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School of
Medicine

Certified Anesthesiologist Assistant Program

Curricular Progression Chart

Curricular Progression Chart

Semester 1

Professional competency prioritization

  • Professionalism
  • Interpersonal and communication skills
  • Medical knowledge
  • Practice-based learning and improvement
  • Patient care
  • Systems-based practice

Didactic and simulation coursework

  • Anesthesia "Boot Camp" (first three weeks of the semester)
  • Introduction to Anesthesia
  • Patient Monitoring and Instrumentation
  • Orientation to the Operating Room
  • Introduction to Physiologic-Based Simulation

Semester narrative

This year provides students with twelve months of broad education in basic science disciplines relevant to the practice of anesthesiology. During the first twelve months of training, the emphasis is on the fundamental aspects of anesthesia, including basic physiology and pharmacology, and the skills involved in the administration of anesthesia and associated invasive and non-invasive monitoring. Much of this year is spent completing the didactic curriculum, with an increasing clinical experience in the general operating rooms of adult hospitals providing anesthesia for intra-abdominal, minor vascular, otolaryngological, dental, ophthalmological, gynecological, orthopedic, and outpatient surgical procedures.

During the first year students develop knowledge and skills in patient assessment and physical examination, vascular access, and airway management. Clinical experience is intertwined with didactic and simulation-based learning. The intent of the first semester is to indoctrinate the new AA student into the patient care environment. Clinical exposure begins almost immediately, following a three week "Anesthesia Boot Camp," which consists of many simulation experiences and several days of didactic preparation. This "Introduction to Anesthesia" summer semester yields about 100 clinical hours, over 100 didactic hours, and over 50 hours of simulation experiences.

Though professionalism and communication skills are stressed throughout the program, the first semester is the initial opportunity to acclimate the student learner how to act in a hospital setting, how to communicate with superiors, colleagues, and patients. Medical knowledge acquisition is fast-paced and somewhat overwhelming for the students. Expectations should focus broad-topic knowledge and basic technical skills performed with assistance of the Instructor.


Semester 2 

Professional competency prioritization

  • Professionalism
  • Interpersonal and communication skills
  • Practice-based learning and improvement
  • Medical knowledge
  • Patient care
  • Systems-based practice

Didactic and simulation coursework

  • Cardiac Electrophysiology
  • Patient Monitoring & Instrumentation II
  • Applied Physiology for the Anesthesiologist Assistant I
  • Anesthesia Clinical Correlation I
  • Pharmacology for Anesthesiologist Assistants
  • Fundamentals of Anesthetic Sciences I
  • Physiologic Model-Based Simulation I

Semester narrative

The next phase begins in the Fall semester and is considered the basic anesthetic management phase of the program. Students work clinically for up to three days each week learning about anesthetic management and honing the procedural skills learned in the simulation labs, while building the foundation of medical and anesthesia knowledge needed, in the classroom. During this semester, CWRU MSA's innovative and integrated simulation program provides a mixture of clinical skills labs and individual attention during hi-fidelity simulation training with the advanced partial task trainers and hi-fidelity simulators.

By the end of the fall semester, the first year MSA student should strive to be 80% successful when performing the following tasks with moderate assistance (defined as "supervision 100% of the time with technical support 50% of the time given by a clinical instructor"):

  • Venous cannulation and fluid therapy on healthy adult patients.
  • Airway management on anesthetized, healthy adult patients.
  • Laryngoscopy and endotracheal intubation on anesthetized, healthy adult patients with Mallampati Class I or II airways.
  • Accurate completion of the intraoperative record with no blank spaces.
  • Anesthesia machine checkout and appropriate room setup for healthy (ASA I & II) adult general anesthesia management.
  • Placement of laryngeal mask airways in healthy adult patients.
  • Closely supervised involvement with pediatric airway management and venous cannulation in preparation for performance testing by the end of the first year.

