Anaesthesia

A. ACVAA

Residents at The University of Melbourne will be registered as ACVAA residents. The American College of Veterinary Anaesthesiologists has specific requirements (ACVAA Residency Standards) that shall be fulfilled by residents during their residency in order to assure eligibility to sit for the anaesthesia boards. These specific requirements may be reviewed at the ACVAA website at http://www.acvaa.org. Read them thoroughly so that you know what you need to accomplish over the three years of your residency.

B. Combined Master Program

The resident will receive a scholarship as a student enrolled in two part time master degrees at The University of Melbourne. In consequence, the students will be required, each semester, to enrol in both:

  1. Master Thesis in Vet Science – Research component
    • Research thesis
      75%
      <30,000 words
    • Practicum exam
      25%
      3 hours examination at end of 3rd year (Mock ACVAA exam)
  2. Master of Veterinary Studies – Clinical work

    Advanced clinical skills

    • Clinical work
      45%
      formal 6-monthly assessments
    • Written assignment
      45%
      once a year (e.g. case report)
    • Oral M&M presentation
      10%
      once a year

    PMS
    • Twelve seven hundred words essay on physiology/pharmacology topics – (Mock ACVAA exam questions) 90%
    • Ten minutes poster presentation of the research 10 %

It is imperative for the resident to pass those 2 masters to complete the residency.

C. Scheduling of clinical and other rotations

In general, each year of the anaesthesia residency will be divided as follows:

1st Year:

  • 31 weeks (minimum) rotation in anaesthesia at The University of Melbourne’s U-Vet Hospital
  • Up to 12 weeks in research
  • 2 weeks in ICU at The University of Melbourne U-Vet Hospital
  • 2 weeks in anaesthesia at a human hospital
  • 1 week for attending conferences
  • 4 weeks’ vacation

2nd Year:

  • 33 weeks rotation (minimum) in anaesthesia at The University of Melbourne’s U-Vet Hospital
  • Up to 12 weeks in research
  • 2 weeks in radiology
  • Up to 1 week for attending conferences
  • 4 weeks’ vacation

3rd Year:

  • 37 (minimum) weeks’ rotation in anaesthesia at The University of Melbourne's U-Vet Hospital
  • Up to 6 weeks research
  • 2 weeks external rotation for completing case log in species not encountered at The University of Melbourne’s U-Vet Hospital (if needed)
  • 2 weeks rotation in a veterinary cardiology service
  • Up to 1 week for attending conferences
  • 4 weeks’ vacation

There is flexibility in that the resident may substitute one or more of the above-suggested rotations with other rotations of the resident’s choice if approve by supervisors. Residents may also spend time in anaesthesia at another institution only if this institution has a well-established residency program and only under supervision of board-certified anaesthesia faculty. For all other rotations, the resident must also be supervised by a faculty who is board-certified in the respective discipline.

At the beginning of each year of the residency a schedule will be handed out to the resident listing the planning of the different rotations as well as the vacations. Requests for changes shall be made to the Program Director.

D. Clinical / Scholarly Activities

The residency will include a balance of both large and small animal anaesthesia training.
The ACVA requires a minimum of 94 weeks of the total 156-week training period to be spent on full-time effort in anaesthesia management (see ACVAA Residency Standards). The schedule of the clinical rotations as outlined above makes sure that those requirements are met. The clinical activities portion of the training program includes doing cases and, dependent on progress of the resident’s clinical proficiency, some supervising both in clinics and laboratories. The rest of the time should be reserved for reading, research, writing and other rotations.

In the first and second year of the residency training program, time slots of 12 weeks per year are allocated for the resident’s research project and other scholarly activities. In the third year, 6 weeks will be allocated for research.
Dependent upon the nature of the research project chosen, the resident may request splitting those 30 weeks over the 3 years differently if this better supports the research activities. It is important to request this change early in advance before the annual time schedule is made by the Resident Program Director. Residents are requested to complete their residency research project with submission of a manuscript prior to completing their residency program.The residency program certificate will not be handed out if a manuscript has not been approved by the project supervising faculty member and submitted for peer review.

E. Morning Rounds and Student Rounds

Anaesthesia rounds and staff meetings of the anaesthesia services are mandatory for all residents. Unless excused for specific reasons beforehand, continuing to care for a case from night duty service, or on an off- campus or non-anaesthesia rotation, the resident shall not miss more than 8 of those rounds per year in order to not jeopardise failing the program.Anaesthesia Literature Review Classes
Literature review classes intended to discuss review articles/book chapters relevant to anaesthesia, critical care and pain management will be held once a week. Those rounds are intended to deepen the understanding of the basic and clinical principles of anaesthesia and will require extensive preparation from the resident. During those rounds and once every 2 months each resident will be required to give a 45 min Power Point presentation about a topic of his/her choice in agreement with the program director/supervisor. In addition, essay questions may be distributed to residents at variable intervals and shall be answered within the set deadline and then be returned to the program director/ supervisor for review by faculty. The purpose of those exercises is to better prepare residents for oral presentations and lectures, and for the written portion of the ACVAA board examinations and to enhance understanding of the basic concepts and practices of anaesthesiology.

