B. MSc. In Clinical Anesthesia
By sharing the vision of Arsi University, College of Health Sciences, Department of Anesthesia aspires to be a center of excellence in Anesthesia education and health research in the notion and produces competent Anesthesia professionals and researchers responsive to demand driven societal needs.
“Arsi University aspires to be one of the best five universities nationally and top ranked university in East Africa by 2033.”
In line to the mission of the Arsi University, the program is also designed to produce competent Anesthesia professionals at Masters (MSc) level through advanced Anesthesia education using philosophy, theory and advanced research and evidence-based training relevant to the field of Anesthesia science and health service provision to the society at advanced and high-quality level
Arsi University is dedicated to produce competent graduates, provide problem solving research outputs, transfer appropriate technologies and deliver demand driven community and consultancy services
Goal and Objectives of the Program
To produce competent Advanced clinical anesthesia practitioners who are able to provide a wide range of specialized clinical anesthesia care for variety of patient groups independently and play a role of supervising other group of anesthesia providers.
- Train anesthetists to apply evidence based clinical anesthesia practice for better patients care
- Train anesthetists apply pre-existing medical and scientific clinical knowledge
- Equip anesthesia providers with advanced specialized knowledge, attitude and clinical skills
- Equip anesthetists develop advanced clinical reasoning and judgment
- Equip anesthetists on methods needed to remain up to date
- Train anesthetists promote professionalism, continued professional development and self-appraisal
- Increase awareness of anesthetists on clinical governance and involvement with audit
- Train anesthetists on improving their clinical teaching skills
- Equip the students with leadership and management skills
- Equip students with critical thinking and decision-making skills which lead to reflective and responsible practice
- Prepare MSc in advanced clinical anesthesia students in conducting individual research and utilizing relevant findings
After critical review of existing local and international documents on learning outcomes, the core (essential) competencies of MSc in Anaesthesia students must demonstrate at the point of graduation are defined.
The core competencies are organized in to 7 domains/ thematic areas
- Anesthesia expert
- Leadership & Management
- Health advocate
- Collaboration and team working
Assessment plays a central role in education process: it determines much of the work students undertake affects their approach to learning and is an indication of which aspects of the course are valued most highly. The purposes of assessment are to motivate students to learn, create learning opportunities, to give feedback to students and teachers, grading and quality assurance. There is a distinction between a formative assessment, which is mainly intended to help the student learn and a summative assessment, which is intended to identify how much has been learned. Formative assessment is most useful part way through the module and will involve giving students feedback which they can use to improve future performance. Faculty should conduct at least two formative assessments of each student during a given module or rotation. Summative assessment is used to make a pass/fail or, promotion decision; findings of formative assessment are not used to make pass/fail decisions, however1. That being said both formative and summative assessments are equally important; however, psychometric rigor is required more from summative assessment strategies. The following principles2,3 are considered in selection of assessment strategies and faculty should keep in mind these principles in appraising and revising assessment methods during implementation. Validity and reliability are of utmost importance but it is also recommended to consider feasibility and cost.
Reliability: Reliability is the reproducibility or consistency or generalizability of assessment scores. An assessment result is said to be reliable if students will get the same score if they re-take the exam. Similarly, for essay type and performance assessment, assessment scores are reliable, if the same results are obtained with
different raters. Reliability of assessments can be improved by increasing the number of questions (or cases in clinical performance examination), aiming for middle difficulty questions, writing clear and unambiguous questions and increasing the number of raters.
Validity: Validity is the ability of an assessment to measure what it is supposed to measure. Validity is not about the method refers to the evidence presented to support or refute the meaning or interpretation assigned to assessment results. Simply put, assessment results are valid if they accurately distinguish competent from incompetent students and if the student who gets “A” grade is actually an “A” student, a student who gets a “B” grade is actually a “B” student, a student who gets an “F” grade is actually an “F” student, etc. Examples of factors that affect validity in written assessment are too few written questions to sample the content adequately, preparing questions from some chapters, mismatch of assessment questions with content covered in the curriculum, poorly constructed questions, too difficult or too easy questions, rater subjectivity and cheating. For performance (clinical) assessment, too few cases or observations to generalize performance, unrepresentative cases, rater bias, flawed rating scales/checklists and indefensible pass/fail cut off points are threats to validity. Note that reliability is a necessary but not sufficient condition for validity.