The performance checklist for the fall semester - basic science year contains the following items:

  • Successful placement of intravenous cannulas with calculation of fluid deficit/replacement and maximum allowable blood loss for healthy adult patients given the previously mentioned criteria
  • Successful completion of general anesthetics on healthy adult patients managed with mask assisted spontaneous respirations given the previously mentioned criteria
  • Successful endotracheal intubations on healthy adult patients (Mallampati Class I or II) given the previously mentioned criteria
  • Adequate completion of intraoperative records for uncomplicated cases given the previously mentioned criteria
  • Appropriate setup of the anesthesia machine and tabletop for uncomplicated (ASA I & II) adult general anesthetics given the previously mentioned criteria
  • Successful placement of laryngeal mask airways in healthy adult patients given the previously mentioned criteria

Semester 3 

Professional competency prioritization

  • Interpersonal and communication skills
  • Professionalism
  • Medical knowledge
  • Practice-based learning and improvement
  • Patient care
  • Systems-based practice

Didactic and simulation coursework

  • Applied Physiology for the Anesthesiologist Assistant II
  • Pharmacology for Anesthesiologist Assistants II
  • Anesthesia Clinical Correlation II
  • Clinical Decision Making in Anesthesia
  • Fundamentals of Anesthetic Sciences II
  • Physiologic Model-Based Simulation II
  • Anesthesia Non-Technical Skills Lab

Semester narrative

The final phase of first year begins in the spring semester, when students are expected to understand and perform basic anesthetic management under the watchful supervision of their clinical instructors, which include anesthesiologists, anesthesiologist assistants, senior anesthesia residents, and fellows. During this semester, students work up to four days in the clinical setting, continue the core anesthesia and medical classroom learning, and begin the most innovative portion of the curricular continuum. CWRU MSA's new and innovative curriculum includes a mixture of advanced simulated skills labs, hi-fidelity crisis management simulation, a cutting edge Anesthesia-Non Technical Skills (ANTS) lab work, and highly interactive Clinical Decision Making class, all integrated to maximize technical skills, crisis management, anesthetic management and knowledge acquisition. CWRU MSA's philosophy encourages early and considerable clinical experience, physician taught basic sciences, AA taught innovative classes, all coupled with an integrated, innovative and technologically advanced simulation programs. An emphasis on student quality management yields the most prepared first year students in the country. All CWRU MSA first year clinical rotations are in the program's home city allowing maximum quality control over first year clinical experiences.

During the third semester of clinical anesthesia experience, the AAS is expected to:

  • Perform a thorough and accurate preanesthetic evaluation, including chart review and patient history/physical examination, identifying pertinent information with minimal assistance.
  • Formulate an appropriate, patient-specific anesthesia plan without assistance, including moderately complex situations (ASA 3 or 4).
  • Demonstrate knowledge of full setup and use of anesthesia and monitoring equipment. Can trouble-shoot without assistance.
  • Demonstrates competency in the execution of the anesthesia plan with some assistance. Is conscientious in utilizing various available resources (e.g. personnel, drugs, equipment, etc.)
  • Perform basic invasive techniques without assistance. Perform advanced invasive techniques (e.g. CVP and PA catheters, neuraxial blocks, etc.) with assistance.
  • Demonstrates technical competency with basic/some advanced anesthesia skills (e.g. airway management, ventilation management, fluid management, etc.)
  • Demonstrate fund of knowledge necessary to administer anesthesia to patients with reasonably well-controlled systemic disease(s).
  • Display integrative problem solving and critical thinking behaviors necessary to solve routine situations. Able to establish appropriate priorities for most situations.
  • Engage faculty appropriately regarding clinical situations. Synthesize and adapt to rapidly-changing situations.
  • Communicate professionally with all healthcare professionals and paraprofessionals using conscientiousness, discretion, and sensitivity.
  • Demonstrates self-direction in completing assignments, deepening fund of knowledge, and seeking learning opportunities.
  • Demonstrate situational awareness and crisis management skills in all clinical situations.

By the end of the spring semester, the first year MSA student should strive to be 90% successful when performing the following tasks with minimal assistance (defined as "supervision 100% of the time with technical support 10% of the time given by a clinical instructor"):

  • Venous cannulation and fluid therapy on all adult and pediatric patients.
  • Airway management on all awake and anesthetized, adult and pediatric patients.
  • Laryngoscopy and endotracheal intubation on all anesthetized adult and pediatric patients.
  • Anesthesia machine checkout and appropriate room setup for all adult and pediatric general anesthesia management.
  • Preoperative interview/physical examination and subsequent development of the anesthetic plan in conjunction with the attending anesthesiologist and anesthetist/resident for uncomplicated (ASA I & II) adult and pediatric patients.
  • Placement of laryngeal mask airways (LMAs) in healthy pediatric patients.

