Ventilation and airway management in patients with critical neurologic illness is a common, complex, and essential skill in neurocritical care that is highly specialized and in demand.
Training occurs in the operating rooms at NYPH-Columbia campus and NYPH-Cornell campus under the supervision of on-service anesthesia attendings and nurse anesthetists. Upon completion, fellows are proficient in the basic skills of sedation, ventilation, and intubation in patients requiring routine intubation. This rotation is combined with lectures and simulation targeted to airway management. The following set of core educational objectives is designed to clearly communicate the expectations of neurocritical care fellows in terms of knowledge, skills and attitudes during their fellowship.
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INDEX OF COMPETENCIES: PC=Patient Care; MK=Medical Knowledge; PBLI=Practice-Based Learning & Improvement; ICS=Interpersonal & Communication Skills; Prof=Professionalism; SBP=Systems-Based Practice |
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The inpatient OR anesthesia rotation is for four weeks in the first year of fellowship (2 weeks at NYPH-Columbia campus and 2 weeks at NYPH-Cornell campus). At the end of this rotation, fellows are expected to demonstrate the following:
Objective 1 (PC, ICS, PBLI, MK): Demonstrate proficiency in all procedures considered to be essential for the area of practice by:
- Demonstrating competence in the following procedural neurocritical care skills, applications of advanced technology and instrumentation for monitoring the physiologic status of critically ill patients with acute brain injury:
- Respiratory: Recognition of patients requiring mechanical ventilation (both invasive and non-invasive), sedation and procedural management of endotracheal intubation for uncomplicated airway, as well as management of mechanical ventilation.
- Cardiac: Interpretation of cardiac telemetry and arterial line waveform interpretation in the setting of ventilation, induction for endotracheal intubation, and management of mechanical ventilation.
- Recognizing common complications in endotracheal intubation and developing a comprehensive approach for procedural management. Examples include (but are not limited to):
- Assessment of difficult to ventilate patients
- Assessment of difficult to intubate patients
- Approaches to procedural sedation for mechanical ventilation
- Ventilation by laryngeal mask airway
- Ventilation by bag-mask valve
- Intubation by direct laryngoscopy
- Intubation by video-assisted laryngoscopy
- Developing and executing a management plan for patients who are difficult to ventilate, or difficult to intubate.
- Participating in a multi-specialty team of physicians, medical students and allied health professionals in patient management.
Objective 2 (MK): Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social behavioral sciences, as well as the application of this knowledge to patient care by:
- Recognizing and independently managing common tasks in patient ventilation and endotracheal intubation including:
- Assessment of difficult to ventilate patients
- Assessment of difficult to intubate patients
- Approaches to procedural sedation for mechanical ventilation
- Ventilation by laryngeal mask airway
- Ventilation by bag-mask valve
- Intubation by direct laryngoscopy
- Intubation by video-assisted laryngoscopy
Objective 3 (ICS, MK, PBLI): Acquire and demonstrate the ability to synthesize and apply knowledge and understanding gained from basic science, clinical research, and information technology to provide accessible information to patients and support one’s own education by:
- Leveraging information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic interventions.
- Proficiently using information technology to manage information, access on-line medical information, support their own education, and apply this information in the clinical care of patients.
- Finding, assessing, and assimilating the best evidence for clinical decision-making and continuously evaluating and improving patient care practices.
Objective 4 (SBP, PROF, ICS): Leverage knowledge of medical systems and regulatory requirements of medical training and practice by:
- Participating in analysis of safety event(s)
- Disclosing patient safety events to patients and their families (simulated/actual) with guidance from mentor as needed
- Performing patient safety and/or quality improvement project(s)
- Delivering patient-centered care with focus on individual needs of patient and family
- Leading interdisciplinary patient-centered care
- Advocating for safe and effective transitions of care
- Adjusting individual practice to address needs of specific patient populations
- Modifying individual practice to optimize care within a broader health care system
Objective 5 (SBP, ICS, PROF): Demonstrate professionalism and expertise in using the system of care in a way that is beneficial and essential for patients, by:
- Effectively communicating with other members of the health care team (i.e., other physicians, nurses, social workers, etc.) to coordinate and optimize patient care.
- Advocating for quality patient care and assisting patients in dealing with system complexities.
- Functioning as a team member to facilitate and optimize patient care.
- Demonstrating effective listening skills and providing patients the opportunity to explain their problem and concerns.
- Actively participating in the education of patients, families, medical students, residents and other health care professionals.
- Demonstrating superior interpersonal and communications skills with professional associates and other health care providers.
Objective 6 (ICS, PROF, PC): Demonstrate the ability to interact and communicate with patients in a manner that is culturally sensitive and patient-centered, by:
- Demonstrating respect, compassion, integrity, and responsiveness to the needs of patients, their families and society that supersede self-interest.
- Providing care that is sensitive to each person’s age; gender; and cultural, economic, and social circumstances.
- Demonstrating clear, understandable, and effective interpersonal and communication skills to counsel and educate patients and their families.
- Demonstrating a commitment to ethical practices pertaining to patient privacy and autonomy, the provision or withholding of clinical care, confidentiality of patient information, informed consent, and conflict of interest and business practices.
- Creating and sustaining a therapeutic and ethically sound patient-physician relationship.
Objective 7 (ICS, PROF, SBP): Demonstrate the ability to interact, communicate and work effectively with clinical and ancillary staff in operating rooms, by:
- Obtaining and providing appropriate consultation.
- Carrying out respectful and effective communication with: colleagues, nurses, and ancillary staff in a way that encourages cooperation and patient-based care.
Objective 8 (PROF): Demonstrate the ability to conduct oneself in a professional manner by:
- Consistently exhibiting a professional appearance; neat, well-groomed, conservative attire in compliance with the hospital dress code
- Consistently demonstrating professional attitudes consistent with being a physician, with an emphasis on responsibility, compassion, sensitivity to diverse patient populations and cultures.
- Continuously adhering to ethical principles, confidentiality, informed consent and a commitment to excellence and on-going professional development.
- Exhibiting dependability, responsibility and self-respect.
- Arriving for clinical duties and completing work in a timely manner and with appropriate attention to detail
- Consistently demonstrating personal integrity and altruism.
- Serving as a role model for residents and medical students.