, and Anti-Platelet Drugs

a) Mechanism of Action b) Comparison of Drugs c) Drug Interaction

I.C.6.a.1

d) Monitoring of Effects
e) Side Effects and Toxicity

f) Alternatives to Transfusion: Hemodilution, Sequestration, Autotransfusion,

Blood Substitutes, Erythropoietin

2) Immunosuppressive and Anti-Rejection Drugs

b. Transfusions

1) Indications
2) Blood Preservation, Storage

3) Blood Filters and Pumps

4) Effects of Cooling and Heating; Blood Warmers

5) Blood Components, Volume Expanders

6) Preparation for Transfusion: Type and Cross, Type and Screen,

Uncrossmatched Blood, Autologous Blood, Designated Donors

7) Synthetic and Recombinant Hemoglobins c. Reactions to Transfusions

1) Febrile
2) Allergic
3) Hemolytic: Acute and Delayed

d. Complications of Transfusions
1) Infections: Hepatitis, Human Immunodeficiency Virus (HIV),
Cytomegalovirus (CMV), Others 2) Citrate Intoxication
3) Electrolyte and Acid Base Abnormalities
4) Massive Transfusion: Coagulopathies, Hypothermia
5) Pulmonary

a)Transfusion-Related Acute Lung Injury

b)Transfusion-Related Circulatory Overload 6) Immunosuppression

7. Endocrine and Metabolic Systems a. Physiology

1) Hypothalamus, Pituitary; Thyroid; Parathyroid, Adrenal Medulla, Adrenal

Cortex and Pancreas

b. Biochemistry of Normal Body Metabolism 1) Carbohydrates

a) Aerobic and Anaerobic Utilization; Chemical Processes, Enzymes

b) Relationship to Hormones; Insulin; Human Growth Hormone,

Glucocorticoids; Glucagon, Epinephrine
c) Effect of Stress

I.C.7.b

2) Proteins
a) Functions, Hormones, Antibodies
b) Cyclic Adenosine Monophosphate (CAMP); Cyclic Guanosine
Monophosphate (CGMP) c) Lipids: Triglycerides, Lipoproteins, Cholesterol

(1) Specific Organ Metabolism (Brain, Heart, Liver, Muscle) 8.

Neuromuscular Diseases and Disorders

a. Physiology of Neuromuscular Transmission

1) Prejunctional Events: Acetylcholine Synthesis and Release, Modulation By

Nicotinic and Muscarinic Prejunctional Receptors

2) Postjunctional Events: Acetylcholine Binding to Acetylcholine Receptors,

Ion Flow Through Acetylcholine Receptor

b. Anatomy of the Neuromuscular Junction

1) Prejunctional Components: Motor Neurons, Neuronal Transport System,
Synaptic Vesicles 2) Postjunctional Components: Muscle Cell, Acetylcholine
Receptor
3) Perijunctional voltage-gated channels

D. Special Problems Or Issues in Anesthesiology

1. Physician Impairment Or Disability: Substance Abuse, Fatigue, Aging,

Visual and Auditory Impairment.

2. Ethics, Practice Management, and Medicolegal Issues

a. Professionalism and Licensure

b. Ethics, Advance Directives/Do Not Resuscitate (DNR) Orders;

Suspended DNR, Patient Privacy Issues.

c. Informed consent (principles, components)

 d. Patient Safety
1) Medication Errors: Assessment and Prevention
2) Disclosure of Errors to Patients

e. Core Competencies

II. Advanced Topics in Anesthesiology

A. Basic Sciences

1. Physics, Monitoring, and Anesthesia Delivery Devices a. Monitoring

Methods

1) Vascular Pressures: Arterial (Invasive/Noninvasive Differences), Central

Venous (CVP), Pulmonary Arterial (PAP), Pulmonary Artery Occlusion
(PAOP), Left Atrial (LAP), Left Ventricular End-Diastolic (LVEDP)

2) Heart Function: Heart Tones, Electrocardiogram (ECG), Echocardiography,

Doppler, Cardiac Output

3) Brain and Spinal Cord Function: Electroencephalogram (EEG) (Raw and

Processed), Depth of Anesthesia Monitors (Bispectral, Other), Evoked
Potentials, Wake-Up Test, Intracranial Pressure (ICP), Jugular Venous
Oxygen Saturation, Near Infrared Spectroscopy (Cerebral Oximetry),
Transcranial Doppler

4) Mixed Venous Oxygen Saturation (SvO2)

5) Awareness Monitors

B. Instruments:

1) Cardiac Output: Fick, Dye Dilution, Thermodilution, Doppler, Impedance,

Pulse Wave Analysis, Stoke Volume Assessment

2) Echocardiography: Technical Aspects, Complications

3) Coagulation Monitors
4) Ultrasound-Guided Placement of Invasive Catheters (Arterial, Central
Venous) and Nerve Blocks

c. Ventilators

1) Continuous Positive Airway Pressure (CPAP) and Positive End-Expiratory

Pressure (PEEP); Nasal CPAP

2) Nebulizers, Humidifiers, Drug Delivery Systems (Nitric Oxide, Others )

D. Pacemakers

1) Temporary Transvenous; Permanent (Epicardial, Endocardial),

Transcutaneous

2) Types: Fixed Rate, Biventricular Synchronized, Ventricular, Atrial, Atrio-

Ventricular (A-V) Sequential

3) Standard Nomenclature

4) Reasons for Failure or Malfunction e. Electrical; Fire and Explosion

Hazards

1) Basic Electronics
2) Lasers, Laser Safety, Laser-Safe Endotracheal Tubes

II.A.1

f. Drug Delivery Devices: Patient-Controlled Intravenous and Epidural

Analgesia, Epidural and Subarachnoid Continuous Drug Delivery Devices

2. Pharmacology
a. General Concepts

1) Pharmacogenetics
a) Malignant Hyperthermia (Including Diagnosis and Therapy) b)
Butyrylcholinesterase (Pseudocholinesterase) Deficiency c) Prolonged Qt
Syndrome
d) Genetic Factors in Drug Dose-Response Relationships
2) Addiction
a) Physiology and Pharmacology
b) Patient Addiction: Anesthetic Implications c) Addiction vs. Tolerance

B. Clinical Sciences: Anesthesia Procedures, Methods, and Techniques 1.

Regional Anesthesia

a. Peripheral and Autonomic Nerve Blocks: Indications, Contraindications,

Techniques, Clinical Assessment, Complications, Use of Nerve Stimulators,
Use of Ultrasound

1) Head and Neck

2) Upper Extremity/Brachial Plexus 3) Trunk and Perineum
4) Lower Extremity

2. Special Techniques
a. Controlled Hypotension; Choice of Drugs, Use of Posture, Ventilation
b. Controlled Hypothermia; Techniques, Systemic Effects, Shivering,
Rewarming, Complications c. Hyperbaric Oxygen and Anesthesia Care
d. High Altitude Anesthesia

