Emory University School of Medicine

Allied Health Professions 1997-1999

Anesthesiology and Patient Monitoring Systems

Program Director W. T. Frazier, M.D.

Coordinator for Educational Administration G. W. Potts, B.S.Ed.

Coordinator for Basic Sciences A. W. Paulsen, M.M.Sc., Ph.D.

Coordinator for Medical Sciences S. H. Odom, M.D.

Coordinator for Clinical Anesthesiology I R. Brouillard, M.M.Sc., D.Sc.

Coordinator for Clinical Anesthesiology IIB. D. Biggs, M.M.Sc.

Coordinator for Preoperative and Critical Care Medicine S. T. Stewart, M.M.Sc.

Allied Health Didactic Faculty D.I. Bauman, M.M.Sc., C.C. Cannarella, M.M.Sc., D.Sc., N.S. Cunningham, M.M.Sc., M. DeCamp, M.M.Sc., R. Grabenkort, M.M.Sc., T.Martin, M.M.Sc., N. Sane, M.M.Sc., K. Roe, M.M.Sc.

Allied Health Clinical Faculty L. Aaberg, M.M.Sc., B. Anderson, M.M.Sc., C. Bai, M.M.Sc., D. I. Bauman, M.M.Sc., P. Bell, M.M.Sc., D.B. Biggs, M.M.Sc., R. Boehlert, M.M.Sc., L. Boras, M.M.Sc., R. Brouillard, M.M.Sc., K. Clark, M.M.Sc., B. Cooper, M.M.Sc., N. Cunningham, M.M.Sc., E. Curtwright, M.M.Sc., D. Davis, M.M.Sc., S. Dawson, M.M.Sc., M. DeCamp, M.M.Sc., P. Dixon, M.M.Sc., S. Duane, M.M.Sc., S. Edwards, M.M.Sc., C. Elmore, M.M.Sc., B. Floyd, M.M.Sc., J. Fridirici, M.M.Sc., C. Gilliland, M.M.Sc., D. Gober, M.M.Sc., W. Gohr, M.M.Sc., G. Gunter, M.M.Sc., J. Griffith, M.M.Sc., A. Hall, M.M.Sc., S. Hancock, M.M.Sc., K. Harris, M.M.Sc., W. Holbrook, M.M.Sc., L. Holda, M.M.Sc., R. Holloway, M.M.Sc., R. Jones, M.M.Sc., P. Kelly, M.M.Sc., D. Kralis, M.M.Sc., H. Lessley, M.M.Sc., J.E. Lewis, B.S., K. Maloney, M.M.Sc., E. Martin, M.M.Sc., G. Moelich, M.M.Sc., M. Mogelnicki, M.M.Sc., C. Morey, M.M.Sc., R. Nardi, M.M.Sc., M. Nassar, M.M.Sc., A. Offutt, M.M.Sc., S. Park, M.M.Sc., M. Pettignano, M.M.Sc., G. Phillips, M.M.Sc., M. Ragsdale, M.M.Sc., K. Roe, M.M.Sc., A. Rosado, M.M.Sc., B. Ryan, M.M.Sc., N. Sane, M.M.Sc., R. Schellman, M.M.Sc., B. Scoggins, M.M.Sc., G. Sedor, M.M.Sc., K. Shipley, M.M.Sc., K. Snider, M.M.Sc., J. Spiceland, M.M.Sc., J. Stewart, M.M.Sc., S. Stewart, M.M.Sc., G. Taras, M.M.Sc., J. Van Duys, M.M.Sc., B. Witz, M.M.Sc., S. Yoakam, M.M.Sc., C. Young, M.M.Sc., A. Ziemann, M.M.Sc., A. Yin, B.S.

Clinical teaching and special lecture assistance is given by the medical school faculty of the Department of Anesthesiology, John L. Waller, M.D., chairman. For a complete listing of departmental faculty, please see the Bulletin of Emory University School of Medicine.