The performance checklist for the spring semester - basic science year contains the following items:

  • Successful placement of intravenous cannulas on healthy pediatric patients given the previously mentioned criteria for adult IV placement
  • Successful completion of general anesthetics on healthy pediatric patients managed with mask assisted spontaneous respirations given the previously mentioned criteria for adult airway management.
  • Successful endotracheal intubations on healthy pediatric patients given the previously mentioned criteria for adult endotracheal intubation.
  • Appropriate setup of the anesthesia machine and tabletop for healthy pediatric patients given the previously mentioned criteria for adult room setup.
  • Completed preoperative interviews/physical examinations on uncomplicated (ASA I & II) adult and/or pediatric patients given the following criteria:
    1. Complete review of all physiologic systems by patient interview and review of old/current chart including previous medical history, history of present illness, current vital statistics, blood chemistries, diagnostic tests and pertinent medical consultations.
    2. Physical examination of the patient focusing on the lungs, heart and airway.
    3. Patient interview focusing on NPO status, drug allergies, previous surgeries noting anesthetic complications, family history of anesthetic complications and current pharmaceutical therapies.
    4. Thorough discussion of the anesthetic options including risks/benefits for each option.
    5. Development of the anesthetic plan in conjunction with the attending anesthesiologist, anesthetist, and/or resident.
  • Successful placement of laryngeal mask airways (LMAs) in healthy pediatric patients given the previously mentioned criteria for adult LMA.

Semester 4

Professional competency prioritization

  • Interpersonal and communication skills
  • Professionalism
  • Medical knowledge
  • Practice-based learning and improvement
  • Patient care
  • Systems-based practice

Didactic and simulation coursework

  • Ethics, Law & Diversity for Anesthesiologist Assistants

Semester narrative

Both clinical and non-clinical learning activities during the AA-S2 year are based upon a philosophy of increasingly self-directed learning. The didactic lectures are presented in a seminar format directed toward critical review of literature on selected topics. The AA-S2 year is spent almost exclusively in subspecialty rotations. Students will be introduced to the following anesthesia sub-specialty areas.
Having gained a solid footing in anesthetic management and knowledge throughout the first year, students begin the senior year of the Program, integrating specialty training rotations. Students are in the operating room up to six days per week, take overnight calls, and essentially put in the hours of a full time anesthesiologist assistant.

CWRU MSA has mandatory specialty rotations in pediatric, cardio-thoracic/cardio-vascular, neurosurgical, obstetrical, trauma, intensive care/preoperative clinic, and ambulatory, anesthesia. CWRU MSA also provides elective rotations that students can use to sub-specialize, or travel to outside rotations in their home states or in areas they are considering for employment. Students can often get as many as 4-5 months of specialty rotations like pediatric or cardiac anesthesia, setting them apart from a field of graduates nationwide when applying to specialty hospitals.

During the second year, journal clubs, presenting at weekly conferences and an Ethics & Law of Practice class round out the completion of the didactic portion of their training. Simulation continues with 100% hi-fidelity, crisis management in all anesthetic specialties.


Semester 5

Professional competency prioritization

  • Interpersonal and communication skills
  • Professionalism
  • Medical knowledge
  • Practice-based learning and improvement
  • Patient care
  • Systems-based practice

Didactic and simulation coursework

  • Anesthesia Clinical Correlation III
  • Fundamentals of Anesthetic Sciences III
  • Physiologic Model-Based Simulation III

Semester narrative

During the second year of clinical anesthesia experience, the AA student is expected to:

  • Perform a thorough and accurate preanesthetic evaluation, including chart review and patient history/physical examination, identifying pertinent information without assistance.
  • Formulate the appropriate, patient-specific anesthesia plan without assistance for basic and most complex situations (ASA 1 through 6).
  • Demonstrate knowledge of full setup and use of anesthesia and monitoring equipment. Can trouble-shoot without assistance. Serves as a resource person to others.
  • Demonstrates competency in the execution of the anesthesia plan, with minimal assistance, to a wide variety of patients including those with life-threatening conditions.
  • Perform basic and advanced invasive (e.g. PA and CVP catheters, neuraxial blocks) techniques without assistance.
  • Demonstrates technical competency with basic/advanced anesthesia skills (e.g. fiberoptic bronchoscopy, transesophageal echocardiography (TEE), ultrasound-guided catheters and blocks, etc.) with assistance.
  • Demonstrate fund of knowledge necessary to administer anesthesia to patients in all states of health. Adept at crisis resource management theory.
  • Display integrative problem solving and critical-thinking behaviors necessary to solve complex situations. Able to maintain appropriate priorities in complex situations.
  • Engage and collaborate with faculty appropriately; utilizes current evidence-based information; performs competently with few supportive cues.
  • Communicate professionally with all healthcare professionals and paraprofessionals using conscientiousness, discretion, and sensitivity.
  • Demonstrates self-direction in completing assignments, deepening fund of knowledge, seeking learning opportunities, and mentoring others.
  • Demonstrate application of problem-based learning skills.