C. Organ-Based Advanced Clinical Sciences 1. Central and Peripheral

Nervous Systems

a. Physiology
1) Metabolism: Substrates, Aerobic and Anaerobic 2) Intracranial Pressure

a) Brain Volume, Elastance and Compliance

b) Increased ICP, Herniation 3) Electroencephalography (EEG)

a) Wave Patterns, Frequency and Amplitude, Raw and Processed, Spectral

Edge

II.C.1.a.3

b) Sleep, Convulsions; O2 and CO2; Hypothermia; Brain Death

c) Depth of Anesthesia; Burst Suppression, Electrical Silence, Specific

Anesthetic and Drug Effects
4) Evoked Responses
a) Morphology, Effects of Ischemia and Anesthetics
b) Sensory: Somatosensory, Visual, Brainstem Auditory c) Motor

b. Anatomy

1) Regional Anesthesia; Main Nerve Blocks (Includes Techniques and

Comparisons of Techniques)

a) Autonomic: Stellate, Celiac, Lumbar Sympathetic

b) Head and Neck: Retrobulbar/Peribulbar, Facial, Trigeminal Nerve and

Branches, Cervical Plexus, Glossopharyngeal, Superior Laryngeal,
Transtracheal, Occipital

c) Extremities: Brachial Plexus (Interscalene, Supraclavicular,

Infraclavicular, Axillary), Ulnar, Radial, Median, Musculocutaneous, Sciatic,
Femoral, Lateral Femoral Cutaneous, Obturator, Lumbar Plexus (PSOAS
Block), Popliteal Fossa, Ankle Block

d) Trunk: Intercostal, Paravertebral Somatic, Ilio-Inguinal, Genito-Femoral

e) Spine: Epidural (Cervical, Thoracic, Lumbar, Caudal, Transforaminal),

Spinal (Subarachnoid), Combined Spinal-Epidural, Facet

c. Pharmacology

1) CNS Drugs for Non-Anesthetic Use (Major Actions, Comparison of Drugs;

Effect on Respiration; Circulation, Adverse Effects)

a) Pre- and Postanesthetic Medications (1) Opioids

(2) Opioid Antagonists, Agonist-Antagonists

b) Alpha-2 Agonists: Clonidine, Dexmedetomidine
c) Tranquilizers: Butyrophenones; Benzodiazepines
d) Anticonvulsants: Phenytoin, Carbamazepine, Gabapentin, Barbiturates,
Others e) Antidepressants, Anti-Parkinson Drugs
f) Arousal Agents: Physostigmine, Benzodiazepine Antagonists
g) Antiemetics and Aspiration Prophylaxis: Phenothiazines; Butyrophenones;
Metoclopramide; Anticholinergics; Serotonin

Antagonists, Antihistamines (H1 Blockers, H2 Blockers, Mixed Blockers),

Antacids, Proton Pump Inhibitors

h) Substance Abuse and Addiction; Dependence

(1) Chronic Opioid Dependence and Therapy
(2) Pharmacologically-Assisted Opioid withdrawal

2) Autonomic Drugs a) Sympathetic

II.C.1.c.2.a

(1) Transmitters and Types of Receptors (2) Target Organ Effects; Metabolic
Effects

(3) Agonists: Peripheral and Central Actions, Direct and Indirect Actions,
Alpha vs. Beta vs. Mixed Agonists, Alpha and Beta-Receptor Subtype-
Selective Agonists

(4) Antagonists: Alpha and Beta Blockers, Selective Blockers, Ganglionic

Blockers

(5) Tocolytic Applications b) Parasympathetic

(1) Transmitters
(2) Muscarinic Effects
(3) Nicotinic Effects
(4) Agonists: Cholinergic and Anticholinesterases (5) Antagonists

d. Clinical Science
1) Central Nervous System

a) Seizures

b) Coma: Traumatic, Infectious, Toxic-Metabolic, Cerebrovascular Accident

(CVA), Cerebral Hypoxia
(1) Glasgow Coma Scale, Management of Traumatic Brain Injury

(2) Therapeutic Barbiturate Coma

c) Drug Intoxication (CNS Drugs, Carbon Monoxide, Insecticides, Nerve
Gases) d) Paraplegia, Quadriplegia, Spinal Shock, Autonomic Hyperreflexia

(1) Airway Management in the Patient with Cervical Spine Disease e)

Tetanus

f) Special Problems of Anesthesia for Neurosurgery

(1) Increased Intracranial Pressure: Tumors, Hematomas, Hydrocephalus
(2) Positioning: Prone, Sitting, Other, Head Stabilization in Tongs
(3) Air Embolism
(4) Cerebral Protection from Hypoxia, Ischemia, Glucose Effects
(5) Aneurysms and A-V Malformations, Cerebral Vasospasm
(6) Interventional Neuroradiology; Coils and Embolization
(7) Pituitary Adenomas, Trans-Sphenoidal Hypophysectomy
(8) Anesthetic and Ventilatory Effects on Cerebral Blood Flow and
Metabolism

(9) Fluid Management: Hypertonic Vs Isotonic Saline vs. Balanced Salt

Solutions

II.C.1.d.1.f

(10) Spinal Fluid Drainage

(11) Stereotactic and Gamma-Knife Techniques, Deep Brain Stimulator

Placement, Intra-Operative Wake-Up Techniques

(12) Ventriculostomy

(13) Awake Craniotomy 2. Respiratory System

a. Physiology: Lung Functions and Cellular Processes 1) Ventilation -

Perfusion

a) Measurement of Ventilation/Perfusion (V/Q) Ratio, Implications of

Alveolar-Arterial O2 Gradient (A-aDO2), Arterial-Alveolar CO2 Gradient (A-
aDCO2), Dead Space to Tidal Volume Ratio (Vd/Vt), Shunt Fraction (Qs/Qt),
Lung Scan

b. Anatomy 1) Lungs

a) Divisions and Bronchoscopic Anatomy b) Bronchial and Pulmonary

Circulations
c) Microscopic Anatomy

c. Biochemistry
1) Normal Acid-Base Regulation: Buffer Systems; Compensatory
Mechanisms; 2) Effects of Imbalance on Electrolytes and Organ Perfusion;
3) Strong Ionic Difference (SID);
4) ABG Interpretation;

a) Anion Gap;

b) Temperature Effect on Blood Gases: Alpha-Stat vs. pH-Stat d. Clinical

Science

1) Respiratory System
a) Obstructive Disease

(1) Upper Airway: Congenital, Infectious, Neoplastic, Traumatic, Foreign

Body, Obstructive Sleep Apnea

(2) Tracheobronchial: Congenital, Infectious, Neoplastic, Traumati c, Foreign

Body

(3) Parenchymal: Asthma, Bronchitis, Emphysema, COPD, Lung Abscess,

Bronchiectasis, Cystic Fibrosis, Mediastinal Masses

b) Restrictive Disease

(1) Neurologic: CNS Depression, Spinal Cord Dysfunction, Peripheral

Nervous System

(2) Musculoskeletal: Muscular, Skeletal, Obesity, Chest Trauma

II.C.2.d.1.b
(3) Parenchymal: Atelectasis, Pneumonia, Interstitial Pneumonitis,
Pulmonary Fibrosis, Respiratory Distress Syndrome (ARDS),
Bronchopulmonary Dysplasia