DESCRIPTION OF THE PROGRAM

The goal of this program is to prepare graduates to function as anesthesiology physician assistants* (APAs) to anesthesiologists (i.e., physicians specifically trained in anesthesiology). Anesthesiology physician assistant programs were created in the late 1960s to help meet quantitative and qualitative challenges created by changes in the scope of anesthesia practice, increasing workload, and changes in the organization of the anesthesia care team (i.e., anesthesiologist directing anesthetists in the delivery of anesthetic care). These changes and advances have occurred over several decades, but were accelerated in the 1960s due to factors such as increased complexity of anesthetic care (i.e., sicker patients, more complex surgery, many new drugs, etc.), the marked increase in the availability of new monitoring technology, increasing demands for a higher quality of anesthetic care, and accentuation of personnel shortages as physicians and nurses who entered the field immediately after World War II retired. These factors have created a need for recruiting and educating a new type of anesthetist. Recruiting has been from a wide variety of educational and work background (e.g., respiratory therapy, medical technology, emergency medicine, nursing, premed, etc.), with an emphasis on the type of aptitudes and premed background (i.e., bachelor's degree level) that support the acquisition of a high level of anesthesia basic and clinical science knowledge. The education has taken place in academic medical center settings in association with an approved residency program.

Since its beginning in 1969, the intent of the Emory program has been to produce a new type of anesthetist--an anesthesiology physician assistant (APA) whose clinical and technological skills complement the traditional medical aspects of the anesthesiologist's training, thereby facilitating an advance in the quality and efficiency of care delivered by the total anesthesia care team. The level of education and subsequent clinical responsibility have been designed to produce an anesthetist who administers anesthesia under the general direction of an anesthesiologist, thus fulfilling the role of physician's assistant in anesthesiology. The basic science training in the program includes courses in anatomy, physiology, biochemistry, pharmacology, biophysics, and medical instrumentation. This basic science training, along with other basic clinical courses and combined with intensive clinical training, prepares the graduate to become an APA anesthetist--assisting the anesthesiologist in the operating room, recovery room, and other patient care areas such as intensive care units and pain clinics. In academic settings, APAs can participate in basic and/or clinical research and in the continuing development of anesthesia delivery systems and patient monitoring systems.

The program consists of seven consecutive semesters beginning in June and graduating in August (i.e., two and one-third years). Semesters one through three concentrate on basic sciences with some clinical experience. Semester four is a transitional semester, and semesters five through seven are mainly clinical rotations in several areas of anesthesia practice, including those of a specialized nature (e.g., pediatrics, obstetrics, cardiothoracic, neurological, intensive care units, pain treatment clinics, trauma centers, etc.). Clinical experience with anesthesia delivery systems and patient monitoring systems is also continued at the advanced level. By utilization of elective time, students are encouraged to develop special interests.

From the Emory program (as of August 1996), there are 370 graduates from twenty-six classes, the first class having graduated in 1971. Approximately 10 to 15 percent of our graduates have gone on to medical school (over 90 percent of whom have chosen anesthesiology residencies). Several are currently enrolled in medical schools, and a few have built on their premedical education and master's degree by continuing in other graduate professional areas such as dentistry, physiology, and veterinary medicine. Most of the remaining graduates are employed in departments of anesthesiology as members of an anesthesia care team comprised of anesthesiologists, anesthesiology physician assistants, and nurse anesthetists. Several APA graduates are faculty members in APA programs. Approximately 60 students are enrolled in the two current classes (thirty per class; one entering and one continuing).

The program is accredited by the Commission on Accreditation of Allied Health Education Programs, 515 North State Street, Suite 7530, Chicago, Illinois, 60610-4377. The telephone number is 312-464-6462. The program underwent its most recent site visit in April, 1994, and continuing accreditation has been granted through 1999.

*The older, atlernate terminology was anesthesiologist's assistant (AA), analogous to surgeon's assistant, etc.

ADMISSIONS REQUIREMENTS

1. Bachelor's Degree: Although many types of majors are acceptable, the traditional premedical courses in biology, chemistry, physics, and math are essential; B.A. degrees are acceptable if premed work is done; typical majors are biology, chemistry, math, physics, engineering, or an allied health area (such as respiratory therapy, medical technology, or nursing).

2. Minimum pre-med course work required:

   Biology:	General (introductory) biology (usually two semesters or three quarters), and preferably additional course work in cell/molecular biology at a more advanced level.
   Chemistry:	Full sequence of general (introductory) chemistry and premedical organic chemistry.
   Physics:	General physics to include mechanics, sound, heat, light, and electricity/magnetism (usually two semesters or three quarters).
   Math:	Math/college algebra through at least an introduction to the concepts of calculus.

