> Dental Education > Dental Anesthesiology > Competency Requirements

Upon completion of training the resident must be:

a)  Able to demonstrate in-depth knowledge of the anatomy and physiology of the human body and its response to the various pharmacologic agents used in anxiety and pain control;

1.  The experience in this area is intended to enable the resident to have:  a thorough understanding of the anatomy and physiology of systems (cardiovascular, respiratory, central and peripheral nervous, autonomic nervous, endocrine, renal, hepatic;) a thorough understanding of the pharmacology of medications used in anxiety and pain control; and how the patient will respond to pharmacologic agents.

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2.   This information will be presented during lectures and reviewed clinically in the perioperative period profound physiologic changes are noted.

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3.   The in-training examination will be an objective measure of assessing resident knowledge and quizzes will be given at the end of lectures. The anesthesiology attendings will give oral quizzes in the clinical environment.  This will be documented by test results and resident evaluations (anesthesia evaluations.)

b)  Able to demonstrate in-depth knowledge of the pathophysiology and clinical medicine related to disease of the human body and effects of various pharmacological agents used in anxiety and pain control when these conditions are present;

1.  The experience in this area is intended to enable the resident to understand clinical medicine related to disease states of various systems(cardiovascular, respiratory, central and peripheral nervous, autonomic nervous, endocrine, renal, hepatic;) a thorough understanding of the pharmacology of medications used in anxiety and pain control; and how patients with various disease states will respond to these pharmacologic agents.

2.  This information will be presented during lectures and reviewed clinically in the perioperative period when patients with various pathologic states present for anesthetic care. Review of clinical medicine related to these disease states will occur during the medicine rotations (medical consult, pediatric inpatient medicine, pediatric outpatient medicine, and emergency medicine.)

3.  The in-training examination will be an objective measure of assessing resident knowledge and quizzes will be given at the end of lectures. The anesthesiology attendings will give oral quizzes in the clinical environment.  This will be documented by test results and resident evaluations (anesthesia evaluations and medicine rotation evaluations.)

c)   Competent in evaluating, selecting and determining the potential response and risk associated with various forms of anxiety and pain control modalities based on patients’ physiological and psychological factors; 

1.   The experience in this area is intended to enable the resident to have an understanding of the entire spectrum of pain and anxiety control.  The resident will understand the control of the perception of pain as well as the effects of pharmacologic agents and potential reactions affecting both physical and psychological well-being. The resident will be competent to evaluate patients and perform a focused history and physical examination to assess their physiological and psychological risks associated with the use of various modalities of pain and anxiety control.

2.   Intended experiences include didactic instruction on patient’s physiological and psychological need for pharmacologic and nonpharmacologic forms of anxiety and pain control methods and their response to such interventions. Intended experiences include didactic instruction on the anatomy, physiology, and pathophysiology of organ systems, pharmacology of agents used in pain and anxiety control, and preoperative assessment of patients and risk assessment. Clinical instruction includes resident’s performing preoperative anesthesia assessments and post-operative checks on the anesthesia service and rotations on the medical consult, pediatric inpatient, and pediatric outpatient services where patients are optimized for anesthesia.

3.   The in-training examination will be an objective measure of assessing resident knowledge and quizzes will be given at the end of lectures. The anesthesiology attendings will give oral quizzes in the clinical environment.  This will be documented by test results and resident evaluations (anesthesia evaluations and medicine rotation evaluations.)Residents will also present cases where patients presented unique considerations for anesthetic management in the journal club.

d)  Competent in patient preparation for sedation/anesthesia, including pre-operative and post-operative instructions and informed consent/assent;

1.   The experience in this area is intended to: enable the resident to assure proper patient preparation for sedation/anesthesia  including pre-operative and post-operative instructions as well as understanding the ethical and legal considerations and components of informed consent or assent.

2.   The resident will experience: preparation and completion of the facility anesthesia consent procedure and will provide preoperative and postoperative instruction to patients and/or their caregivers. Residents will receive didactic instruction in bioethics including core ethical principles, informed consent, and decision-making capacity.

3.   Measures of assessment will include: daily clinical supervision of consents obtained by residents, biannual anesthesiology evaluations, quizzes at the end of lectures, and the in-training examination will assess didactic knowledge of the bioethical principles underlying consent.

e)  Competent in the use of anesthesia-related equipment for the delivery of anesthesia, patient monitoring, and emergency management;

1.   The experience in this area is intended to enable the resident to: understand the proper selection and preparation of anesthesia-related equipment for the delivery of anesthesia (including gas systems fixed and mobile, anesthesia machines, breathing systems and airway equipment,) patient monitoring (invasive and non-invasive blood pressure monitoring, EKG, pulse oximetry, capnography, precordial stethoscopes, bispectral index monitoring,) and emergency management (automatic external defibrillators, defibrillators, cricothyrotomy equipment, emergency medications.) 