(4) Pleural and Mediastinal: Pneumo-, Hemo-, and Chylothorax, Pleural

Effusion, Empyema, Bronchopleural Fistula

(5) Other: Pain, Abdominal Distention

c) Management of the Patient with Respiratory Disease

(1) Evaluation: History and Physical Examination, Chest X-Ray, Arterial

Blood Gases (ABGs), Pulmonary Function Tests (PFTs); Assessment of
Perioperative Risk

(2) Anesthetic Management

(a) Preoperative Preparation: Respiratory Therapy, Drug Therapy

(Antibiotics, Bronchodilators, Mucolytics, Steroids), Tobacco Smoking
Cessation (Techniques to Assist Patients, Benefits)

(b) Intraoperative Management (1) Monitoring

(2) Choice of Anesthesia

(3) Anesthetic Techniques: Nonpulmonary Surgery, Thoracic and Pulmonary

Surgery, One-Lung Ventilation, Thoracoscopic Techniques, Lung
Transplantation, Mediastinoscopy

(c) Postoperative Care: Pain Management, Respiratory Therapy, Ventilator

Support, Extubation Criteria

(3) Management of Respiratory Failure

(a) Nonventilatory Respiratory Management: O2 Therapy and Toxicity,

Tracheobronchial Toilet, Positive Airway Pressure, Respiratory Drugs

(b) Ventilatory Management

(1) Criteria for Ventilatory Commitment and Weaning

(2) Mode of Ventilation: Conventional Mechanical Ventilation, Peep, CPAP,
IMV, SIMV, Pressure Support, Pressure Control, High Frequency Ventilation
(Positive Pressure, Jet, Oscillation), Prone Ventilation, BIPAP, Airway
Pressure-Release Ventilation

(3) Complications and Side Effects of Mechanical Ventilation: Volutrauma,

Barotrauma, Biotrauma

(4) Management of Bronchospasm: Bronchodilator Drugs, Anti-

Inflammatory Drugs, Acute and Chronic Management, Perioperative
Management

(c) Other Management Adjuncts: Nitric Oxide, Steroids (d) Lung

Transplantation: Anesthetic Implications

II.C

3. Cardiovascular System
a. Normal Anatomy of Heart and Major Vessels

1) Echocardiographic Heart Anatomy: Chambers, Valves, Great Vessels,

Pericardium, Basic Transesophageal Echocardiography (TEE) Views

2) Radiographic: Roentgenograms, CT, MRI

3) Other
b. Clinical Sciences

1) Ischemic Heart Disease

a) Risk Factors; Predictors of Perioperative Risk, Modification of Perioperative

Risk (e.g., Prophylactic Beta-Blockers)

b) Manifestations

c) Diagnosis of Myocardial Infarction and Acute Coronary Syndrome; Clinical,

ECG, Enzymes, Echocardiography, Nuclear Techniques,

d) Classification of types of MI (STEMI vs. demand)

e) Pharmacological Treatment of Angina, Thoracic Epidural for Angina,
Interventional Cardiologic Techniques

f) Determinants of Myocardial Oxygen Requirements and Delivery, Silent

Ischemia, Postoperative Ischemia

g) Perioperative Diagnosis and Treatment of Ischemia; ECG, TEE

h) Coronary Artery Bypass Procedures; Cardiopulmonary Bypass; of F-Pump

Techniques

2) Valvular Heart Disease

a) Classification
b) Diagnosis (Including Echocardiography), Natural History, Surgical

Management c) Anesthetic Considerations

d) Subacute Bacterial Endocarditis Prophylaxis

3) Rhythm Disorders and Conduction Defects

a) Chronic Abnormalities: Etiology, Diagnosis, Therapy

(1) Automated Implantable Cardioverter/Defibrillator (AICD) Implantation

(2) Pacemakers: Permanent, Temporary, Transvenous, Transcutaneous;

Ventricular Synchronization

(3) Ablations, Cryotherapy, Maze Procedure

b) Perioperative Dysrhythmia: Etiology, Diagnosis, Therapy

c) Perioperative Implications of Pacemaker and AICD

4) Heart Failure and Cardiomyopathy (Ischemic, Viral, Hypertrophic)

a) Definition and Functional Classification, Perioperative Diagnosis and
Treatment b) Compensatory Responses

c) Right or Left Ventricular Dysfunction

II.C.3.b.4.c

(1) Etiology
(2) Signs and Symptoms
(3) Diagnostic Tests
(4) Systolic vs. Diastolic Dysfunction

d) Treatment
(1) Pulmonary Edema

(2) Pulmonary Hypertension

(3) Cardiogenic Shock e) Cardiac Transplantation

5) Cardiac Tamponade and Constrictive Pericarditis

a) Etiology

b) Diagnosis; TEE, PA Catheter

c) Anesthetic Management 6) Circulatory Assist

a) Cardiopulmonary Bypass
(1) Components (Pump, Oxygenator, Heat Exchanger, Filters) (2)

b) Cardiopulmonary Bypass Techniques

(3) Mechanisms of Gas Exchange

(4) Priming Solutions, Hemodilution

(5) Anticoagulation and Antagonism; Activated Clotting Time (ACT) and

Other Clotting Times, Heparin Assays, Antithrombin III, Protamine
Reactions, Heparin and Protamine Alternatives

(6) Prophylaxis with Aminocaproic Acid, Tranexamic Acid

(7) Anesthetic Considerations During Bypass
(8) Extracorporeal Membrane Oxygenation (ECMO)
(9) Cooling and Warming, Deep Hypothermic Circulatory Arrest (10)
Monitoring, Blood Pressure Management

(11) Minimally Invasive Bypass Techniques

(12) Myocardial Preservation: Physiology, Techniques, Complications (13)
Preconditioning

b) Minimal Invasive Cardiac Surgery

(1) Off-pump coronary artery bypass (OPCAB)

(2) Minimally invasive direct coronary artery bypass (MIDCAB)

(3) Percutaneous valve repair/replacement

c) Intraaortic Balloon: Rationale, Indications, Limitations

II.C.3.b.6

d) Ventricular Assist Devices and Artificial Heart: Internal and External 7)

Pulmonary Embolism

a) Etiology: Blood, Air, Fat, Amniotic Fluid b) Diagnosis, TEE Findings

c) Treatment; Acute, Preventive

8) Hypertension
a) Etiology, Pathophysiology, Course of Disease
b) Drug Treatment, Interactions with Anesthetics, Risk of Anesthesia
c) Intra or Postoperative Hypertension; Differential Diagnosis and Treat ment