   Candidates should consult a premed advisor at their school to determine what specific course work would meet the above requirements. Although there is some flexibility in the number and type of courses (partially dependent on differences between schools), undergraduate science courses should generally be those an undergraduate advisor would consider appropriate as preparation for a medical school application, postgraduate work in the basic medical sciences, and the requisite GRE (Graduate Record Exam) and/or the Medical College Admission Test (MCAT).

   A strong premed science background is needed to deal effectively with the master's level course work. Candidates with a B.A. degree or B.S. degree in some allied health areas (e.g., nursing or respiratory therapy) may need to supplement their other undergraduate work with extra science and math courses to be sure than standard premed requirements have been met and to be able to put forward a competitive application. A GPA of 3.0 or above is desirable but not required and is only one factor among many to be considered. In evaluation of grades, those in the most relevant math and science courses are given more consideration than the overall GPA.

3. International applicants: Applicants with premed education at a non-U.S. university must take at least one semester of an upper-level undergraduate premedical course in English at a U.S. university, preferably in advanced cell/molecular biology. Additional information should be obtained from the program ofice regarding evaluation of undergraduate course work taken at institutions outside the U.S.

4. Entrance exams: The GRE is required. As of February 15, 1997, the MCAT is optional, although we strongly recommend taking it. GRE results tend to reflect aptitudes and are generally sufficient to predict the capability of adequate performance in our program. MCAT scores tend to reflect the current level of the student's knowledge in the premedical sciences and assists in the evaluation of his/her level of achievement. Absolute performance levels are not used as threshold requirements for admission, but rather are considered in the context of the applicant's goals, rationale for seeking post-graduate education, work experience, references, and broader academic experience over several years. Exams must have been taken within four years of the anticipated admission date. The appropriate institutional code for the GRE is 5196. Exams must have been taken within four years of the anticipated matriculation date. We require the general GRE (i.e., verbal, quantitative, and analytical).

   We recommend taking the GRE in the new computerized format--mainly because it can be taken on short notice, the results are quickly available, and applicants who are computer literate tend to do slightly better in this format. If you have not taken the GRE in the computer format, you may want to consider doing so, especially if your grades are marginal. Note that you should apply early to take either the GRE or the MCAT since there can be a considerable delay in getting the grades to us.

5. College Transcripts: College transcripts from all schools/colleges attended must be submitted directly from the registrar to our program office. Applicable courses taken in other schools or departments may be transferred with approval of the program director. Upon graduation from an undergraduate program, a final transcript showing the date of graduation must also be submitted.

6. Course/grade summary: In addition to the transcripts, we require that each applicant summarize his/her course work and grades in a standardized format (the form is provided with the application). This is the applicant's best opportunity to summarize and present his/her academic program in the most favorable and understandable way. This process assists greatly in the identification of strengths, missing prerequisites, and areas needing remedial work. Also, it helps in demonstrating continuity of effort and meaningful changes in direction and emphasis. Considerable detail is needed in the premedical sciences and less detail in the other courses. Adequate performance in courses in the humanities is important for one's general breadth of education; it is, however, one's performance in the science courses that is critical to graduate medical education of this type. In addition, if an applicant prefers to write a narrative description of his/her major academic decisions (e.g., change of school or major), this sometimes helps make the application more understandable to the admissions committee.

7. Letters of Recommendation: Three letters of recommendation are required. Recommendations should be obtained from people who have direct knowledge of the applicant's academic capabilities and work record. These are not only personal (i.e., character) references, but are also references that will assist the admissions committee in evaluating the applicant's suitability for the type of academic work and the profession desired (i.e., aptitudes, current skills level, etc.). References from friends or family members are generally not acceptable (or only accepted in addition to those from teachers, supervisors, etc). Forms for references are included in the application package and should be completed and returned to the program ofice as soon as possible..

8. Background: While previous patient care experience is not an absolute requirement for admission, it is strongly recommended. Candidates who are new college graduates are eligible for consideration, but are strongly urged to gain some degree of patient care exposure (part-time employment, volunteer work, etc.) whenever possible. In more recent years, many applicants have received valuable training in entry level emergency medicine work (i.e., EMT) that can usually be obtained locally on a part-time basis.

