DESCRIPTION

Training level with limited or no previous anaesthetic experience Involves intensive period of training and skills acquisition under registrar or consultant supervision

EXPERIENCE

Less than 6 months full-time (or part-time equivalent) general anaesthetic experience at SRMO or registrar level

DIAGNOSTIC

May possess limited diagnostic skills at entry

MANAGEMENT

Resuscitation

Resuscitation skills as outlined in Annexure A

Procedural Skills

May possess limited skills at entry but is rapidly acquiring those necessary for progression to higher levels of anaesthetics

General

May possess only limited knowledge of anaesthetics

DESCRIPTION

Less supervised anaesthetics. Able to function in the anaesthetic sphere in a semi-autonomous role but where a senior registrar or consultant is continually available on site for consultation

EXPERIENCE

Greater than 6 months full-time (or part-time equivalent) general anaesthetic experience at SRMO or registrar level

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, radiological and ECG investigations in order to perform a competent pre-op assessment, anaesthetic and post-op assessment in particular in the recovery room.

MANAGEMENT

Resuscitation

Resuscitation skills as defined in Annexure A

Procedural Skills

Competence in the following skills, this implies not just technical proficiency but where applicable a knowledge of indications, contraindications plus complications and their management.

Venous access:

- peripheral (adult and paediatric including intraosseous insertions*)
- central (subclavian, cubital fossa long line insertion)

Insertion of arterial line

Airway management

- mouth, mouth-mask, bag-mask ventilation
- use of oral and nasal airways Laryngeal mask ventilation

Uncomplicated Endo-tracheal intubation - oral and nasal

Needle and surgical cricothyroidotomy *

Use of mechanical ventilation

Failed intubation drill

Recognition of oesophageal intubation

Oral/Nasal gastric tube insertion

Intercostal needle / chest drain insertion

Urethral catheterisation

Regional anaesthesia

- spinal blockade
- axillary and Biers blockade
- digital and ring blockade

General anaesthetic techniques

- intra-venous including raid sequence induction
- inhalations
- self ventilation anaesthetic
- bag mask
- laryngeal mask
- mechanical ventilation
- neurolept analgesia

Use of external cardiac pacemaker

* Indicates procedures that owing to limited opportunities individuals may have only limited experience in. They must however demonstrate a thorough undertaking of the procedure.

General

Possess the diagnostic skills to perform a competent pre-op assessment

Understanding of the impact of age, pregnancy, obesity, disease states in particular renal, hepatic, diabetic, cardiovascular and respiratory disease on anaesthesia

Familiarity with different anaesthetic gas delivery systems(Mapleson Systems) and Boyles machine

Fluid and electrolyte therapy including blood and component therapy.

Familiarity with monitoring during anaesthesia in particular cardiac monitoring, O2 saturation's, capnography and ET CO2 , temperature, central venous and respiratory pressures and peripheral nerve stimulator. Recognise and initially manage deviations from normal.

Familiarity with a wide range of drugs, in particular,

IV induction agents - thiopentone, propofol, ketamine;

muscle relaxants - depolarising and non-depolarising;

inhalation agents - oxygen, nitrous oxide, halothane, sevoflurane, isoflurane, enflurane;

local anaesthetics;

reversal agents - neostigmine, atropine

plus a wide array of drugs such as narcotics, anti-emetics, Blockers, adrenaline and other intropes, ephedrine, metaraminol, salbutamol, dantrolene.

Diagnose and initially manage life threatening emergencies such as

anaphylaxis,
laryngeal spasm,
aspiration,
high spinal or epidural blockade,
malignant hyperthemia,
cardiac and respiratory failure

Diagnose and initially manage post anaesthetic problems especially in recovery or failure to emerge from anaesthesia,

inadequate neuro-muscular reversal,
the confused patient,
respiratory distress,
pain control,
cardiovascular problems such as hypo and hypertension, chest pain, cardiac failure and cardiac dysrhythmmias.

Transport critically ill patients to ICU

Liaise and co-ordinate with VMO's, nursing & ward staff and communicate with family members as required.

Assessment will largely depend on the supervising anaesthetists report and log books.

DESCRIPTION

Able to give an unsupervised anaesthetic except in specific sub-specialised areas and in the high risk patient. (Consulting the specialist on call does not equate to supervision in this context)

Able to function adequately on the anaesthetic over-time roster and potentially be able to be accredited for anaesthetics in rural hospital

Able to supervise more junior staff

EXPERIENCE

At least one year of anaesthesia at SRMO or Registrar level including adequate experience in paediatric and obstetric anaesthesia to allow you to function on the over-time roster within the IAHS.