9) Shock States: Anesthetic Management of Patient in Shock 10) Vascular

Diseases

a) Cerebral Circulation; Luxury Perfusion, Steals, Infarcts, Intracranial

Hemorrhage

b) Carotid Endarterectomy: Anesthetic Management, Monitoring of Cerebral

Perfusion, Complications
c) Abdominal Aneurysm Resection: Anesthetic Management d) Peripheral
Arteriosclerotic Disease

e) Aneurysms of Ascending, Descending and Arch of Aorta,

Thoracoabdominal Aneurysms, Including Endovascular Repair Techniques

11) Cardiopulmonary Resuscitation a) Recognition

b) Management - Drugs, Defibrillators, Monitors, Advanced Cardiac Life

Support (ACLS) Algorithms

c) Complications and Outcomes of Therapy

d) Pediatric/Adult Differences 4. Gastrointestinal / Hepatic Systems

a. Biochemistry: Nutrition

1) Parenteral: Peripheral Or Central Vein, Hyperalimentation, Solutions Used

and Complications, Anesthetic Implications

2) Enteral: GI Elemental Diets, Routes of Delivery, Complications, Anesthetic

Implications b. Clinical Science

1) Morbid Obesity/Anesthesia for Bariatric Surgery

a) Pre-Anesthetic Evaluation and Management
b) Pharmacologic Considerations
c) Anesthetic Management (Airway, Ventilation, Monitoring, Venous Access)
d) Postoperative Management (Ventilation, Analgesia)

2) Hepatic Disease

II.C.4.b.2

a) Preoperative Laboratory Assessment

b) Anesthesia Choice (Hepatocellular Disease, Ascites, Portal Hypertension)
c) Postoperative Hepatic Dysfunction, Hepatic Failure, Hepatorenal
Syndrome d) Hepatic Transplantation

3) Intestinal Obstruction
a) Causes; Paralytic Ileus; Mechanical; Vascular
b) Physiological Changes; Fluid and Electrolyte; Respiratory
c) Anesthesia Management: Full Stomach; Fluid Therapy; Nitrous Oxide

5. Renal and Urinary Systems/ Electrolyte Balance: Clinical Science a. Renal

Disease

1) Pathophysiology of Renal Disease; Risk Factors for Acute Renal Failure 2)

Anesthetic Choice in Reduced Renal Function
3) Anesthetic Management in Renal Failure, Arteriovenous (A-V) Shunts 4)
Anesthetic Management in Renal Transplantation
5) Perioperative Oliguria and Anuria
6) Dialysis and Hemofiltration: Hemodialysis, Peritoneal Dialysis, Continuous
Hemofiltration (Arteriovenous, Venovenous)

7) Pharmacologic Prevention and Treatment of Renal Failure

b. Urologic Surgery - Lithotripsy, Transurethral Resection of Prostate

(TURP)/Irrigating Fluids/Hyponatremia

c. Perioperative Electrolyte Abnormalities 6. Hematologic System

a. Clinical Science
1) Hematologic Disorders

a) Diseases of Blood
(1) Anemias; Compensatory Mechanisms (2) Polycythemias; Primary vs.
Secondary (3) Clotting Disorders

(a) Thrombocytopenia and Thrombocytopathy (b) Congenital and Acquired

Factor Deficiencies

(c) Disseminated Intravascular Coagulation

(d) Fibrinolysis
(e) Pharmacologic: Anticoagulants and Antagonists (f) Coagulopathy in
Trauma Patients

(4) Hemoglobinopathies, Porphyrias

b) Massive Transfusion Protocol

II.C

7. Endocrine and Metabolic Systems: Clinical Science a. Pituitary Disease

1) Hypopituitarism, Pituitary Removal - Substitution Therapy a)

Panhypopituitarism

b) Diabetes Insipidus 2) Hyperpituitarism

a) Acromegaly, Including Airway Management

b) Inappropriate ADH Secretion b. Thyroid Disease

1) Hyperthyroidism
a) Metabolic and Circulatory Effects b) Anesthetic Management
c) Thyroid Storm

2) Hypothyroidism
a) Metabolic and Circulatory Effects, Myxedema Coma b) Substitution
Therapy
c) Anesthetic Implications

3) Complications of Surgery: Hypocalcemia, Recurrent Laryngeal Nerve

Injury, Diagnosis and Treatment

c. Parathyroid Disease
1) Hyperparathyroidism; Physiological Effects
2) Hypoparathyroidism; Postoperative Manifestations and Treatment

d. Adrenal Disease
1) Cushing's Syndrome 2) Primary Aldosteronism 3) Addison's Disease
4) Pheochromocytoma
a) Circulatory and Metabolic Manifestations b) Diagnosis
c) Anesthetic Management

e. Carcinoid Syndrome f. Diabetes Mellitus

1) Pathophysiology
2) Control of Blood Glucose - Hypoglycemia; Hyperglycemia and
Ketoacidosis 3) Elective Anesthesia - Perioperative Management

II.C.7.f

4) Emergency Anesthesia 5) Hyperosmolar Coma

6) Pancreas Transplantation

8. Neuromuscular Diseases and Disorders: Clinical Science a. Demyelinating

Diseases

1) Multiple Sclerosis

2) Motor Neuron Diseases: Amyotrophic Lateral Sclerosis, Spinobulbar

Muscular Atrophy, Hereditary Spastic Paraplegia

3) Guillain-Barre Syndrome

4) Charcot-Marie-Tooth Disease b. Primary Muscle Diseases

1) Muscular Dystrophies: Duchenne’s, Becker’s, Limb-Girdle, Congenital,

Myotonic

2) Mitochondrial Myopathies c. Channelopathies

d. Myasthenic Syndromes

1) Myasthenia Gravis
2) Lambert-Eaton Myasthenic Syndrome 3) Congenital Myasthenic
Syndromes

e. Ion Channel Myotonias

1) Acquired Neuromyotonia
2) Myotonia Congenita
3) Hyperkalemic Periodic Paralysis, Paramyotonia Congenita, Postassium-
Aggravated Myotonia 4) Hypokalemic Periodic Paralysis

D. Clinical Subspecialties
1. Painful Disease States

a. Pathophysiology 1) Acute Pain

2) Cancer-Related Pain 3) Chronic Pain States

a) Acute and Chronic Neck and Low Back Pain b) Neuropathic Pain States

(1) Complex Regional Pain Syndrome, Types I and II (2) Postherpetic

Neuralgia
(3) Phantom Limb, Post-Stroke
(4) Peripheral Neuropathies (e.g., Diabetic Neuropathy)

II.D.1.a.3

c) Somatic Pain Conditions: Myofascial Pain, Facet Arthropathy, etc. b.

Treatment

1) Acute Postoperative and Posttraumatic Pain

a) Postoperative Epidural Analgesia
b) Neuraxial Opioids
c) Peripheral Nerve Blockade and Catheters d) Patient-Controlled Analgesia

e) Other Modalities, Multimodal Analgesia (Nonsteroidal Analgesics, Electrical

Stimulation, Acupuncture, Ketamine, etc.)