Anaesthesia Journal Club

Every other week anaesthesia faculty and residents will attend Journal Club (day and time to be determined), where scientific articles related to veterinary anaesthesia are discussed. The resident is expected to take an active part in these meetings.

Morbidity Mortality Rounds

All faculty, staff and residents will gather (Friday morning from 8h00 to 9h00) to review cases which posed particularly difficult diagnostic or therapeutic challenges or which have died despite best attempts.

Student Rounds

First year residents are obliged to attend student rounds every day at least in the beginning months of their residency. Cases do not take precedence over student rounds. However, since rounds may become redundant over time, at the discretion of the anaesthesiologists, the resident may be excused from attending student rounds, and instead do clinical cases. Later in the resident’s training and once the resident has shown sufficient knowledge, the resident may be asked to give those rounds.

F. Clinical Responsibilities

When on clinics, residents should spend most time doing cases. There is no other way to learn anaesthesia. The better a resident is prepared for an individual case the greater is the learning experience.Cases may be assigned the day before in order for the residents to review the patho-physiology and pharmacology concepts relevant for that particular case. Therefore, after a thorough physical exam of each assigned patient, faculty expects residents to read-up on the specific circumstances of each individual case and keep up with studying the necessary literature in anaesthesia and related disciplines. This is especially important in the first and second year of the residency. Depending upon the resident’s experience, progression and anaesthesiologist’s discretion, the resident may be asked to help out on the floor such as assisting students or junior residents with catheter placement, inductions or anaesthetic management.

The anaesthesia services at The University of Melbourne comprise of a very diverse group of anaesthesia faculty with different training backgrounds and experiences, special interests, and research focuses. As a result, case management may vary from anaesthesiologist to anaesthesiologist, which however should not be perceived as confusion or disagreement among faculty but rather as an opportunity to get exposed to the full breadth of adequate anaesthetic management.

1st Year:
After the resident has been assigned a case, the patient must be evaluated and the record thoroughly read. The resident is expected to already have the appropriate skills for performing a physical exam and assess physical status and for handling appropriately most of the species we work with on a routine basis. It goes without saying that compassion and appropriate behaviour towards animals is expected. Once the patient’s assessment is complete, an appropriate anaesthetic plan shall be formulated, and then the patient and the anaesthetic plan discussed with the anaesthesiologist(s) on clinic duty. Until it is made clear by the Anaesthesia Officer (AO) of the day or another anaesthesiologist on clinics and the anaesthetic plan has been discussed, residents should not be inducing anaesthesia in patients or giving drugs. During the anaesthetic management of the case, any problems shall be reported or any questions directed to the AO or other anaesthesiologist(s) on clinics. In order to begin cases on-time early in the morning right after Anaesthesia rounds/meeting, student rounds or other seminars,
residents are well advised to set-up anaesthesia machines and other equipment for those cases prior to going to those meetings.
As stated above, depending upon the resident and at the discretion of the anaesthesiologist(s), the resident may be asked to assist students or do cases with students. When not working on a case residents are encouraged to observe the management of other cases and interact with the anaesthesiologist(s) on the floor, or after consultation with the AO retreat to their offices to prepare themselves for another case by reading up on specific literature related to the case. Before leaving the OR area in the evening or at any other time during the workday, please let the AO know that you are leaving and where you can be reached if your assistance is needed.

2nd Year:

In general, second year residents are left to choose their own cases (allowing it does not interfere with workflow). They are still expected to discuss difficult or complicated cases with the AO or other anaesthesiologist on clinics.
Second year residents may assist the students with inductions and intra-operative problems if requested to do so by the anaesthesia nurse or anaesthesiologist(s) on clinic duty.

3rd Year:

In addition to doing cases, the third year resident may be assigned days to run the clinical floor in the function of an AO or taking on parts of the AO’s responsibilities. This requires that senior residents give the student rounds, discuss anaesthetic plans with the students, technicians, and junior residents, and manage any anaesthetic-related problems that may arise. During these periods, at least one faculty person will be available in the hospital in case the resident wants to consult with a more experienced anaesthesiologist on difficult to manage cases.

General Thoughts:

When being on clinics, the resident’s primary responsibility is anesthetising animals in the first and second year. Therefore, the majority of that time should be spent practicing anaesthesia, and the resident should expect to do a minimum of one very long case or 2-3 short cases each day. However, as stated above, when not anesthetising cases, the resident should be assisting the anaesthesiologists on clinic duty. Also, residents will be expected to assist in the teaching laboratories on occasion.