2.   The resident will have experience: didactic lectures on the operating room environment (gas systems, scavenging, fire and electrical safety,) breathing systems, anesthesia machine, airway management, anesthetic emergencies and complications. The resident will also be certified and maintain certification in cardiopulmonary resuscitation basic life support (CPR-BLS,) advanced cardiac life support (ACLS,) and pediatric advanced life support (PALS.) The resident will be in the simulation lab for the following courses: Advanced Airway, Pediatric Airway, Adult Code, and Pediatric Code Courses. Clinical experiences will include participating in emergency call on the anesthesia service in Jacobi (a level 1 trauma center,) medical consult rotation (responds to “code” scenarios in the hospital,) and emergency medicine rotation.

3.   Measures of competency include: daily clinical observation and oral quizzes, biannual anesthesia evaluation, medical consult rotation evaluation, emergency medicine rotation evaluation, quizzes following lectures, and the in-training examination.

f)  Competent in the administration of local anesthesia, sedation, and general anesthesia, as well as in psychological management and behavior modification as they relate to anxiety and pain control in dentistry;

1.   The experience in this area is intended to enable the resident to evaluate the dental patient and to formulate and effectively deliver the most appropriate anesthetic treatment plan for the patient including psychological management and behavior medication, administration of local anesthesia, sedation, and/or general anesthesia.

2.   The residents will experience: didactic instruction on the spectrum of sedation and anesthesia, patient evaluation, equipment, pharmacology, and emergencies and complications. Clinical experiences will include providing sedation and anesthesia in the operating room and dental clinics.  

3.  Measures of competency will include: daily clinical observation and oral quizzes, biannual anesthesia evaluations, presentations of notable cases in journal club, quizzes at the end of lectures, and the in-training examination. 

g)   Competent in managing perioperative emergencies and complications related to anxiety and pain control procedures, including the immediate establishment of an airway and maintenance of ventilation and circulation;

1.The experience in this area is intended to enable the resident to: prevent, diagnose, and treat perioperative emergencies and complications, including immediate establishment of the airway and maintenance of circulation and ventilation. 

2.   The resident will experience: didactic instruction on the prevention, diagnosis, and treatment of  perioperative emergencies and complications, airway anatomy and management, and advanced cardiac life support (ACLS) and pediatric advanced life support (PALS) algorithms and protocols.  The residents will receive simulation training the in the SimLab on Advanced Airway, Pediatric Airway, Adult Code, and Pediatric Code Courses. Clinical experiences include taking anesthesia emergency call at Jacobi Medical Center, a level 1 trauma center and medicine rotations on  medical consult (responding to rapid-response team “codes” throughout the hospital) and emergency medicine.

3.   Measures of assessment will include: the in-training examination yearly, quizzes following selected lectures, biannual resident evaluations. (anesthesia evaluations,) rotation evaluations, and daily clinical observation.

h)   Competent in the diagnosis and non-surgical treatment of acute pain related to the head and neck region;

1.   The experience in this area is intended to enable the resident to diagnose and manage acute head and neck pain non-invasively.

2.   The residents will experience: didactic instruction on the pathophysiology of  acute pain (including pain pathways and neurotransmitters involved) and treatment modalities. There will be an emphasis on multimodal analgesic regimens. Clinical  experience will include pre-emptive analgesia in the operating room and dental  clinics as a part of anesthetic care and assignment to the post anesthesia care unit  (the department of anesthesia assigns residents to the post anesthesia care unit.)

3.   Measures of assessment will include: the in-training examination yearly, quizzes  following selected lectures, biannual resident evaluations (anesthesia evaluation,)  and daily clinical observation.

i)   Familiar with the diagnosis and treatment of chronic pain related to the head and neck region; and

1.   The experience in this area is intended to: familiarize the resident with the diagnosis and treatment of chronic pain related to the head and neck. 

2.   The resident will experience: didactic instruction on the pathophysiology of chronic pain (including pain pathways and neurotransmitters involved) and the treatment modalities. Clinical experience will include exposure to patients with chronic head and neck pain both at Jacobi Medical Center and at the Columbia University Orofacial Pain Clinic.  

3.  Measures of assessment will include: the in-training examination and resident

evaluations (anesthesiology evaluation and orofacial pain evaluation.)

j)  Able to demonstrate in-depth knowledge of current literature pertaining to dental anesthesiology;

1.   The experience in this area is intended to: provide didactic instruction of research methodology, including biostatistics; to review the literature critically in journal club; and to complete a research project and present one’s findings at a national dental anesthesiology forum or produce a literature review suitable for publication. 

2.   The residents will experience: didactic instruction on research methodology, biostatistics, and analysis; will present literature reviews and participate in  journal clubs, and will complete a research project.

3.  Measures of assessment include: in-training examination, presentation of the current literature in the dept of anesthesiology journal club (and subsequent evaluation  in the bi-annual evaluations by the anesthesiology attendings,) and by satisfactory completion of a research project.