MEDIC ST 5014BHO - Anaesthesia, Pain Medicine & Intensive Care V Pt 2
Teaching Hospitals - Semester 2 - 2017
General Course Information
Course Code MEDIC ST 5014BHO Course Anaesthesia, Pain Medicine & Intensive Care V Pt 2 Coordinating Unit Medicine Term Semester 2 Level Undergraduate Location/s Teaching Hospitals Units 2 Contact attachments, common program & research Available for Study Abroad and Exchange N Prerequisites MEDIC ST 4000AHO and 4000BHO Restrictions Available to MBBS students only Course Description The clinical attachments are a program of clinical education through a selection of placements so that students will be competent in history-taking, patient examination and management. This includes problem formulation, investigations, treatment (pharmacological and non-pharmacological), counselling, good communication skills, the practice of empathetic medicine, and a sound knowledge base that allows diagnosis and management of common disorders to be carried out under appropriate supervision. Some students will have the opportunity to undertake their training for an extended period of time in a rural or remote setting.
Course Coordinator: Julia ColdreyRAH ICU contact:
A/Prof Mary White
RAH Anaesthetics contact:
Dr Julia Coldrey
RAH & TQEH Pain and Palliative Care contact:
A/Prof Pam Macintyre
The Queen Elizabeth Hospital Anaesthetics and ICU contact:
Dr Thava Visvanathan
Lyell McEwin Hospital contact:
Dr Lynda D’Souza
The full timetable of all activities for this course can be accessed from Course Planner.The course timetable for the APIC rotation is made available to students on the first day of the rotation.
Course Learning OutcomesThe course objectives for the anaesthesia component are:
1. Preoperative Assessment
1.1. Rational ordering of Preoperative investigations
1.2. Assessment Cardiorespiratory reserve
1.3. Airway assessment
1.5. Management of peri-operative medications1.5.1. Hypoglycaemics1.5.2. Anticoagulants/Antiplatelet agents1.5.3. Herbal preparations1.5.4. Other1.6. Fasting Guidelines
1.7. Pre-medication (bronchodilators, reflux prevention, etc.)
2. Pharmacology (brief overview)
2.1. iv induction agents
2.2. inhalational agents
2.3. muscle relaxants
2.4. reversal agents
2.5. local anaesthetics (safe doses, routes of administration, toxicity & its treatment)
3. Monitoring (basic overview)
3.1. Pulse oximetry
3.4. Blood pressure
4. Emergency Anaesthesia
4.1. EMST principles (primary survey)
4.2. Rapid Sequence Induction
5. Gas Exchange
5.1. Oxygen therapy– routes and delivered concentrations
5.2. Hypoxia – differential and management
5.3. Hypercarbia – differential and management
6. CVS crises
6.1. BLS/ALS pricinples
6.2. mangement of cardiac arrest
6.3. management of anaphylaxis
7. Co-morbidites (outline of principles and peri-operative implications)
7.1. Gastro-oesphageal reflux
7.3. Sleep Apnoea
7.5. Ischaemic heart disease
8. Peri-operative Fluid Management
8.1. Water, Na+, K+
8.2. Blood transfusion and transfusion triggers
9.1. Analgesia (see pain week)
9.4. Nausea and vomiting
9.5. Airway/breathing issues
10.1. iv cannulation
10.2. chin lift/jaw thrust
10.3. oropharyngeal/nasopharyngeal airway insertion
10.4. bag and mask ventilation.
The objectives of the pain component are:
1. Assessment of pain in relation to clinical diagnosis, classification and response to therapy
2. Knowledge of the pharmacology of drugs commonly used in pain management
3. Develop a familiarity with drug and non-drug techniques commonly used in pain management
4. Develop pain management strategies required to competently fulfil the role of an intern.
The objectives of the ICU component are:
1. Revision of physiology and pharmacology in a case-based, clinical setting
2. Approach to the management of critically ill patientsa. Essentials of identification, triage and management of critically ill patientsb. Principles of life-support and monitoring systemsc. Practical aspects of advanced life support3. Understanding of the ethical issues involved in the care of critically ill patients
4. Revision of basic and advanced life support skills (BLS, ALS).
University Graduate Attributes
This course will provide students with an opportunity to develop the Graduate Attribute(s) specified below:
University Graduate Attribute Course Learning Outcome(s) Deep discipline knowledge
- informed and infused by cutting edge research, scaffolded throughout their program of studies
- acquired from personal interaction with research active educators, from year 1
- accredited or validated against national or international standards (for relevant programs)
All of the above Critical thinking and problem solving
- steeped in research methods and rigor
- based on empirical evidence and the scientific approach to knowledge development
- demonstrated through appropriate and relevant assessment
All of the above Teamwork and communication skills
- developed from, with, and via the SGDE
- honed through assessment and practice throughout the program of studies
- encouraged and valued in all aspects of learning
All of the above Career and leadership readiness
- technology savvy
- professional and, where relevant, fully accredited
- forward thinking and well informed
- tested and validated by work based experiences
All of the above Intercultural and ethical competency
- adept at operating in other cultures
- comfortable with different nationalities and social contexts
- able to determine and contribute to desirable social outcomes
- demonstrated by study abroad or with an understanding of indigenous knowledges
All of the above Self-awareness and emotional intelligence
- a capacity for self-reflection and a willingness to engage in self-appraisal
- open to objective and constructive feedback from supervisors and peers
- able to negotiate difficult social situations, defuse conflict and engage positively in purposeful debate
All of the above
• Acute Pain Management: Scientific Evidence 3rd edition, 2010: see http://www.anzca.edu.au/fpm/resources/books-and-publications
• Macintyre and Schug, Acute Pain Management: a practical guide, WB Saunders, 3rd edition 2007
• Therapeutic Guidelines: Palliative Care: available via the University of Adelaide library
• Australian Medicines Handbook: available via the University of Adelaide library
• Introductory anaesthetics textbook such as:o Gwinnutt, Lecture Notes: Clinical Anaesthesia, 4th edition, 2012o Harley and Hore, Anaesthesia an introduction, 5th edition, 2012
Online LearningStudents are recommended to review the SMTS pain and palliative care content available on MyUni as well as the relevant lectures on pain and analgesia from the MLTU website.