9. Personal Interview: Interviews are granted by invitation of the program administration, begin in late fall, and continue until approximately the end of March. The interview consists of a two-day period during which the applicant has an opportunity to tour the clinical facilities and talk with students, graduates, and faculty, in addition to having formal interviews with admissions committee members. Applicants will be contacted by the program office regarding dates.

Continuation Requirements

Additional information regarding leaves-of-absence, academic probation, and appeal mechanisms for academic dismissals are available from the dean's office.

Technical Standards

In order to maintain an acceptable level of performance in an anesthesia care setting as relates to technical skills, the student must:

1. Develop the ability to deal with patients and professional staff in all types of medical settings, including obtaining medical historical information and performing a physical evaluation as related to the practice of anesthesiology. These activities require that the student be able to:

   A. Communicate effectively with the patient and/or patient's family in order to obtain an adequate history.

   B. Review records that relate to the patient's medical history, interpret these findings, and develop a medical record for the current anesthetic episode that will be useful to others who care for the patient both interoperatively and postoperatively.

   C. Effectively use the appropriate instruments that are necessary for a thorough examination of the patient's airway and other physical anomalies as related to the practice of anesthesiology.

2. Participate in physical activities in the operating room, preop holding area, postoperative care unit, and intensive care unit. These activities require that the student be able to:

   A. Perform delicate manual operations such as starting intravenous lines, central lines, arterial lines, placement of catheters, intubation, mask manipulation, etc., which require "fine" dexterity of both upper extremities.

   B. Lift, move, and position patients as required for the type of anesthetic being given and/or surgical procedure being performed.

   C. Move quickly and surefootedly to assure patient safety and rapid application of emergency procedures as may arise during the course of an anesthetic episode.

   D. Recognize colors of leads and other electronic signals found on the various types of monitoring equipment used in the preop holding area, operating room, postoperative care unit, and intensive care unit; demonstrate the ability to work with safety and accuracy in both "light" and "dark" conditions and recognize details at both distant and close settings.

   E. Hear, process, and interpret multiple conversations, monitoring signals/alarms, and patient sounds simultaneously in a fast-paced operating room setting.

3. Learn and employ such skills as indicated by patient need or at the direction of the anesthesiologist as relates to the diligent and uninterrupted application of resuscitative and life-support functions.

4. Participate in and demonstrate an understanding of all phases of the educational program which will include lectures, laboratory activities, teaching conferences, hospital rounds, and clinical duties.

5. Demonstrate characteristics that, by implication, suggest that the student has the ability to function in complex social and personal roles and in delicate interpersonal relationships; demonstrate the ability to manifest honesty, reliability, genuineness, warmth, and empathy while controlling impulses and maintaining good judgment even under physically and emotionally exhausting conditions.

Degree Requirements

1. A residence of seven semesters: the first three semesters emphasizing classroom activity, the fourth semester a transitional time, and the last three semesters emphasizing mainly clinical training.

2. The degree candidate must have passed all anesthesia knowledge-based exams during the senior year at a level predicting a satisfactory probability of passing performance on the National Exam for APAs.

3. The degree candidate must have satisfactorily completed all required didactic and clinical courses.

4. The degree candidate will sit for the NCCAA certifying exam during the semester prior to graduation.

COURSE DESCRIPTIONS

Semester I: Twelve semester hours

502. Introduction to Cardiovascular Anatomy and Physiology
Summer. Credit, one hour. Introductory and supplementary coverage to the basic science courses in physiology and anatomy. Emphasizes the anatomy and physiology of the heart and great vessels.

503. Medical Terminology
Summer. Credit, one hour. An introduction to the language of the medical profession including word formulation, abbreviations, association to body systems, and various medical procedures, with special emphasis on terminology relative to the field of anesthesiology.

509. Introduction to Airway Anatomy and Management
Summer. Credit, one hour. Normal and abnormal anatomy and physiology of the airway (including anatomy of the oral, pharyngeal, and laryngeal areas). Emphasizes principles of airway management and devices.

510. Physiology of Blood Gas Transport
Summer. Credit, two hours.
Physiology of hemoglobin, oxygen, carbon dioxide, and hydrogen ions. Includes principles of instrumentation and measurement techniques as well as practical laboratory experience.

