Milestones for Head and Neck Anesthesia and Advanced Airway Management

Medical Knowledge; Patient Care and Technical Skills; Interpersonal and Communication Skills; Professionalism; System-Based Practice; Practice-Based Learning

MEDICAL KNOWLEDGE, AND ITS APPLICATION TO PATIENT CARE
Objectives	Instructional Strategies	Assessment of Competence	Milestones
1. List and describe 5 major objectives and principles of anesthesia for head and neck surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
2. Draw and interpret 4 figures that illustrate pharmacokinetic principles of different opioid infusions	Syllabus study Didactic teaching in/outside OR	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
3. Draw the ASA Difficult Airway Algorithm	Syllabus study Didactic teaching in/outside OR	Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
4. Develop a systematic and safe approach to anticipated and unanticipated difficult airway, based on the ASA Difficult Airway Algorithm	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
5. Recall and appraise the predictors of difficult and impossible mask ventilation, and their association with difficult direct laryngoscopy (DL)/tracheal intubation	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
6. Describe and assess a rational approach to patients with partially obstructed airway	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
7. Articulate to attending 5 major differences between steering and channeled techniques of video laryngoscopy	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
8. Recall and appraise the predictors of failure of video laryngoscopy	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
9. Recall and appraise the predictors of difficult supraglottic airway placement	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
10. List and explain indications and contraindications to a flexible fiberoptic intubation	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
11. Review and evaluate the techniques of topical and regional anesthesia of the airway for awake intubation	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
12. Review and evaluate the technique of preoperative endoscopic airway examination (PEAE)	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
13. Explain and summarize clinical pathophysiology of obstructive sleep apnea (OSA) and its implications for anesthetic management	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
14. Formulate anesthetic management plan for elective maxillofacial and orthognatic surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
15. Review and summarize principles of anesthetic management for otologic and neurotologic surgery, and skull base surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
16. Appraise and compare techniques of anesthetic management for head and neck cancer surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
17. Define and justify anesthetic techniques for functional endoscopic surgery, nasal surgery, and facial cosmetic surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
18. Identify and outline essential anesthetic requirements for thyroid surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
19. Discuss and assess different ventilating strategies for laryngologic surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
20. Identify and explain safety principles of jet ventilation. Articulate troubleshooting and correction of JV problems.	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
21. Identify and explain safety principles and mechanisms of action of high-flow nasal oxygen technique (Optiflow; THRIVE)	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1
22. Summarize principles of anesthetic management for the laryngologic and laser airway surgery	Syllabus study Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	MK 1