These are the descriptions of the major assessment methods including when and where they would be used in the curriculum.
- Direct Observed Practice (DOP)
The purpose of DOPs or mini-clinical evaluation exercise is to assess clinical skills while a student performs a specific skill/ task in different settings. Typically it takes 5-10 minutes and the assessor follows the student with a checklist and gives feedback at the end. The DOPs offers students immediate and ongoing feedback about their observed specific clinical skill and performance (interviewing skills, physical examination skills, professionalism, clinical judgment, counseling skills, organization/efficiency and overall clinical competence). This method will be used throughout the two years of the training and the number of DOPs required per specialty module, assessment tool & suggested CBD areas are clearly indicated in respective modules assessment sections. This assessment method enables one to follow the progress of the student and will be used for formative as well as summative assessment.
- Case Based Discussion (CBD)
CBDs are structured interviews conducted by a supervisor and a trainee in a focused manner around the actual written case records a trainee presents. It is a process which has both a grading element and a feedback function. Generally the trainee will select some cases and should give the necessary records (as anesthetic records, discharge notes and preoperative evaluation sheets) prior to the case discussion. The trainee should be guided to choose cases in which uncertainty or where a conflict of decision making has arisen. In practical terms, it is helpful for the supervisor to be familiar with the competencies being assessed using the assessment tools attached on annex section of this curriculum. This method will be used throughout the two years of the training and the number of CBDs required per specialty module, assessment tool & suggested CBD areas are clearly indicated in respective modules assessment sections. This assessment method enables one to follow the clinical decision making of the student and will be used for formative as well as summative assessment.
- Practical Clinical Evaluation (PCE)
PCEs are objectively structured clinical evaluations of a student while he/she provided a full package of anesthetic care for clients in different settings. Unlike DOPs where a students is assessed for a specific task/ skill performed, the full image of anesthetic management of selected patient/ client by the student will be
observed in PCEs. The PCEs offers students immediate and ongoing feedback about their observed general clinical skill and performance. This method will be used throughout the two years of the training and the number of PCEs required per specialty module, assessment tool & suggested PCE areas are clearly indicated in respective modules assessment sections. This assessment method enables one to follow the progress of the student and will be used for formative as well as summative assessment.
- Standardized oral exam
The standardized oral examination1 is a type of performance assessment using realistic patient cases for questioning the examinee. The examiner begins by presenting to the examinee a clinical problem in the form of a patient case scenario and asks the examinee to manage the case. Questions probe the reasoning for requesting clinical findings, interpretation of findings, and treatment plans. In efficiently designed exams each case scenario takes three to five minutes. One or two faculty serve as examiners and students can be tested on several different clinical cases. Oral exam can be used as a compulsory assessment tool to CBDs formative & summative assessment.
- Written exam
Written assessments may include different item formats such as multiple choice questions, matching, true-false, essay and short answer. Written assessment methods will help to evaluate knowledge and understanding of basic, clinical, public health and psychosocial sciences and professionalism and ethics. Important point to remember is to ensure written exams assess higher order knowledge in addition to recall and comprehension. Written assessments would be parts of both as formative and summative assessment in all of the program modules.
Logbook documentation serves as evidence of scope of patient care and clinical experience to meet requirements or specific learning outcomes. Maintaining logbook will encourage students to make use of all possible learning opportunities for clinical/procedural skills and community skills to fulfill minimum requirement. Regular review of logbook can be used to help the student track what procedures or experiences must be sought to meet requirements. The logbook document should be counter checked by faculty. The number reported in a logbook may not necessarily indicate competence. Electronic Logbook will be part of the formative assessment throughout the MSc in Anesthesia curriculum.