2) Cancer-Related Pain
a) Systemic Medications, Tolerance and Addiction b) Continuous Spinal and
Epidural Analgesia
c) Neurolytic and Non-Neurolytic Blocks
d) World Health Organization Analgesic Ladder

3) Chronic Pain (Non-Cancer-Related)

a) Systemic Medications: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs),

Opioid Analgesics, Anticonvulsants, Antidepressants
b) Spinal and Epidural Analgesia

c) Peripheral Nerve Blocks

d) Sympathetic Nerve Blocks

e) Other Techniques: TENS, Spinal Cord Stimulation, Neuroablation (Surgical

and Chemical Neurolysis)

2. Pediatric Anesthesia

a. Apparatus: Breathing Circuits (Advantages/Disadvantages, Dead Space,

Etc.), Humidity, Thermal Control

1) Endotracheal Tube Selection (Cuffed vs. Uncuffed) and Sizing

2) Warming Devices: Types, Efficacy, Complications

b. Premedication: Drugs; Dosage; Routes; Vehicles, Including Topical

Anesthetics; Parental Presence

c. Agents and Techniques

1) Induction Techniques
2) Anesthetics: Actions Different From Adults

a) Drug Toxicities Preferentially Occurring in Children: e.g., Propofol b)

Opioid Dosing and Sensitivity

c) Neuromuscular Blockers (Sensitivity, Congenital Diseases, Complications

of Succinylcholine, Age-Related and Drug-Related Pharmacodynamics and
Pharmacokinetics)

II.D.2.c.2

d) Regional Anesthesia

d. Fluid Therapy and Blood Replacement, Physiologic Anemia, Glucose

Requirements
e. Problems in Intubation and Extubation (Full Stomach, Diaphragmatic
Hernia, Tracheo Esophageal (T-E) Fistula, Pierre-Robin, Treacher-Collins,
Crouzon’s, Goldenhar’s, Hurler’s, Awake/Fiberoptic Intubation, Dentition,
Laryngospasm, Stridor)

f. Neonatal Physiology 1) Respiratory

a) Development, Anatomy, Surfactant b) Pulmonary Oxygen Toxicity

c) Pulmonary Function
d) Lung Volumes vs. Adult

e) Airway Differences, Infant vs. Adult 2) Cardiovascular

a) Transition, Fetal to Adult

b) Persistent Fetal Circulation

3) Retinopathy of Prematurity: Anesthetic Implications
4) Metabolism, Fluid Distribution and Renal Function
5) Thermal Regulation (Neutral Temperature, Nonshivering Thermogenesis)
6) Fetal Hemoglobin
7) Prematurity, Apnea of Prematurity
8) Bronchopulmonary Dysplasia

g. Congenital Heart and Major Vascular Disease 1) Cyanotic Defects

2) Acyanotic Defects
3) Primary Pulmonary Hypertension

4) Major Vascular Malformations: Coarctation, Persistent Patent Ductus

Arteriosus, Vascular Rings.

5) Altered Uptake/Distribution of IV and Inhalation Anesthetics 6) Anesthetic

Considerations

a) Cardiac Surgery; Corrective and Palliative

b) Noncardiac Surgery
c) Chronic Congenital Heart Disease, Corrected, Uncorrected, and Palliated

(1) In Childhood Beyond the Newborn and Infant Periods

(2) In Adulthood h. Emergencies in the Newborn

1) Diaphragmatic Hernia

II.D.2.h

2) Tracheoesophageal Fistula and Esophageal Atresia 3) Neonatal Lobar

Emphysema
4) Pyloric Stenosis
5) Necrotizing Enterocolitis

6) Omphalocele/Gastroschisis
7) Respiratory Distress Syndrome: Etiology, Management, Ventilation
Techniques 8) Myelomeningocele

i. Pediatric Medical Problems with Anesthetic Implications

1) Respiratory: Upper Respiratory Infections (Colds, Epiglottitis,

Laryngotracheobronchitis), Bronchopulmonary Dysplasia, Cystic Fibrosis

2) Musculoskeletal: Muscular Dystrophies, Myotonias, Etc.

3) Developmental Delay, Cerebral Palsy, Autism

4) Childhood Obesity

5) Endocrine Diseases: Childhood Diabetes, Congenital Adrenal Hyperplasia,

Etc.

6) Skeletal Abnormalities with Or without Systemic Implications: Klippel -Feil,

Achondroplasia, Marfan’s, Morquio’s, Osteogenesis Imperfect

7) Trisomy 21 and Other Chromosomal Abnormalities

8) Juvenile Rheumatoid Arthritis

9) Anemias: Congenital and Acquired: Iron Deficiency, Physiologic Anemia,

Sickle Cell, Thalassemia, Etc.

10) Malignant Hyperthermia in Children; Susceptibility, Associated Diseases,

Anesthetic Management of MH Susceptibility, Intraoperative Diagnosis,
Treatment
j. Anesthetic Implications for Common Non-Neonatal Pediatric Subspecialty
Surgery

1) Otolaryngology: Cleft Lip and Palate, Tonsillectomy and Adenoidectomy,

Common Ear Procedures, Peritonsillar Abscess, Flexible and Rigid
Bronchoscopy, Diagnostic and Therapeutic Laryngoscopy Techniques (Jet
Ventilation, Laser Implications), Airway Foreign Bodies

2) Neurosurgery: Craniotomies for Tumor Or Vascular Malformations,

Hydrocephalus, Ventriculoperitoneal Shunts, Craniofacial Procedures,
Tethered Spinal Cord, Halo Placement Implications

3) Thoracic Surgery: Anterior Mediastinal Mass, Lung Isolation Techniques,

Pectus Excavatum and Carinatum

4) General and Urologic Surgery: Laparotomy vs Laparoscopy, Bowel

Surgery, Urologic Surgery (Wilms Tumor, Ureteral Reimplantation, Bladder
and Urethral Malformations, Neuroblastoma)

5) Orthopedic Surgery: Fractures and Dislocations, Congenital Hip Dysplasia,

Foot and Hand Malformations; Scoliosis Implications and Repair

6) Ophthalmologic: Strabismus, Cataract, Glaucoma Procedures, Etc.

II.D.2

k. Outpatient Pediatric Anesthesia

1) Indications and Contraindications

2) Anesthetic Considerations: Premedication, Induction, Maintenance,

Monitoring

3) Postoperative Considerations: Recovery Period, Discharge Criteria, Post -

Discharge Monitoring/Follow-Up

l. Postoperative Analgesia
1) Systemic Medications and Routes of Administration, Multimodal Therapy
2) Regional Techniques: Caudal, Epidural, Nerve Blocks
m. Postoperative Nausea and Vomiting: Risk Factors, Prophylaxis, Treatment

n. Pediatric Sedation: Guidelines, Pharmacology, Credentialing, Indications,

Monitoring, Complications

o. Pediatric Anesthesia Outside the Operating Rooms: Diagnostic and

Interventional Radiologic Procedures, Gastroenterology Laboratory, MRIs,
Radiation Therapy

3. Obstetric Anesthesia
a. Maternal Physiology

1) Effects of Pregnancy on Uptake and Distribution

2) Respiratory (Anatomy, Lung Volumes and Capacities, Oxygen

Consumption, Ventilation, Blood Gases, Acid Base)

3) Cardiovascular (Aorto-Caval Compression, Regulation of Uterine Blood

Flow)

4) Renal

5) Liver (Albumin/Globulin Ratio, Protein Binding of Drugs)

6) Gastrointestinal (Gastric Acid, Motility, Anatomic Position,

Gastroesophageal Sphincter Function)

7) Hematology (Blood Volume, Plasma Proteins, Coagulation) 8) Placenta

a) Placental Exchange - O2, CO2 b) Placental Blood Flow

c) Barrier Function

b. Maternal-Fetal Considerations 1) Pharmacology

a) Anesthetic Drugs and Adjuvants

b) Oxytocic Drugs (Indications, Adverse Effects)
c) Tocolytic Drugs (Indications, Adverse Effects)
d) Antiseizure Drugs; Interactions (Magnesium Sulfate)
e) Mechanisms of Placental Transfer, Placental Transfer of Specific Drugs f)
Fetal Disposition of Drugs
37

II.D.3.b.1

g) Drug Effects on Newborn

2) Amniotic Fluid (Amniocentesis, Oligohydramnios, Polyhydramnios)

3) Antepartum Fetal Assessment and Therapy (Ultrasonography, FHR

Monitoring, Nonstress Test, Stress Test, Biophysical Profile)

4) Anesthetic Techniques and Risks (Elective vs. Emergency, General vs.