DIAGNOSTIC

Able to interpret results of history, physical examination, pathology, radiological and ECG investigations in order to perform a competent pre-op assessment, anaesthetic and post-op assessment in particular in the recovery room.

MANAGEMENT

Resuscitation

Resuscitation skills as defined in Annexure A

Procedural Skills

Competence in the following skills, this implies not just technical proficiency but where applicable a knowledge of indications, contradictions plus complications and their management

Venous access:

- peripheral (adult and paediatric including intraosseous insertions )
- central (subclavian, cubital fossa long line insertion)
- venous cut down * (in peripheral access)
- internal jugular line in central venous access

Insertion of arterial line

Airway management:

- mouth, mouth-mask, bag-mask ventilation
- use of oral and nasal airways

Laryngeal mask ventilation

Uncomplicated Endo-tracheal intubation - oral and nasal

Needle and surgical cricothyroidotomy *

Use of mechanical ventilation

Failed intubation drill

Recognition of oesophageal intubation

Oral/Nasal gastric tube insertion

Intercostal needle/chest drain insertion

Urethral catheterisation

Regional anaesthesia

- spinal blockade
- axillary and Biers' blockade
- digital and ring blockade
- epidural blockade
- retro orbital block + facial nerve block
- femoral nerve block

General anaesthetic techniques

- intra-venous including raid sequence induction
- inhalations
- self ventilation anaesthetic

- bag mask
- laryngeal mask

- mechanical ventilation
- neurolept analgesia

Use of external cardiac pacemaker
External + temporary transvenous pacemaker insertion*
Sengstaken-Blackmore tube insertion*

* Indicates procedures that owing to limited opportunities individuals may have only limited experience in. They must however demonstrate a thorough understanding of the procedure.

General

Possess the diagnostic skills to perform a competent pre-op assessment

Understanding of the impact of age, pregnancy, obesity, disease states in particular renal, hepatic, diabetic, cardiovascular and respiratory disease on anaesthesia

Familiarity with different anaesthetic gas delivery systems (Mapleson Systems) and Boyles machine

Fluid and electrolyte therapy including blood and component therapy

Familiarity with monitoring during anaesthesia in particular cardiac monitoring ,02 saturation's capnography and ET CO2, temperature, central venous and respiratory pressures and peripheral nerve stimulator. Recognise and initially manage deviations from normal.

Familiarity with a wide range of drugs in particular:

IV induction agents -thiopentone, propofol, ketamine,

muscle relaxants - depolarising and non-depolarising;

inhalation agents-oxygen, nitrous oxide, halothane, sevoflurane, isoflurane, enflurane,

local anaesthetics,

reversal agents, neostigime, atropine,

plus a wide array of drugs such as narcotics, anti-emetics, B-Blockers, adrenaline, and other inotropes, ephedrine, metaraminol, salbutamol, dantrolene.

Diagnose and initially manage life threatening emergencies such as

anaphylaxis,
laryngeal spasm,
aspiration,
high spinal or epidural blockade,
malignant hyperthermia,
cardiac and respiratory failure.

Diagnose and initially manage post anaesthetic problems especially in recovery or failure to emerge from anaesthesia,

inadequate neuro-muscular reversal,
the confused patient,
respiratory distress,
pain control,
cardiovascular problems such as hypo and hypertension, chest pain, cardiac failure and cardiac dysrhythmias.

Transport critically ill patients to ICU

Liaise and co-ordinate with VMO's, nursing & ward staff and communicate with family members as required.

Able to supervise and teach more junior staff

Formal certification such as E.M.S.T, E.L.S courses and Diploma of Anaesthetics (UK) will be looked on favourably but the minimum experience component is considered essential for anaesthetics.

Assessment will largely depend on the supervising anaesthetists report and log book.

LEVEL 1

- basic CPR
- bag/mask ventilation
- peripheral venous access
- ECG interpretation/recognition of arrhythmias
- emergency cardioversion (unconscious pt)
- use of first line anti-arrhythmic

LEVEL 2

- all items specified at level 1
- establish the uncomplicated airway and manually ventilate
- large bore peripheral venous cannula
- intraosseus cannula
- simple use of fluid and blood products
- intercostal catheter

LEVEL 3

- all items specified at levels 1 & 2
- maintenance of the established uncomplicated airway
- ability to recognise the complicated airway and to possess an appropriate complicated airway drill
- use of mechanical ventilation
- complicated venous access
- complicated use of fluid and blood products
- cardioversion of the conscious pt
- use of second line anti-arrhythmic
- use of transcutaneous pacemaker

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