Portfolio2 is collection of papers and other forms of evidence that learning has taken place. It provides evidence for learning and progress towards learning objectives. Reflecting upon what has been learned is an important part of constructing portfolio. In addition to products of learning, the portfolio can include statement about what has been learnt, its application, remaining learning need, how they can be met. Portfolio helps to assess learning outcomes including those that are not easy to assess with other methods like personal growth, self- directed learning, reflective ability, self-assessment of personal growth and professionalism. Portfolio allows assessment of progress towards learning outcomes by using chronological work samples collected at different
points in time. Portfolio will be part of the formative assessment throughout the duration of the training and can be used as a summative assessment during professional modules.
- Global Rating
Global Rating1 is assessment of general categories of ability (e.g. patient care skill, medical knowledge, interpersonal and communication skills, professionalism, etc.) retrospectively based on general impression over a period of time and derived from multiple source of information. The purpose is to evaluate knowledge, skill and attitude over a period of time during and at the end of specialty clinical attachment thereby helping the evaluation of the student’s effort across time. Global rating will be main part of both formative and summative assessment of students throughout the duration of the Msc in anesthesia curriculum. Some of the simple but critical assessments will be either passed or failed, whilst the others will be marked out of 4 points. 4 is considered excellent, 3.5 good, 3.0 satisfactory, 2.0 “needs to improve” and 1.0 is poor. A grade point average of 3.0 or more in each Module is required to obtain the MSc.
The duration of the MSc in anesthesia training is TWO YEARS with the following components: Foundations of evidence based clinical practice, specialty based advanced clinical anesthesia management and social and population health as shown in table 1 below. In the Foundations of evidence based clinical practice phase, students acquire foundational knowledge, skills and attitudes in applying evidence-based anesthesia practice. Moreover, students will be able to monitor clinical practice following principles of clinical audit and engage themselves in teaching of others. Specialty based advanced clinical anesthesia management modules provide the basic knowledge, skills and attitude that are necessary to practice safe and effective anesthetic management. During this time, students develop clinical knowledge, skills and attitude through intensive patient-based teaching and guided practice in different specialty areas with opportunities to develop advanced clinical anesthesia skills. They also acquire knowledge and skills of clinical research. Then, students must score a pass score on final year individual research project.
Table 1: Composition and duration (in hours & weeks) of the MSc in Advanced Clinical Anesthesia curriculum
|Module Name||Theory Hrs.||Practice Hrs. (SDL + HP1)||Self- study||Total Hrs.||Total ECTS||Duration (Weeks)|
|Clinical Audit & Evidence Based Medicine||33||10||52||95||3||3|
|Leadership, management and medical ethics||23||53||32||108||3||3|
|Anesthesia for General surgery||38.5||176||64||278.5||5||8|
|Gynecology and Obstetrics Anesthesia||43.5||184||64||291.5||5||8|
|Pediatrics & Neonatal Anesthesia||45||180||64||289||5||8|
|Trauma & Orthopedic anesthesia||47.5||181.5||64||293||5||8|
|EENT & Maxillofacial surgery||31.5||89||32||152.5||3||4|
|Anesthesia for Neurosurgery||36||130||48||214||5||6|
|Regional anesthesia and Pain Management||34||135||48||217||5||6|
|Critical care & ICU||34||135||48||217||3||6|
|Thesis (Project write-up)||–||400||400||800||10||16|
Admission to this MSc in Anesthesia program requires:
- Bachelor of Science (BSc) degree in Anesthesia from a recognized institution
- Must pass & certified with National licensure examination graduates after 2011 E.C, Graduates before 2011E.C no need of asking licensure exam result.
- A minimum of 2 years clinical/teaching experience
- Two recommendation letters from work place. These may be:
- Both from professionals who are able to attest to the applicant’s professional ability, or
- From senior anesthetist and other related one from physician surgeon.
- The applicant must successfully pass the screening process as described below:
- Entrance examination – 50%
- Previous academic record (Bachelor degree CGPA) – 30%
- Oral interview – 15%
- Curriculum vitae – 5%
- For female applicants’ after they equally treated out of 100% due to affirmative action 5 points will be added.
- Sponsorship letter from sponsoring institution
- Official transcript
- To enroll to the program applicants should have to record 50% and above over all exam.
