To perform a structured preoperative anaesthetic assessment of a patient prior to surgery and recognise when further assessment/optimisation is required
To explain options and risks of routine anaesthesia to patients, in a way they understand, and obtain their consent for anaesthesia
To formulate a plan for the management of common co-existing diseases, in particular the perioperative plan for the patient with diabetes
History Taking: Knowledge
PA_BHK_01 History Taking – Lists the important elements of anaesthetic history taking
PA_BHK_02 Recognises that patients do not always present history in a structured fashion
PA_BHK_03 Lists the likely causes and risk factors for conditions relevant to mode of presentation
PA_BHK_04 Uses the patient’s agenda and history to inform examination, investigation and management
History Taking: Skills
PA_BHS_01 Identifies and overcomes barriers to effective communication
PA_BHS_02 Manages time and draws consultations to a close appropriately
PA_BHS_03 Recognises that effective history taking in non-urgent cases may require several discussions with the patient and other parties over time
PA_BHS_04 Supplements history with standardised instruments or questionnaires when relevant
PA_BHS_05 Identifies alternative and conflicting views from family, carers, friends and members of the multi-professional team
PA_BHS_06 Assimilates history from the available information from the patient and other sources
PA_BHS_07 Interprets and uses non-verbal communication to and from patients and carers
PA_BHS_08 Focuses on relevant aspects of history
Clinical Evaluation: Knowledge
PA_BCK_01 Describes the need for a targeted and relevant clinical examination
PA_BCK_02 Describes the basis for clinical signs and the relevance of positive and negative physical signs
PA_BCK_03 Recognises constraints to performing physical examination and uses strategies to overcome them
PA_BCK_04 Recognises the limitations of physical examination and the need for adjunctive forms of assessment to confirm diagnoses
PA_BCK_05 Offers or uses a chaperone when appropriate
Clinical Evaluation: Skills
PA_BCS_01 Performs an examination relevant to the presentation and risk factors that is valid, targeted and time efficient
PA_BCS_02 Reports the possibility of deliberate harm [both self-harm and harm by others] in vulnerable patients to appropriate agencies
PA_BCS_03 Actively elicits important clinical findings
* Physiological investigations such as: – ECGs – Echocardiography and stress testing – Pulmonary function tests
Investigations: Skills
PA_BIS_01 Interprets clinical laboratory data including:
* Haematology such as – Routine report of Hb, WBC, haematocrit etc.
* Biochemistry such as
Arterial blood gases/acid-base balance
Urea and electrolytes
Liver function – Endocrine biochemistry such as blood glucose and thyroid function
PA_BIS_02 Identifies normal appearances and significant abnormalities in radiographs including:
* Chest X-rays
* Trauma films ‘ cervical spine, chest, pelvis, long bones
* Head CT and MRI showing clear abnormalities
Specific Anaesthetic Evaluation: Knowledge
PA_BSK_01 Gives examples of methods of anaesthesia that are suitable for common operations
PA_BSK_02 Describes the ASA and NCEPOD classifications and their implications in preparing for and planning anaesthesia andpostoperative care
PA_BSK_03 Explains the indications for and interpretation of preoperative investigations
PA_BSK_04 Lists the indications for preoperative fasting and appropriate regimens
PA_BSK_05 Explains the methods commonly used for assessing the airway to predict difficulty with tracheal intubation
PA_BSK_06 Lists the indications for Rapid Sequence Induction
PA_BSK_07 Gives examples of the effect of common co-existing diseases on anaesthesia and surgery including but not exclusively: obesity; diabetes; asthma; ischaemic heart disease; hypertension; rheumatoid disease; epilepsy
PA_BSK_08 Discusses how to manage drug therapy for co-existing disease in the perioperative period including, but not exclusively: diabetic treatment; steroids; anti-coagulants; cardiovascular and respiratory medication; anti-convulsants
PA_BSK_09 Explains the available methods to minimise the risk of thromboembolic disease following surgery
PA_BSK_10 Describes the complications of anaesthetic drugs [including anaphylaxis, suxamethonium apnoea and malignanthyperpyrexia] and how to predict patients who are at increased risk of these complications
PA_BSK_11 Identifies the principles of consent for surgery and anaesthesia, including the issue of capacity
PA_BSK_12 Explains the guidance given by the GMC on consent, in particular:
* Understands that consent is a process that may culminate in, but is not limited to, the completion of a consent form
* Understands the particular importance of considering the patient’s level of understanding and mental state [and alsothat of the parents, relatives or carers when appropriate] and how this may impair their capacity for consent
PA_BSK_13Summarises the factors determining a patient’s suitability for treatment as an ambulant or day-stay patient
PA_BSK_14 Recalls the factors that affect the risk of a patient suffering post-operative nausea & vomiting
Specific Anaesthetic Evaluation: Skills
PA_BSS_01 Obtains a history specifically relevant to the planned anaesthesia and surgery including:
* A history of the presenting complaint for surgery
* A systematic comprehensive relevant medical history
* Information about current and past medication
* Drug allergy and intolerance
* Information about previous anaesthetics and relevant family history
PA_BSS_02 Performs a relevant clinical examination including when appropriate:
* Cardiovascular system
* Respiratory system
* Central and peripheral nervous system: GCS, peripheral deficit
PA_BSS_06 Makes appropriate plans for anaesthesia:
* Reviews current medication and seeks advice where appropriate
* Plans appropriate anaesthetic technique[s]
* Secures consent for anaesthesia
* Recognises the need for additional investigation and acts accordingly
* Discusses issues of concern with relevant members of the team
* Reliably predicts the level of supervision they will require
PA_BSS_07 Presents information to patients [and carers] in a format they understand, checking understanding and allowing time for reflection on the decision to give consent
PA_BSS_08 Provides a balanced view of care options