PATIENT CARE AND TECHNICAL SKILLS
Objectives	Instructional Strategies	Assessment of Competence	Milestones
1. Formulate airway strategies based on the predictors of difficult and impossible mask ventilation, and their association with difficult DL/tracheal intubation	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Rating/ Evaluation by attending Self-assessment and reflection	PC 1
2. Appraise the findings of the preoperative endoscopic airway examination (PEAE) in at least 3 patients	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Direct observation Rating/ Evaluation by attending Self-assessment and reflection	PC 1
3. Select and prepare difficult airway equipment according to defined airway management strategies	Syllabus study Didactic teaching in the OR	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 1
4. Identify major preoperative concerns in head and neck anesthesia patients during a preoperative visit, and record in EPIC note	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 1
5. Define and perform the technique of moderate controlled hypotension	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
6. Illustrate in practice basic pharmacokinetic principles of opioid infusions and total intravenous anesthesia	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Direct observation Rating/ Evaluation by attending Self-assessment and reflection	PC 2
7. Appraise and perform the techniques of anesthetic management for head and neck cancer surgery	Syllabus study Didactic teaching in the OR	Pretest/ Posttest Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
8. Demonstrate anesthetic management for H&N cancer surgery with free flap reconstruction	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
9. Demonstrate anesthetic management for transoral robotic surgery (TORS)	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
10. Discuss anesthetic implications and perform anesthetic management for major OSA surgery and orthognatic surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
11. Employ safe anesthetic techniques for patients with associated OSA	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
12. Formulate anesthetic management plan and conduct anesthesia for elective maxillofacial and dental surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
13. Summarize and demonstrate in practice principles of anesthetic management for otologic, neurotologic, and skull base surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
14. Discuss anesthetic implications and demonstrate anesthetic management for functional endoscopic surgery, intranasal, and pituitary surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
15. Define and demonstrate anesthetic techniques for facial cosmetic and nasal surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
16. Identify and demonstrate essential principles of anesthetic management for thyroid surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
17. Prepare and properly position NIM EMG endotracheal tubes for thyroid surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
18. Summarize and demonstrate principles of anesthetic management for the laryngologic and laser airway surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
19. Prepare and properly position a laser endotracheal tube for airway laser surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
20. Discuss and demonstrate safe use of different jet ventilation modalities	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
21. Demonstrate a technique of apneic intermittent ventilation (AIV) for laryngologic surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
22. Appraise and employ a technique of high-flow nasal oxygen insufflation (THRIVE) for laryngologic surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
23. List and illustrate the principles of safe use of different SGAs with positive pressure ventilation for elective H&N surgery in at least 5 patients	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 2
24. Formulate a plan for intraoperative and postoperative pain management for different head and neck surgical procedures	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 3
25. Formulate a plan for a multimodal analgesia for selected H&N surgical procedures	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 3
26. Appraise and describe a technique of staged extubation using the Cook airway exchange catheter	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 4
27. Discuss, choose and perform smooth extubation techniques after head and neck surgery	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 4
28. Communicate to the attending the risks and benefits of 5 different airway management devices and techniques	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 4
29. Formulate management plan of the laser-induced airway fire	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 5
30. Demonstrate on a mannequin selected advanced airway management techniques at the end of the rotation	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 5
31. Recall, break down, and illustrate the intubating LMA Fastrach intubation using the up down, Chandy 1 and Chandy 2 maneuvers in at least 5 patients in under 5 minutes each	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
32. Appraise and place iGel, AirQ and LT (laryngeal tube) SGAs in at least 1 patient each	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
33. Articulate to the attending and perform the LMA Unique, FLMA, LMA Proseal/Supreme insertion techniques in at least 5 patients	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
34. Demonstrative safe and effective use of the steering and channeled techniques of video laryngoscopy in at least 5 patients	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
35. Describe and display the airway exchange techniques, including the use of the Aintree catheter in at least 5 patients	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
36. Demonstrate the techniques of placement of rigid fiberoptic stylets such as Bonfils and Levitan in at least 1 patient each	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
37. Articulate to the attending the signs of tracheal placement of the gum elastic bougie, and place it electively to facilitate intubation in at least 2 patients in under 2 min each	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
38. Perform asleep flexible fiberoptic intubation in 5 uncomplicated patients in under 5 min each	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
39. Formulate a plan and safely perform an awake flexible fiberoptic intubation	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
40. Explain and perform a combined video laryngoscopy/fiberoptic intubation technique in at least 3 patients	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
41. Formulate a plan and safely perform a retrograde intubation in at least 1 patient	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
42. Discuss and safely perform a technique of nasal intubation	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
43. Demonstrate application of high-flow nasal oxygen insufflation (THRIVE) intraoperatively and during difficult airway management	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
44. Perform a technique of the preoperative endoscopic airway examination (PEAE) in at least 3 patients	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
45. Discuss and demonstrate a technique of light wand-guided tracheal intubation	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 8
46. Select and fully prepare the equipment for a flexible fiberoptic intubation on the main OR and ASC teaching carts. Same for the video tower fiberoptic set up in ASC.	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 9
47. Prepare and operate Monsoon high frequency jet ventilator with the LaserJet catheter	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 9
48. Prepare and operate Optiflow (high-flow nasal oxygen) unit	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 9
49. Appraise and demonstrate the use of the hypnotic monitoring (Sedline, BIS) intraoperatively	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 9
50. Justify and perform the superior laryngeal and transtracheal nerve blocks during awake intubation	Syllabus study Direct patient care experience Didactic teaching in the OR Role modeling by the attending	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PC 10

INTERPERSONAL AND COMMUNICATION SKILLS (PATIENTS, THEIR FAMILIES, HEALTH CARE PROFESSIONALS)
Objectives	Instructional Strategies	Assessment of Competence	Milestones
1. Communicate to the patient’s family members a safe conclusion of anesthetic, whenever feasible	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Self-assessment and reflection	ICS 1
2. Conduct postoperative anesthetic visits with each patient	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	ICS 1
3. Work effectively with the surgical team to identify patient’s medical and surgical factors that may affect anesthetic plan and management	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	ICS 2
4. Assure proper and safe patient positioning with the rest of the OR team prior to incision	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Self-assessment and reflection	ICS 2
5. Complete a time out with the OR team	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	ICS 2
6. Communicate major intraoperative and postoperative concerns to the PACU nurse during the handoff	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	ICS 2
7. Discuss airway management plan and strategies with the surgical team	Syllabus study Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	ICS 3
8. Communicate major preoperative, intraoperative and postoperative concerns to the surgical team	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	ICS 3