Regional) a) Systemic Medications: Opioids, Sedatives, Inhalational Agents
b) Regional Techniques

(1) Epidural, Caudal, Spinal, Combined Spinal/Epidural

(2) Paracervical Block, Lumbar Sympathetic Block, Pudendal Block c)

Complications (Aspiration, Nerve Palsies)

5) Physiology of Labor (Metabolism, Respiration, Cardiovascular,

Thermoregulation)

6) Influence of Anesthetic Technique on Labor

7) Cesarean Delivery: Indications, Urgent/Emergent, Anesthetic Techniques

and Complications, Difficult Airway, Aspiration Prophylaxis

c. Pathophysiology of Complicated Pregnancy 1) Problems During Pregnancy

and Delivery

a) Anesthesia for Cerclage or Non-Obstetric Surgery

b) Ectopic Pregnancy
c) Spontaneous Abortion
d) Gestational Trophoblastic Disease (Hydatid Mole)
e) Autoimmune Disorders (Lupus, Antiphospholipid Syndrome) f) Endocrine
(Thyroid, Diabetes, Pheochromocytoma)

g) Heart Disease (Valvular Disorders, Pulmonary Hypertension, Congenital

Heart Disease, Arrhythmias, Cardiomyopathy)
h) Hematologic (Sickle Cell Anemia, Idiopathic Thrombocytopenic Purpura,
Von Willebrand Disease, Disseminated Intravascular Coagulation (DIC),
Anticoagulant Therapy, Rh and ABO Incompatibility)

i) Hypertension (Chronic, Pregnancy-Induced)

j) Neurologic (Seizures, Myasthenia, Spinal Cord Injury, Multiple Sclerosis,

Subarachnoid Hemorrhage)

k) Respiratory (Asthma, Respiratory Failure) l) Renal

m) Human Immunodeficiency Virus Infection

2) Problems of Term and Delivery

a) Intrapartum Fetal Assessment (Fetal Heart Rate Monitoring, Fetal Scalp

Blood Gases, Fetal Pulse Oximetry)

b) Preeclampsia and Eclampsia

II.D.3.c.2

c) Supine Hypotensive Syndrome

d) Aspiration of Gastric Contents
e) Embolic Disorders (Amniotic Fluid Embolism, Pulmonary
Thromboembolism) f) Antepartum Hemorrhage (Placenta Previa, Abruptio
Placenta, Uterine Rupture) g) Postpartum Hemorrhage (Uterine Atony,
Placenta Accreta)
h) Cord Prolapse
i) Retained Placenta
j) Dystocia, Malposition, and Malpresentation (Breech, Transverse Lie)
k) Maternal Cardiopulmonary Resuscitation
l) Fever and Infection
m) Preterm Labor
n) Vaginal Birth After Cesarean Section (VBAC)
o) Multiple Gestation
3) Resuscitation of Newborn a) Apgar Scoring

b) Umbilical Cord Blood Gas Measurements

c) Techniques and Pharmacology of Resuscitation

d) Intrauterine Surgery (Maternal and Fetal Considerations, Intrauterine

Fetal Resuscitation)

4. Otorhinolaryngology (ENT) Anesthesia: Airway Endoscopy; Microlaryngeal

Surgery; Laser Surgery, Hazards, Complications (Airway Fires, Etc.)

5. Anesthesia for Plastic Surgery, Liposuction

6. Anesthesia for Laparoscopic Surgery; Cholecystectomy; Gynecologic

Surgery; Gastric Stapling; Hiatus Hernia Repair; Anesthetic Management;
Complications

7. Ophthalmologic Anesthesia, Retrobulbar and Peribulbar Blocks; Open Eye

Injuries

8. Orthopedic Anesthesia; Tourniquet Management, Complications, Regional

Vs. General Anesthesia 9. Trauma Anesthesia

a. Massive Trauma
1) Evaluation of the Trauma Patient 2) Hemorrhagic Shock

b. Burn Management c. Mass Casualty

1) Crisis Management and Teamwork d. Biological Warfare

II.D

10. Anesthesia for Ambulatory Surgery

a. Patient Selection and Preoperative Management
b. Anesthetic Management
c. Discharge Criteria and Postoperative Follow-Up, Including
Continuous Nerve Blocks d. Office-Based Anesthesia: Equipment,
Safety, Organization, Patient Management
 11. Geriatric Anesthesia / Aging
a. Pharmacological Implications, MAC Changes
b. Physiological Implications: CNS, Circulatory, Respiratory, Renal,
Hepatic

12. Critical Care

a. Shock States
1) Etiology, Classification, Pathophysiology
2) Septic Shock and Life-Threatening Infection 3) Systemic
Inflammatory Response Syndrome 4) Multiple Organ Dysfunction
Syndrome
b. Poisoning and Drug Overdose c. Near-Drowning
d. Infection Control
1) General and Universal Precautions 2) Needle Stick Injury
3) Catheter Sepsis
4) Nosocomial Infections
5) Antibiotics: Antibacterial, Antifungal, Antiviral, Antiparasitic;
Antimicrobial Resistance e. Ventilator Management
1) Volume Controlled; Pressure Controlled; PEEP, Inspired Oxygen
Concentration; Tidal Volume
2) Pressure Support; Weaning

E. Special Problems or Issues in Anesthesiology

1. Electroconvulsive Therapy

2. Organ Donors: Pathophysiology and Clinical Management

3. Radiologic Procedures; CT Scan; MRI-Anesthetic

Implications/Management, Anesthesia in Locations Outside the Operating
Rooms

4. Ethics, Practice Management, and Medicolegal Issues

a. Professionalism and Credentialing, Licensure

b. Ethics, Advance Directives/Do Not Resuscitate (DNR) Orders; Patient
Privacy Issues

II.E.4

c. Malpractice: Definition, Legal Actions and Consequences, National

Practitioner Database, Closed Claims Findings, Anesthetic Accidents,
Professional Liability Insurance

d. Practice Management; Medicare/Medicaid Requirements

e. Primary Certification, Recertification, Maintenance of Certification and

Related Issues (Professional Standing, Lifelong Learning, Cognitive
Knowledge, Clinical Practice Assessment, Systems-Based Practice)

f. Costs of Medical/Anesthesia Care, Operating Room Management g. Patient

Safety

1) Definitions: Medical Error, Adverse Event, Sentinel Event

2) Medication Errors: Assessment and Prevention
3) Reporting: Mandatory and Voluntary Systems, Legal Requirements 4)
Disclosure of Errors to Patients
5) Safety Practices: Process-Based, Evidence-Based
6) Root Cause Analysis

h. Quality Improvement

1) Quality Improvement Basics: Design, Analysis, Implementation of Quality

Improvement Project

a) Anesthesia Quality Institute; Data Entry; Information

b) Lean Six Sigma; Assessing QI Methods; Approach
c) Physician Quality Reporting System: Significance and Role in
Practice d) Barriers to Quality Improvement
Thesis Component
 (Fifth year of MS Anaesthesiology Programme)

RESEARCH/ THESIS WRITING

Total of one year will be allocated for work on a research project with thesis writing.
Project must be completed and thesis be submitted before the end of training.
Research can be done as one block in 5 th year of training or it can be
stretched over five years of training in the form of regular periodic rotations during the
course as long as total research time is equivalent to one calendar year.