Learning & Teaching Activities
Learning & Teaching ModesCore teaching process for ICU includes:
1. Small and large group teaching sessions ie. lectures and tutorials
2. Skills sessions (simulator sessions)
3. Case presentations
4. Clinical attachments with ward rounds
5. Self-directed study
6. Presentation of ICU related topics.
The pain component learning is delivered via:
2. Clinical attachments to acute pain, chronic pain and palliative care
4. Group work and group presentation
5. Case based discussion of chronic pain and palliative care
6. Self-directed learning
The anaesthetics teaching and learning modes include:
1. PBL sessions
2. Clinical attachments in theatre, OPD and recovery
3. Simulator sessions
4. Self-directed learning
The information below is provided as a guide to assist students in engaging appropriately with the course requirements.Workload for the individual students will vary from week to week but students can assume that on average they will work a 45 hour week which will include clinic sessions, lectures (both delivered and online), seminars, tutorials and private study but does not include after hours call.
Learning Activities SummaryFor all components, students are expected to attend all clinical rounds and rostered tutorials and participate actively in these.
RAH: Students will be provided with handouts on initial assessment and management of trauma, management of shock and preoperative care and will be expected to have read this in preparation for the PBL sessions, along with material available on the MLTU website.
TQEH: Students are requested to pre-read the PBL on local anaesthetics available on the MLTU website for their PBL on the first Monday afternoon. All other PBLs and rostering will be notified during orientation and material will be available on website.
Students are expected to complete the recommended readings:
1. Revisit 4th year lectures on pain and analgesics
2. Macintyre and Schug – Acute Pain Managementa. Chapter 3 – Assessment of painb. Chapter 4 – pharmacology of opioidsc. Chapter 6 – non-opioid and adjuvant analgesic drugsd. Chapter 7 – routes of systemic opioid administratione. Chapter 8 – patient-controlled analgesiaf. Chapter 9 – epidural analgesiag. Chapter 12 – acute neuropathic painh. Chapter 14 – elderly, opioid-tolerant and substance abuse patients3. Therapeutic Guidelines – Palliative Carea. Chapter – Getting to know your drugsb. Chapter – Pain4. Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care. 2011 Jul;39(4):545-58
5. Coldrey JC, Upton RN, Macintyre PE. Advances in analgesia in the older patient. Best Pract Res Clin Anaesthiol. 2011 Sep; 25(3):367-78
6. Huxtable CA, Roberts LJ, Somogyi AA, Macintyre PE. Acute pain management in opiod-tolerant patients: a growing challenge. Anaesth Intensive Care. 2011 Sep;39(5):804-23
Specific Course RequirementsN/A
Small Group Discovery ExperienceThe predominant learning method for the MBBS Program is small group discovery learning.
The University's policy on Assessment for Coursework Programs is based on the following four principles:
- Assessment must encourage and reinforce learning.
- Assessment must enable robust and fair judgements about student performance.
- Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
- Assessment must maintain academic standards.
Assessment SummaryAssessment for the APIC rotation is a combination of the individual assessments for each sub-rotation. It is based on attendance, presentation assessments and clinical competency.
Assessment Related RequirementsSee Assessment Detail
1. Attendance at and participation in clinical rounds and tutorials
2. MCQ paper based on material covered in acute pain and pharmacology lectures in year 4. See chapters 3,4,6,7 in Macintyre and Schug.
3. Group presentation of allocated clinical “patient in pain” casea. The presentation should not exceed 30 minb. The presentation is a group effort – all students should discuss the case and be prepared to answers any questions asked by the examiners
1. Attendance at and participation in clinical activities including simulator session
2. Participation in PBL sessions
3. TQEH: in addition to 1&2, each student is required to research and present a 15-20 minute presentation on a preoperative scenario at the end of their second week.
4. LMH: in addition to 1&2, student are required to present a case.
1. Professional behaviour
2. Participation in clinical activitiesa. Attendance, including out of hours (minimum 95% attendance required to pass rotation)b. Actively seeks learning opportunitiesc. Contributes to patient discussion3. Medical competencea. Thorough history and physical examination skillsb. Concise and accurate case presentations4. Theoretical knowledgea. Good knowledge base with ability to apply to clinical situations5. ICU presentation
Grades for your performance in this course will be awarded in accordance with the following scheme:
GS8 (Coursework Grade Scheme) Grade Description CN Continuing FNS Fail No Submission NFE No Formal Examination F Fail NGP Non Graded Pass P Pass C Credit D Distinction HD High Distinction RP Result Pending
Further details of the grades/results can be obtained from Examinations.
Grade Descriptors are available which provide a general guide to the standard of work that is expected at each grade level. More information at Assessment for Coursework Programs.Grades for your performance in this course will be awarded in accordance with the following scheme: GS4
Grade Description NGP Non-Graded Pass S Satisfactory U Unsatisfactory F Fail
Final results for this course will be made available through Access Adelaide.Submission details will be outlined at the beginning of the attachment.
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