CCT in Anaesthetics - Intermediate Level Training

Published: 05/09/2019

General, urological and gynaecological surgery

(Incorporating peri-operative care of the elderly)

It is anticipated that it will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the entire duration of Intermediate Level training and that these should be achievable in most general hospitals.

Learning outcomes:

Builds on the knowledge, understanding and skills gained in Basic Level training and becomes confident at managing more complex cases
To gain knowledge of the anaesthetic management of patients with transplanted organs for non-transplant surgery
To gain knowledge, skills and experience of the perioperative anaesthetic care of patients requiring major general urological and gynaecological surgery, including the immediate management of major blood loss
To manage the peri-operative care of an elderly patient in general, urological or gynaecological surgery, focussing on the issues of advancing age

Core clinical learning outcomes:

Deliver safe perioperative anaesthetic care to complex ASA 1-3 adult patients requiring elective and emergency intra-abdominal surgery [both laparoscopic and open] with distant supervision
Manage a list with complex ASA 1-3 adult patients for elective and emergency surgery in all disciplines with distant supervision

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Final examination identified in the FRCA examination blueprint section.

Knowledge

Competence	Description	Assessment Methods	GMP
GU_IK_01	Recalls/describes the principles off the peri-operative management of the commoner complex cases including, but not exclusively: Pancreatic and liver resection Oesophagectomy [including one lung ventilation] Resection of neuroendocrine tumours [e.g. carcinoid and pheochromocytoma] Splenectomy Resection of retroperitoneal masses [including management of pleural breach]	A,C,E	1,2
GU_IK_02	Explains the effects of chemotherapy/radiotherapy, and the implications for anaesthesia	A,C,E	1
GU_IK_03	Recalls/describes the anaesthetic considerations of co-existing diseases including problems such as spinal injury	A,C,E	1,2
GU_IK_04	Recalls/ describes the ethical considerations of cadaveric and live-related organ donation for the donor [and relatives], recipient and society as a whole	C,E	1,2,3,4
GU_IK_05	Describes the issues of anaesthesia for renal transplant surgery	C,E	1,2,3,4
GU_IK_06	Explains the anaesthetic management of patients with transplanted organs for non-transplant surgery	A,C,E	1,2
GU_IK_07	Recalls/explains the anaesthetic complications related to disturbance of fluid balance, oedema, and dehydration	A,C,E	1,2
GU_IK_08	Recalls/describes the anaesthetic implications of bariatric surgery	A,C,E	1,2,3,4
GU_IK_09	Recalls/describes the principles of enhanced recovery programmes	A,C,E	1,2
GU_IK_10	Recalls / describes the rationale and principles of perioperative haemodynamic management and optimisation	A,C,E	1,2,3
GU_IK_11	Recalls / describes the principles of preoperative evaluation of patients at risk of post-operative morbidity, including risk stratification tools, for example scoring systems and measures of functional capacity [including cardiopulmonary exercise testing]	A,C,E	1,2,3
GU_IK_12	Discusses the importance of the timing of non-elective surgery and the effect that this may have on the delivery of ‘emergency surgery’	A,C	1,2,3

Skills

Competence	Description	Assessment method	GMP
GU_IS_01	Demonstrates the ability to recognise when it is/is not necessary to order complex preoperative assessment tests such as cardiopulmonary exercise testing and echocardiography prior to anaesthesia/surgery	A,C,D	1,2,3,4
GU_IS_02	Demonstrates the ability to manage safely and effectively the peri-operative care of patients requiring elective and/or emergency resection of the lower bowel or similar complexity urological and/or gynaecological case [open or laparoscopic], with distant supervision	L.M	1,2,3,4
GU_IS_03	Demonstrates the ability to manage the effects of sudden major blood loss effectively	A,C,D	1,2
GU_IS_04	Demonstrates the ability to work with all members of the theatre and surgical teams to manage an operating list with a mixture of ASA 1- 3 cases effectively, along with the ability to provide safe peri-operative anaesthetic care for the patients	L,M	1,2,3,4
GU_IS_05	Shows the ability to lead [where appropriate] the theatre team in the perioperative management of surgical patients requiring out of hours surgery, including understanding of when to seek help appropriately	A,C,D,L,M	1,2,3,4
GU_IS_06	Demonstrates the ability to present a balanced judgement to the patient and their relatives of the perceived risks and complications of anaesthesia and surgery	A,C,D,M	1,2,3,4