511. Introduction to Pulmonary Anatomy and Physiology
Summer. Credit, one hour. Pulmonary anatomy and physiology, including lung volumes, gas exchange, and pulmonary function testing.

513. Anesthesia Delivery Systems and Equipment
Summer. Credit, one hour. Introductory experience with the equipment necessary for supply of the anesthetic gases, including compressed gas delivery systems and the anesthesia machine and vaporizers. Including compressed gas delivery systems and the the anesthesia machine and vaporizers. Also covers laws, regulations, and principles of safety pertaining to anesthesia equipment; includes lab correlation.

530. Biophysics of Life Support and Monitoring Systems
Summer. Credit, one hour. Basic physical principles and processes applied to clinical practices of anesthesia and critical care medicine. Includes dimensional analysis, gas laws, fluid mechanics, heat transfer, vaporization, diffusion, and solubility.

531. Introduction to Electric Circuits and Electronics
Summer. Credit, one hour. Elementary circuit theory including special emphasis on electric circuit analogs of physiological systems and concepts of solid state devices, amplifier principles, and fundamentals of analog and digital circuits as applied to medical devices.

533a. Introduction to Patient Monitoring Techniques
Summer. Credit, one hour. Introductory principles and techniques of patient monitoring (e.g., ECG, blood pressure, pulse oximetry, capnometry, etc.) Emphasizes set-up, trouble-shooting and interpretation from the point of view of the bedside anesthesia care team.

560a. Introduction to Clinical Anesthesia I
Summer. Credit, two hours. Introduction to the practice of anesthesia, including a survey of rationale, techniques, and pharmacology..

Semester II: 17 semester hours

505A. Physiology, Pharmacology, and Monitoring Lab I
Fall. Credit, one hour Animal laboratory experience using structured protocols for teaching the principles and procedures used in administering anesthesia, as well as monitoring and providing electromechanical and pharmacological support to healthy and critically ill patients; emphasizes invasive and noninvasive techniques for measuring cardiovascular parameters, as well as comparable function of the pulmonary, renal, and neuromuscular systems; includes acute care/clinical chemistry measurements (e.g., blood gases and electrolytes); correlated with ANES 532a.

532a. Instrumentation and Monitoring I
Fall. Credit, one hour.
Principles of equipment for monitoring patients. Emphasizes measurement of basic physiological variables such as temperature, neuromuscular function and ECG; includes material related to electrical safety and general patient safety considerations.

540a. Interviewing and Examination Techniques
Fall. Credit, one hour. Techniques for examining patients in the process of the preoperative patient evaluation. Includes the neurological exam for assessing regional anesthesia procedures.

560b. Introduction to Clinical Anesthesia II
Fall. Credit, two hours. Classroom and clinical education in the basic methods for the administration of general anesthesia. Includes correlation with BAHS 502 in terms of anesthetic basic science, as well as introduction to the pathological processes and their impact on anesthetic care.

BAHS 500. Anatomy
Fall. Credit, hour hours.

BAHS 501. Biochemistry
Fall. Credit, four hours.

BAHS 502. Physiology
Fall. Credit, four hours.

Semester III: 13 semester hours

505b. Physiology, Pharmacology, and Monitoring Lab II
Spring. Credit, one hour.
Continuation of 505a.

517. Medical Statistics
Spring. Credit, one hour.
Statistics as applied to anesthesia/critical-care laboratories (e.g., ABGs, electrolytes, etc.) and as relevant to the anesthesia research literature.

532b. Instrumentation and Monitoring II
Spring. Credit, two hours.
Principles of display, storage, and hardcopy devices. Principles and application of instruments for the analysis of anesthetic and respiratory gases, including instruments such as mass spectrometers, oximeters, and capnographs.

540b. Principles and Techniques for Acquisition of the Pre-Anesthetic History
Spring. Credit, one hour.
Gathering of data by patient interviews and chart review; includes recording of relevant laboratory data, as well as the summarization of preoperative consultations and special studies.

541r. Anesthesia Plans and Techniques
Spring. Credit, one hour.
The principles involved in the formulation of anesthetic plans, especially as related to disease states; includes the formulation of different anesthetic plans and procedures as related to type of surgical procedure (e.g., trauma, OB, cardiac, neurological, etc.); correlated with ANES 540b.