Research Experience
The active research component program must ensure meaningful, supervised
research experience with appropriate protected time for each resident while
maintaining the essential clinical experience. Recent productivity by the program
faculty and by the residents will be required, including publications in peer-
reviewed journals. Residents must learn the design and interpretation of research
studies, responsible use of informed consent, and research methodology and
interpretation of data. The program must provide instruction in the critical
assessment of new therapies and of the surgical literature. Residents should be
advised and supervised by qualified staff members in t he conduct of research.

Clinical Research
Each resident will participate in at least one clinical research study to
become familiar with:
1. Research design
2. Research involving human subjects including informed consent and
operations of the Institutional Review Board and ethics of human
experimentation
3. Data collection and data analysis
4. Research ethics and honesty
5. Peer review process

This usually is done during the consultation and outpatient clinic rotations.

Case Studies or Literature Reviews

Each resident will write, and submit for publication in a peer-reviewed
journal, a case study or literature review on a topic of his/her choice.

Laboratory Research
Bench Research
Participation in laboratory research is at the option of the resident and may
be arranged through any faculty member of the Division. When appropriate,
the research may be done at other institutions.
Research involving animals
Each resident participating in research involving animals is required to:
1. Become familiar with the pertinent Rules and Regulations of the
University of Health Sciences Lahore i.e. those relating to "Health and
Medical Surveillance Program for Laboratory Animal Care Personnel" and
"Care and Use of Vertebrate Animals as Subjects in Research and
Teaching"
2. Read the "Guide for the Care and Use of Laboratory Animals"
3. View the videotape of the symposium on Humane Animal Care

Research involving Radioactivity

Each resident participating in research involving radioactive materials is
required to
1. Attend a Radiation Review session
2. Work with an Authorized User and receive appropriate instruction from
him/her.
 METHODS OF INSTRUCTION/COURSE CONDUCTION
As a policy, active participation of students at all levels will be encouraged.
Following teaching modalities will be employed:

1. Lectures
2. Seminar Presentation and Journal Club Presentations
3. Group Discussions
4. Grand Rounds
5. Clinico-pathological Conferences
6. SEQ as assignments on the content areas
7. Skill teaching in ICU, Operation theatres, emergency and ward
settings
8. Attend genetic clinics and rounds for at least one month.
9. Self study, assignments and use of internet
10. Bedside teaching rounds in ward
 11. OPD & Follow up clinics
12. Long and short case presentations

In addition to the conventional teaching methodologies interactive strategies

like conferences will also be introduced to improve both communication and
clinical skills in the upcoming consultants. Conferences must be conducted
regularly as scheduled and attended by all available faculty and res idents.
Residents must actively request autopsies and participate in formal review of
gross and microscopic pathological material from patients who have been
under their care. It is essential that residents participate in planning and in
conducting conferences.

1. Clinical Case Conference

Each resident will be responsible for at least one clinical case conference
each month. The cases discussed may be those seen on either the
consultation or clinic service or during rotations in specialty areas. The
resident, with the advice of the Attending Surgeon on the Consultation
Service, will prepare and present the case(s) and review the relevant
literature.

2. Monthly Student Meetings

Each affiliated medical college approved to conduct training for MS

Anaesthesiology will provide a room for student meetings/discussions such
as:

a. Journal Club Meeting

b. Core Curriculum Meetings
c. Skill Development

a. Journal Club Meeting

A resident will be assigned to present, in depth, a research article or topic of

his/her choice of actual or potential broad interest and/or application. Two
hours per month should be allocated to discussion of any current articles or
topics introduced by any participant. Faculty or outside researchers will be
invited to present outlines or results of current research activities. The
article should be critically evaluated and its applicable results should be
highlighted, which can be incorporated in clinical practice. Record of all such
articles should be maintained in the relevant department.
b. Core Curriculum Meetings
All the core topics of Anaesthesiology should be thoroughly discussed during
these sessions. The duration of each session should be at least two hours
once a month. It should be chaired by the chief resident (elected by the
residents of the relevant discipline). Each resident should be given an
opportunity to brainstorm all topics included in the course and to generate
new ideas regarding the improvement of the course structure

c. Skill Development

Two hours twice a month should be assigned for learning and practicing
clinical skills.

List of skills to be learnt during these sessions is as follows:

1. Residents must develop a comprehensive understanding of the

indications, contraindications, limitations, complications, techniques, and
interpretation of results of those technical procedures integral to the
discipline
2. Residents must acquire knowledge of and skill in educating patients
about the technique, rationale and ramifications of procedures and in
obtaining procedure-specific informed consent. Faculty supervision of
residents in their performance is required, and each resident's
experience in such procedures must be documented by the program
director.
3. Residents must have instruction in the evaluation of medical literature,
clinical epidemiology, clinical study design, relative and absolute risks
of disease, medical statistics and medical decision-making.
4. Training must include cultural, social, family, behavioral and economic
issues, such as confidentiality of information, indications for life
support systems, and allocation of limited resources.
5. Residents must be taught the social and economic impact of their
decisions on patients, the primary care physician and society. This can
be achieved by attending the bioethics lectures
 6. Residents should have instruction and experience with patient
counseling skills and community education.
7. This training should emphasize effective communication techniques for
diverse populations, as well as organizational resources useful for
patient and community education.
8. Residents should have experience in the performance of
Anaesthesiology related clinical laboratory and radionuclide studies
and basic laboratory techniques, including quality control, quality
assurance and proficiency standards
9. Each resident will manage at least the following essential
Anaesthesiological cases and observe and participate in each of the
following procedures, preferably done on patients under supervision
initially and then independently.
3. Annual Grand Meeting

Once a year all residents enrolled for MS Anaesthesiology should be invited

to the annual meeting at UHS Lahore.
One full day will be allocated to this event. All the chief residents from
affiliated institutes will present their annual reports. Issues and concerns
related to their relevant courses will be discussed. Feedback should be
collected and suggestions should be sought in order to involve residents in
decision making.
The research work done by residents and their literary work may be
displayed.
In the evening an informal gathering and dinner can be arranged. This will
help in creating a sense of belonging and ownership among students and the
faculty.
 LOG BOOK

Would be part of Portfolio

The residents must maintain a log book and get it signed regularly by the
supervisor. A complete and duly certified log book should be part of the
requirement to sit for MS examination. Log book should include adequate
number of diagnostic and therapeutic procedures observed and performed,
the indications for the procedure, any complications and the interpretation of
the results, routine and emergency management of patients, case
presentations in CPCs, journal club meetings and literature review.