Letter grades shall be given based on the points earned out of 100. The letter grading system has a fixed scale as described in the table below.1
The weights of different assessment methods in each respective module and attachment are described in the syllabi.
|Raw mark||Letter||Grade point|
ACADEMIC ACHIEVEMENT AND STATUS FOR GRADUATE PROGRAMS
Academic Standing of Graduate Students
1) A graduate student must sustain a minimum SGPA of 2.75 and a CGPA of 3.00 throughout his/her study period at the graduate studies. Thus, at the end of each semester, the respective DGC shall examine and determine the academic status of each candidate who has failed to maintain the minimum requirements of SGPA of 2.75and/or a CGPA of 3.00 based on the following rules:
- A first-year graduate student who, at the end of the first semester, receives SGPA of less than 2.50 shall be dismissed.
- A first-year graduate student who, at the end of the first semester, scores a Semester Grade Point Average (SGPA) between 2.50 and 2.75 (2.75exclusive) shall be warned.
- A first-year graduate student who, at the end of the second semester, receives either an SGPA of less than 2.75 and/or a CGPA of less than 3.00shall be warned. If the student was on warning status, during the first semester, and his SGPA is below 2.75 or CGPA is less than 3.00 the student shall be dismissed unless put on probation.
- A first-year complete student, who fails to achieve either a SGPA of 2.75or a CGPA of 3.00 at any semester, shall be warned.
- A first-year complete student, who scores either a SGPA of less than 2.75or fails to maintain a CGPA of 3.00 for a second consecutive semester, is subject to dismissal unless put on probation.
- Student shall be dismissed after being placed for one semester on warning and for another consecutive semester on probation, if he does not remove himself from probation by bringing his CGPA to3.00.
- 2) A student may be placed on a discretionary probation, if reasons exist to justify as to why the candidate failed to attain the minimum GPA requirement of 3.00, and if the CGC is convinced that he may remove the academic deficiencies in the future, and will meet the standards set by the university.
- 3) When a candidate is placed on probation, he shall be notified by the department head of his status and what is expected of him by way of academic performance in the future and what will be the consequences of failure to meet the conditions.
Upon completion of the two years program, the graduate will be awarded the degree of ‘Masters of Science in Clinical Anesthesia’ and in Amharic ‘የሳይንስ ማስተርስ ዲግሪ በክሊኒካል አንስቴዝያ’
Higher institutions delivering this program will establish a health sciences education development center (HSEDC) to lead and coordinate quality assurance and program monitoring and evaluation. Quality assurance will be guided by educational standards and benchmarks defined by the Higher Education Relevance and Quality Agency. The ongoing quality of the Msc in Anesthesia education will be monitored and ensured through:
- Establishment of a curriculum committee under the HSEDC to oversee the implementation of the curriculum, develop standard guidelines for teaching and assessment and make necessary adjustments along the way.
- Self-review of the educational inputs, processes and outputs (including human resources physical infrastructure, teaching/learning in classroom, skills lab, clinical and community settings, student assessment, management and governance and student performance results) semi-annually and taking action. This will be coordinated by the quality assurance committee or team.
- Organizing regular faculty development and support programs on instructional methods, technical updates, research, leadership, etc. This will be coordinated by the faculty development committee or team.
- Establishment of an assessment committee or team under the HSEDC to develop and maintain exam banks and coordinate, review and administer student assessment practices
- Evaluation of teaching effectiveness by systematic collection of feedback from students and at the end of each module or attachment and use it for program improvement
- Peer and module/rotation evaluation by instructors at the end of module delivery
- Annual assessment of the program by the teaching staff
- Exit interviews at graduation and for all those who drop out for any reason
- Establishing alumni of graduates as a mechanism to assess their career choice and development
- Evaluation of graduate’s performance including obtaining feedback from employers and society and use the information for program improvement
- Review of curriculum every three years to be led by the curriculum committee under the HSEDC
Human Resources -Anesthesia department Staff Profile
- The department of Anesthesia has currently 17 members of staff on activities
- 4 Assistant professors (two MSc, background, One MD background Anesthesiologist)
- 6 Lecturer
- 4 Assistant lecturers
- 2 MSc Students in Clinical Anesthesia
- 2 MD, Anesthesiologist residents
- 1 Secretary