542. Special Topics in Critical Care Medicine
Spring. Credit, one hour.
Pathophysiology and treatment of patients with selected disease states in relation to anesthetic management and as related to the practice of critical-care medicine (e.g., in post-operative care units); emphasizes metabolic/endocrine/renal considerations and includes topics such as antibiotic therapy, IV fluid therapy, and instruction in cardiopulmonary resuscitation.

560c. Introduction to Clinical Anesthesia III
Spring. Credit, three hours.
Continued classroom clinical education in the basic methods for the administration of general anesthesia. Includes special emphasis in the pharmacology of anesthesia (correlated with BAHS 504).

BAHS 504. Pharmacology.
Spring. Credit, three hours.

Semester IV: 12 semester hours

512. Advanced Airways
Summer. Credit, one hour.
Emphasizes advanced techniques and equipment used in acute and chronic airway management.

514. Ventilation Support
Summer. Credit, one hour.
Principles and techniques for ventilatory support of anesthetized and/or critically ill patients. Includes short-term post-operative ventilation, longer term (e.g., ICU), and principles/techniques of weaning.

515. Anesthesia Neuroscience
Summer. Credit, one hour.
Supplemental anatomy, physiology, and pharmacology to address areas of vital importance to anesthesiology and critical care. Integrates basic sciences with clinical management of critical variables such as cerebrospinal fluid pressure and cerebral blood flow; includes principles of CNS monitoring.

532c. Instrumentation and Monitoring III
Summer. Credit, one hour.
Continuation of 532b.

533b. Introduction to Patient Monitoring Techniques II
Summer. Credit, one hour.
Continuation of 533A; emphasizes advanced cardiovascular monitoring principles and techniques.

560D. Clinical Anesthesia I.
Summer. Credit, seven hours. Clinical experience in anesthesia, including surgical subspecialties. Includes examinations on correlated reading assignments.

Semesters V, VI, VII: 17 semester hours each

650r. Literature Review - Anesthesiology
Fall, spring, summer. Credit, three hours.
Registered in summer for three credit hours. A monthly meeting to review and discuss current and classical literature pertaining to anesthesiology, life support systems, and instrumentation.

660a,b,c. Clinical Anesthesia I
Fall, spring, summer. Clinical hours, 750. Credit hours, 14. Includes examinations on correlated reading assignments.

691r. Student Case Presentations
Fall, spring, summer. Credit, three hours.
Registered in summer for three credit hours. Case presentation from the student's clinical experience. Includes problems in pathophysiology and pharmacology, as well as operational and safety considerations of anesthesia/life-support equipment and instrumentation.

692a,b,c. Anesthesiology Seminar
Fall, spring, summer. Credit, one hour.
Lectures and discussions by faculty and residents on special clinical topics. Supplementation of textbook information with information from current literature. Includes correlation to case management and complications.

Electives

516r. Clinical Instrumentation and Monitoring Laboratory
Summer. Variable credit.
Laboratory and clinical experience with anesthesia equipment for the delivery of anesthesia and for patient monitoring. Correlated with ANES 510, 513, and 533a.

596r. Individual Tutorial
Each semester. Credit, variable.

597r. Individual Directed Study
Each semester. Credit, variable.

610r. Clinical Instrumentation and Monitoring
Summer. Credit, one hour.
Advanced laboratory and clinical experience with equipment related to anesthesia delivery and patient monitoring.

630r. Computer Systems in Medicine
Each semester. Credit, variable.
A survey of computer systems applied to the operating room and intensive care unit. Topics include introduction to computer hardware, software, and terminology; economics related to computerization; systems analysis; and organizational and administrative aspects of implementing computer systems. Includes hands-on programming experience with minicomputer and microcomputer systems.

670r. Special Problems in Instrumentation and Monitoring
Each semester. Credit, variable.
Advanced work under the direction of faculty and staff. Selected problems associated with monitoring and instrumentation of critically ill patients or patients undergoing anesthesia.

671r. Special Problems in Medical Computing
Each semester. Credit, variable.
Prerequisite: ANES630R. Advanced work on a selected topic in medical computing under the direction of faculty and staff.

697R. Individual Directed Study
Each semester. Credit, variable.

699r. Individual Research.
Each semester. Credit, variable.

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