Proposed Format of Log Book is as follows:

Candidate’s Name: _________________________________

Roll No. _____________

The above mentioned procedures shall be entered in the log book as per
format:
Procedures Performed

Sr.# Date Name of Patient, Age, Diagnosis Procedure Supervisor’s

Sex & Admission No. Performed Signature
1
2
3
4

Emergencies Handled

Sr. Date Name of Patient, Age, Diagnosis Procedure/ Superviso

# Sex & Admission No. Manageme r’s
nt Signature
1
2
3
4

Case Presented

Sr.# Date Name of Patient, Age, Case Presented Supervisor’s

Sex & Admission No. Signature
1
2
3
4
Seminar/Journal Club Presentation

Sr.# Date Topic Supervisor’s

signature
1
2
3
4

Evaluation Record
(Excellent, Good, Adequate, Inadequate, Poor)

At the end of the rotation, each faculty member will provide an evaluation of
the clinical performance of the fellow.

Method of Evaluation
Sr.# Date (Oral, Practical, Theory) Rating Supervisor’s
Signature
1
2

4
 EVALUATION & ASSESSMENT STRATEGIES

Assessment

It will consist of action and professional growth oriented student-centered

integrated assessment with an additional component of informal
internal assessment, formative assessment and measurement-based
summative assessment.

Student-Centered Integrated Assessment

It views students as decision-makers in need of information about their own

performance. Integrated Assessment is meant to give students responsibility
for deciding what to evaluate, as well as how to evaluate it, encourages
students to ‘own’ the evaluation and to use it as a basis for self-
improvement. Therefore, it tends to be growth-oriented, student-controlled,
collaborative, dynamic, contextualized, informal, flexible and act ion-
oriented.

In the proposed curriculum, it will be based on:

 Self Assessment by the student

 Peer Assessment
 Informal Internal Assessment by the Faculty

Self Assessment by the Student

Each student will be provided with a pre-designed self-assessment form to

evaluate his/her level of comfort and competency in dealing with different
relevant clinical situations. It will be the responsibility of the student to
correctly identify his/her areas of weakness and to take appropriate
measures to address those weaknesses.

Peer Assessment
The students will also be expected to evaluate their peers after the monthly
small group meeting. These should be followed by a constructive feedback
according to the prescribed guidelines and should be non-judgmental in
nature. This will enable students to become good mentors in future.

Informal Internal Assessment by the Faculty

There will be no formal allocation of marks for the component of Internal

Assessment so that students are willing to confront their weaknesses rather
than hiding them from their instructors.

It will include:

a. Punctuality
b. Ward work
c. Monthly assessment (written tests to indicate particular areas of
weaknesses)
d. Participation in interactive sessions

Formative Assessment

Will help to improve the existing instructional methods and the curriculum in
use

Feedback to the faculty by the students:

After every three months students will be providing a written feedback

regarding their course components and teaching methods. This will help to
identify strengths and weaknesses of the relevant course, faculty members
and to ascertain areas for further improvement.

Summative Assessment

It will be carried out at the end of the programme to empirically evaluate

cognitive, psychomotor and affective domains in order to award diplomas for
successful completion of courses.
 Intermediate Examination
MS Anaesthesiology
Total Marks: 500

All candidates admitted in MS Anaesthesiology course shall appear in

Intermediate examination at the end of second calendar year.

There shall be one written paper of 300 marks, clinical, TOACS/OSCE &
ORAL of 200 marks.

Topics included in paper:

Basic Principles of General Surgery related to Anaesthesiology.
Basic Principals of Internal Medicine related to Anaesthesiology.
 Written Component = 300 Marks
Clinical, TOACS/OSCE & ORAL = 200 Marks

Total = 500 Marks

Written Paper:

MCQs = 100 Marks

SEQ = 10 Marks

Total = 300 Marks

Clinical, TOACS/OSCE & ORAL

4 Short Cases = 100 Marks

1 Long Case = 50 Marks
TOACS/OSCE & ORAL = 50 Marks

Total = 200 Marks

 Final MS Anaesthesiology
Total Marks: 1500

All candidates admitted in MS Anaesthesiology course shall appear in Final

examination at the end of structured training programme (end of 5th
calendar year) and after clearing Intermediate examinations.

There shall be two written papers of 250 marks each, clinical, TOACS/OSCE
& ORAL of 500 marks, C.I.S assessment of 100 marks and thesis
examination of 400 marks.

Final MS Anaesthesiology
Clinical Examination
Total Marks: 1000

Topics included in paper 1

1. Preoperative assessment and preparation (25 MCQs)

2. General anaesthesia: methods and techniques (25 MCQs)
3. Local and regional anaesthesia (25 MCQs)
4. Anaesthesia for special situations (25 MCQs)

Topics included in paper 2

1. Pre-hospital and emergency medicine (20 MCQs)

2. Postoperative care (20 MCQs)
3. Intensive care medicine (20 MCQs)
4. Technical equipment and monitoring (20 MCQs)
5. Pain management (20 MCQs)

Components of Final Clinical Examination

Theory
Paper I 250 Marks 3 Hours
5 SEQs (10 marks each) 50 Marks
100 MCQs (2 marks each) 200 Marks

Paper II 250 Marks 3 Hours

5 SEQs (10 marks each) 50 Marks
100 MCQs (2 marks each) 200 Marks

The candidates who pass in theory papers, will be eligible to appear in the
clinical and oral Examination

Clinical,TOACS/OSCE & ORAL 500 Marks

Four short cases 200 Marks

One long case: 100 Marks
TOACS/OSCE & ORAL 200 Marks

Continuous Internal Assessment 100 Marks

Final MS Anaesthesiology
Thesis Examination
Total Marks: 400

All candidates admitted in MS Anaesthesiology course shall appear in thesis

examination at the end of 5th year of the MS programme. The examination
shall include thesis evaluation with defense.
 RECOMMENDED BOOKS

1. Aithenhead A. R., Smith G., Rowbotham D. J. Textbook of

Anaesthesia. 5th ed. Churchill Livingstone
2. Morgan G. E., Mikail M. S., Murray M. J. Clinical Anaesthesiology. 4th
ed. Lange
3. Yao and Artusio’s. Anaesthesiology:Problem oriented Patient
Management 5th ed. Lippincott Williams and Wilking
4. David P. D. and Kenny G. N. C. Basic Physics and Measurement in
Anaesthesia. 5th ed. Butterworth Heinmann
5. Fathalla M. F. and Fathalla M. M. F. A Practical Guide for Health
Researcher. Cairo: World Health Organization; 2004.

RECOMMENDED JOURNALS

1. British Journal of Anaesthesiology

2. Anaesthesia (British Journal)
3. Anaesthesia and Analgesia (American Journal)
4. Anaesthesia and Critical Care (British Journal)