CCT in Anaesthetics - Stage 2 Training

2_POM_A: Delivers high quality, individualised perioperative care to ASA 1-4 patients for elective surgery and ASA 1-3 emergency patients, focusing on optimising patient experience and outcome

2_POM_A_1	The Identification and assessment of pathology in or around the airway, including but not limited to: •     History and examination •     Anaesthetic chart review •     Interpretation of investigations such as lateral C-spine X-ray, cross sectional imaging of the upper airway (MRI/CT), flow volume loops, nasendoscopy  •     Discussion with surgeons
2_POM_A_2	The preoperative assessment of patients with particular reference to associated co-morbidities and complex planned surgery. Including those for cardiothoracic, neuro, general, airway and plastic procedures.
2_POM_A_3	The effects of ethnicity and patient diversity on pre-operative assessment

2_POM_B: Liaises appropriately with other healthcare professionals to optimise patient care

2_POM_B_1	Balances the need for early surgery against the need for further investigation, prehabilitation and pre-optimisation
2_POM_B_2	Contributes to discharge planning

2_POM_C: Explains the principles of shared decision making

2_POM_C_1	Shared decision making in the context of planning peri-operative care
2_POM_C_2	How a multidisciplinary team approach improves patient recovery and outcomes

2_POM_D: Makes appropriate plans to mitigate co-morbidities and their treatment in the perioperative period, with particular reference to less common cardiovascular, neurological, respiratory, endocrine, haematological and rheumatological diseases

2_POM_D_1	Understanding of the principles of anaesthesia for patients with neurological disease including but not limited to: •       Guillain-Barré •       Myasthenia gravis •       Myasthenic syndrome •       Dystrophia myotonica •       Muscular dystrophy •       Paraplegia and long-term spinal cord damage
2_POM_D_2	The abnormalities found in the adult patient with congenital heart disease [including corrected or partially corrected], and the implications for anaesthesia in these patients
2_POM_D_3	The effects of chemotherapy/radiotherapy and the implications for anaesthesia
2_POM_D_4	The perioperative management of patients undergoing transplant surgery
2_POM_D_5	The perioperative management of patients with transplanted organs for non-transplant surgery
2_POM_D_6	Appropriate preoperative strategies for minimising the use of blood products
2_POM_D_7	Assessment of the patient with complex comorbidities taking account of their individual needs and requirements including those with cardiac, respiratory, and renal disease
2_POM_D_8	Endocrine abnormalities of significance to anaesthesia – e.g., Cushing’s, Addison’s, diabetes mellitus, thyroid/pituitary disease, phaeochromocytoma and the stress response

2_POM_E: Appreciates how integrated care pathways influence patient outcomes

2_POM_E_1	The principles of enhanced recovery programmes
2_POM_E_2	The strategies for prehabilitation and patient optimisation and the limits of such strategies

2_POM_F: Describes the use and limitations of common risk-scoring systems

2_POM_F_1	Peri-operative risk assessment in patients with cardiac/respiratory disease or other co-morbidities, using common scoring systems including but not exclusively Lees RCRI, SORT, PPOSSUM, ACS NSQIP etc
2_POM_F_2	The uses and limitations of common risk scoring systems

 

2_POM_G: Recognises when advanced physiological testing is indicated, interpreting the data to help stratify risk

2_POM_G_1	Assessment of cardiac function including; Coronary angiography, ECHO, CT, MRI, nuclear imaging, and cardiopulmonary exercise testing both formal (CPET) and informal (six-minute shuttle tests)
2_POM_G_2	Assessment of respiratory function:  blood gases, pulmonary function tests and diffusion capacity
2_POM_G_3	The use of specialised imaging techniques (e.g., CT, MRI) in planning anaesthesia and surgery for head and neck surgery
2_POM_G_4	The principles of preoperative evaluation of patients at risk of post-operative morbidity, including risk stratification tools e.g., ·       Scoring systems ·       Measures of functional capacity (including cardiopulmonary exercise testing) ·       Echocardiography
2_POM_G_5	Responds appropriately to investigation results when planning perioperative care
2_POM_G_6	Sleep studies - principles
2_POM_G_7	Interpretation of biochemical data
2_POM_G_8	Interpretation of haematological data
2_POM_G_9	Measurement of coagulation of the blood and interpretation of data including use of point of care tests eg TEG/ROTEM

2_POM_H: Applies basic sciences to perioperative care

2_POM_H_1	The pathophysiological changes and organ dysfunction associated with cardiac disease, and implications in the perioperative period
2_POM_H_2	The causes, pathophysiology and management of obstructive sleep apnoea and the surgical procedures used to treat
2_POM_H_3	The anaesthetic complications related to disturbance of fluid balance, oedema, and dehydration
2_POM_H_4	The rationale for and principles of perioperative haemodynamic management and optimisation, including management of phaeochromocytoma.
2_POM_H_5	Recognises that a relatively large proportion of patients requiring ophthalmic surgery are elderly and understands their particular needs including, but not exclusively, the effects of physiological changes associated with ageing and altered pharmacological responses

2_POM_I: Applies the principles of public health interventions such as smoking cessation, reducing obesity and alcohol intake

2_POM_I_1

The effects of smoking, excessive alcohol/drugs, and obesity on health

2_POM_J: Recognises the potential harms of health care interventions

2_POM_J_1

Adverse effects of medications in the peri-operative period eg antihypertensives, anticoagulants, hypoglycaemic agents, and anti-platelet medications

2_POM_K: Explains how religious, cultural, and lifestyle factors may influence healthcare choices, such as blood transfusions, implants, and use of animal derived products

2_POM_K_1	The particular sensitivity of patient choice even when this is not in line with accepted evidence based best practice e.g., choice of birth plan, and refusal of blood products
2_POM_K_2	How ethnicity and patient diversity may influence conduct of anaesthesia

 

2_POM_L

Describes the needs and roles of carers and those providing support in the perioperative period and applies this to practice

 

2_POM_M

Describes the requirement for postoperative organ support and its limitations

 

2_POM_N

Applies end of life care as part of a multidisciplinary team

2_POM_O: Explains and acts on the importance of perioperative management of haematological conditions including anaemia and coagulopathy

2_POM_O_1	Management of concurrent use of anticoagulant/antiplatelet therapy
2_POM_O_2	Management of peri-operative anaemia

2_POM_P: Recognises the factors associated with abnormal perioperative nutritional states and applies strategies to mitigate risks where appropriate

2_POM_P_1	Nutritional assessment techniques including laboratory tests
2_POM_P_2	Clinical consequences of poor nutritional status: including wound healing, infection, cardiovascular stability, thermoregulation, respiratory control

2_POM_Q: Applies adjustments required that co-existing disease and surgical complexity have on the conduct of anaesthesia and perioperative care, including frailty, cognitive impairment and the impact of substance abuse or obesity

2_POM_Q_1	Perioperative implications of bariatric surgery
2_POM_Q_2	Recognition and management of patient with frailty including use of clinical frailty scoring system

 

2_POM_R

Demonstrates adjustments in perioperative care for children with co-morbidity

 

2_POM_S

Plans appropriate obstetric anaesthetic care for all parturients collaboratively with the wider multi-disciplinary team

2_POM_T: Recognises and manages critical illness in patients, including immediate resuscitation, and leads the care of acute obstetric emergencies

2_POM_T_1

Recognition and management of amniotic fluid embolus