PROFESSIONALISM
Objectives	Instructional Strategies	Assessment of Competence	Milestones
1. Properly introduce yourself to the patient, review risks and benefits of anesthesia, and obtain the informed consent	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PROF 1
2. Communicate perioperative concerns and possible complications of management to the surgical team in a timely manner, at all times	Syllabus study Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PROF 2 PROF 3
3. Facilitate the first scheduled surgical procedure through timely arrival and preparation	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PROF 3
4. Facilitate OR turnover times (a goal is under 30 min) through full and thorough set up during the preceding case	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PROF 3
5. Maintain the professional tone and communications at all times	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PROF 3 PROF 5
6. Actively solicit daily feedback with the supervising faculty, and with the surgical team, where appropriate	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PROF 4

SYSTEM-BASED PRACTICE (EFFECTIVE USE OF RESOURCES FOR OPTIMAL CARE)
Objectives	Instuctional Strategies	Assessment of Competence	Milestones
1. Accept professional input from the health care team	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	SBP 1
2. Confirm full preoperative assessment note in EPIC for every patient	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	SBP 2
3. Practice cost-conscious patient care by choosing the rationale anesthetic plan, appropriate anesthesia and airway management equipment and techniques, and anesthetic drugs	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	SBP 2
4. Identify at least one system problem that caused or may have caused adverse patient outcome, or negatively affected anesthetic management	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	SBP 2
5. For above, identify at least 2 strategies for intervention and the ways for their implementation	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	SBP 2
6. For each strategy, describe how the proposed intervention would have positively affected the patient outcome, or anesthetic management	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	SBP 2
7. Promote patient safety by adhering to the suggested safe anesthetic protocols	Syllabus study Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	SBP 2

PRACTICE-BASED LEARNING (EVALUATE CARE OF OWN PATIENTS, SELF-EVALUATION AND IMPROVEMENT)
Objectives	Instructional Strategies	Assessment of Competence	Milestones
1. Keep track of the learning portfolio	Direct patient care experience	Log and performance audit Self-assessment and reflection	PBL 1
2. Identify at least 3 aspects of anesthesia care that can be improved upon by the trainee after the rotation	Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PBL 1
3. Complete the postoperative visit and EPIC postoperative note on more than 80% of inpatients the trainee anesthetizes	Direct patient care experience Role modeling by the attending	Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PBL 1
4. Take proactive role in learning new anesthetic and airway management techniques	Syllabus study Direct patient care experience Role modeling by the attending	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PBL 2 PBL 3
5. Read and critically assess the rotation syllabus	Didactic teaching in/outside OR Direct patient care experience	Pretest/ Posttest Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PBL 3
6. Share the newly-acquired knowledge and skills to promote better patient care	Didactic teaching in/outside OR Direct patient care experience	Direct observation Individual interviews Rating/ Evaluation by attending Self-assessment and reflection	PBL 4

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Airway Assessment

Airway Management Algorithms and Practice

Controlled Hypotension

Endoscopic Sinus Surgery and Nasal Surgery

Extubation of the Difficult Airway and Airway Exchange

Fiberoptic Stylets

Flexible Fiberoptic Bronchoscopy and Intubation

Head and Neck Cancer Surgery and Flap Reconstruction

Jet Ventilation

Laryngeal Framework Surgery

Laryngologic Surgery and Transoral Robotic Surgery

Laser Surgery of the Airway

Maxillofacial and Orthognatic Surgery

Obesity

Obstructed Airway

Obstructive Sleep Apnea

Otology and Neurotology

Percutaneous Dilatational Tracheotomy and Cricothyrotomy

Retrograde Intubation

Supraglottic Airways

Thyroid and Parathyroid Surgery

Total Intravenous Anesthesia and Remifentanil

Video Laryngoscopy

Zenkers Diverticulum

Milestones for Head and Neck Anesthesia and Advanced Airway Management