CCT in Anaesthetics - Core Level Training

Published: 14/08/2019

Orthopaedic surgery (incorporating peri-operative care of the elderly)

This unit includes all aspects of elective and emergency orthopaedic surgery. It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the entire duration of Core Level training and that these should be achievable in most general hospitals at this level.

Learning outcomes:

To gain knowledge, skills and experience of the perioperative anaesthetic care of patients requiring orthopaedic surgery including the elderly and patients with long-bone fractures
To understand the relevance of diseases of bones and joints to anaesthesia
To be able to recognise and manage the perioperative complications of orthopaedic surgery relevant to anaesthesia

Core clinical learning outcome:

Deliver perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients for straightforward elective and emergency orthopaedic/trauma surgery to both upper and lower limbs, including Open Reduction Internal Fixation [ORIF] surgery [which includes fractured neck of femur], under distant supervision

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.

Knowledge

Competence	Description	Assessment Methods	GMP
OR_BK_01	Recalls/describes the perioperative implications of rheumatological disease, including but not limited to rheumatoid arthritis, osteoarthritis, osteoporosis and ankylosing spondylitis	A,C,E	1
OR_BK_02	Recalls the complications of prolonged immobility, including those due to traction	A,C,E	1,2
OR_BK_03	Recalls the problems associated with limb tourniquets	A,C,E	1,2
OR_BK_04	Recalls/explains the potential hazards associated with positioning [supine, lateral, prone, sitting]	A,C,E	1,2
OR_BK_05	Recalls/explains the problems associated with anaesthesia for surgery in the prone and lateral positions	A,C,E	1,2
OR_BK_06	Recalls/describes the pathophysiology, diagnosis and management of specific orthopaedic surgical complications that are relevant to anaesthesia including but not exclusively: Bone cement Implantation Syndrome Diagnosis and management of fat embolism Upper and lower limb compartment syndromes	A,C,E	1
OR_BK_07	Discusses strategies for blood conservation in major orthopaedic surgery	A,C,E	1,2
OR_BK_08	Describes the principles of perioperative anaesthetic care for elective and emergency upper and lower limb orthopaedic surgery, including primary arthroplasty	A,C,E	1,2,3
OR_BK_09	Discusses the current guidance on early surgical management of hip fractures and the necessary assessment for anaesthesia	A,C,E	1,2
OR_BK_10	Discusses the timing of surgery, and the need for investigations in urgent [surgical] cases with cardiovascular signs	A,C,E	1,2
OR_BK_11	Describes the different surgical procedures for managing hip fractures, the anaesthetic requirements for each and the current evidence for the choice of anaesthetic technique	A,C,E	1
OR_BK_12	Discusses the importance of consistent decision making on fitness for surgery in elderly patients	A,C,E	1,4
OR_BK_13	Recalls/describes the peri-operative care of the elderly	A,C,E	1,2

Skills

Competence	Description	Assessment Methods	GMP
OR_BS_01	Demonstrates the provision of perioperative anaesthetic care for patients requiring orthopaedic surgery to the upper and lower limbs including but not exclusively: ORIF surgery including internal fixation of fractured neck of femur Lower limb primary arthroplasty including patients in the lateral position	A,D,M	1,2
OR_BS_02	Demonstrates sensitive handling of the patient with cognitive disturbance or communication problems	A,D,M	1,3,4
OR_BS_03	Demonstrates correct assessment and perioperative management of the elderly patient with a hip fracture	A,D,M	1,2,3,4
OR_BS_04	Shows sensitive handling of patient with cognitive impairment in anaesthetic room	A,D,M	1,2,3,4