The resident should not leave for the day without checking with the anaesthesiologist on duty to be sure that the anaesthesiologist does not need his/her help. It is not unusual to have cases anaesthetised or still recovering from anaesthesia past 6:00 PM. Residents are requested to keep track of the cases that they have done. The ACVAA require that residents anesthetise a minimum number of cases for each species, and it is the resident’s responsibility to assure that he/she meets the ACVAA requirements. This may be best achieved by keeping copies of all anaesthesia records of cases in which the resident was involved in and by entering the data from those anaesthesia protocols into a case log (using a format suggested by the ACVAA – www.acvaa.org).
Elective cases should not be viewed as routine and boring. Unexpected problems develop in elective ASA I and II cases as frequently as they do in the more critical patients. The elective cases also provide an opportunity to use new drugs, different anaesthetic techniques and the various monitors. One can learn something from every case that you do. If you have a question about anything, don’t be afraid to ask.

G. Scholarly Responsibilities

According to the ACVAA Residency Standards the resident must participate in the development of new knowledge, learn general principles of “good science”, and learn to evaluate research findings. A first author manuscript reporting new knowledge in the area of anaesthesiology, pain management or critical/intensive care must be submitted prior to completion of the residency program and receiving the residency certificate. Furthermore, the resident is expected to present the study results at a national or international anaesthesia meeting as a short communication or in poster format. The full manuscript must be accepted for publication in a refereed biomedical journal acceptable to the ACVAA’s Credential Committee prior to examination for admittance into the ACVAA. The Masters programs requires furthermore a two other papers in the area of anaesthesiology, pain management or critical/intensive care (case report, review or CPD article of which the applicant is first author).

H. Emergency and Other Duties

Emergency duty is considered an important part of the resident’s training, since emergencies frequently prove to be the most challenging cases. Initially, residents on call may have faculty back-up in the room, which consists of a veterinary anaesthesiologist, depending and their knowledge and competences. Residents may also be called in for emergency duties outside their emergency duty schedule, when the primary anaesthesia staff or faculty person on-call might need additional help due to a complex case scenario or when simultaneous anaesthesia in more than one emergency case is necessary.

Residents may be on-call one weekend and 6 to 8 other nights per month dependent on scheduling needs. How long residents should be accompanied by faculty initially will be decided on an individual basis. Once a resident is deemed capable of handling cases on his/her own, they will take on-calls independently but faculty back-up will be reachable by phone if needed.

It will be expected that residents are proficient in handling most after-hour on calls by themselves by the mid of their first year of residency.

Residents may be expected to have clinic duties over the Christmas, New Year and Easter holidays but this duty will be shared with the rest of the anaesthesia staff. In addition, residents should be prepared to fulfil clinical duties on days or at times that may interfere with their religious requirements, although efforts will be undertaken to accommodate religious needs of the individual as best as possible.

New ACVAA guidelines regarding after-hour duties will likely soon be published in the ACVAA Training Standards.
In consequence emergency duties may change during the residency to adopt those guidelines.

I. Evaluation

The resident’s performance will be formally evaluated constructively by the anaesthesia faculty at 6 months intervals. It will be in written and may also be verbal. Upon the resident request, an informal oral evaluation could also be performed every 3 months.
At 6, 18 and 30 months into the residency an oral examination following the template of the oral board examination may take place. At 12, 24 and 36 months into the residency a written examination following the template of the written board examination may take place.
Based on those evaluations and mutual satisfaction the resident will enter into the second or third year of residency. The resident will also be asked to offer an evaluation of the program. The Program Director(s) will hold at least once a year a meeting with all residents to discuss the residency program and problems/changes pertinent to the residency program.

J. "Moonlighting" during Residency

Employment (as a veterinarian) outside of The University of Melbourne’s U-Vet Hospital during a residency training program is permitted with prior approval of the resident's direct supervisor (i.e. Residency Program Director). Such employment is permissible as long as it does not negatively impact upon the resident’s obligations to any aspect of the residency program or create potential conflict of interest with the management and care of Veterinary School patients. Each resident must receive permission from his/her supervisor (i.e., the Residency Program Director) for each unique employment opportunity, as requests will be considered on a case-by-case basis.

K. Miscellaneous

Residents are encouraged to attend one national/international meeting each year. If scholarly productivity allows further meetings may be attended for presentation of research work.

Residents are entitled to 4 weeks (20 days) of vacation per year and 1 sick leave day/month, and are encouraged to inform the Residency Program Director as early as possible about preferred vacation times in a given year.

For more information on the residency program, do not hesitate to contact Sebastien Bauquier (Bauquier@unimelb.edu.au).

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