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:
|
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 |