By the end of the spring semester of the second year and having completed the entire didactic and clinical programs of study, the MSA graduate candidate should strive to be at least 95% successful when performing all of the previously mentioned tasks in addition to the following tasks with rare assistance (defined as "supervision 100% of the time with technical support 5% of the time given by a clinical instructor"):

  • Arterial vessel cannulation.
  • Central venous cannulation.
  • Lumbar epidural catheter placement and management.
  • Placement and management of pediatric caudal blocks.
  • Placement and management of IV perfusion (Bier) blocks.
  • Nasotracheal intubation.
  • Endobronchial tube placement.
  • Nasogastric tube placement.
  • Management of monitored anesthesia care (MAC).
  • Management of anesthesia for outpatient surgery.
  • Management of anesthesia for cardiac surgery.
  • Management of anesthesia for thoracic surgery.
  • Management of anesthesia for obstetrics.
  • Management of anesthesia for pediatric surgery.
  • Management of anesthesia for neurosurgery.
  • Management of anesthesia for trauma surgery.
  • Management of anesthesia for vascular surgery.
  • Management of anesthesia for geriatric patients.

Semester 6

Professional competency prioritization

  • Interpersonal and communication skills
  • Professionalism
  • Medical knowledge
  • Practice-based learning and improvement
  • Patient care
  • Systems-based practice

Didactic and simulation coursework

  • Anesthesia Clinical Correlation IV
  • Fundamentals of Anesthetic Sciences IV
  • Physiologic Model-Based Simulation IV

Semester narrative

The performance checklist for the entire clinical (second) year contains the following items:

  • Successful placement of arterial catheters by the second needle stick given the following criteria:
    1. An appropriate vessel is chosen for insertion.
    2. An appropriate catheter is chosen.
    3. Aseptic technique is used.
    4. The transducer tubing is connected with minimal blood loss.
    5. The catheter and tubing are secured adequately.
    6. The transducer is zeroed properly.
  • Successful placement of subclavian or internal jugular central venous catheters by the second needle stick given the following criteria:
    1. An appropriate vessel is chosen.
    2. An appropriate catheter is chosen.
    3. Aseptic technique is used.
    4. Tubing is connected with minimal blood loss.
    5. The catheter and tubing are secured properly.
    6. The transducer is zeroed properly (when appropriate).
    7. The Swan-Ganz catheter is inserted properly (when appropriate).
  • Successful placement of lumbar epidural catheters by the second Touhy needle stick given the following criteria:
    1. Aseptic technique is used.
    2. The appropriate level for insertion is chosen.
    3. The dura is not punctured.
    4. No persistent paresthesia is elicited.
    5. An appropriate local anesthetic/dosage is chosen.
    6. No intravascular injection is evident.
    7. The level of analgesia is deemed adequate.
    8. Follow up management of the block is appropriate.
  • Successful placement of pediatric caudal blocks by the second needle stick given the following criteria:
    1. Aseptic technique is used.
    2. No CSF, heme or stool is aspirated.
    3. An appropriate local anesthetic/dosage & volume is chosen.
    4. An adequate level of analgesia is obtained.
  • Successful placement of intravenous perfusion (Bier) blocks given the following criteria:
    1. Standard practice is followed.
    2. Adequate surgical analgesia is achieved without the need for follow up general anesthesia.
  • Successful placement of adult or pediatric nasotracheal tubes by the second tube pass given the following criteria:
    1. An appropriately sized endotracheal tube is chosen.
    2. Magill forceps are used effectively when needed.
    3. Tube insertion is atraumatic.
    4. No epistaxis is noted.
    5. The tube is secured adequately.
  • Successful placement of endobronchial tubes by the second tube pass given the following criteria:
    1. An appropriately sized tube is chosen.
    2. Proper tube placement is verified by fiberoptic endoscopy.
    3. The tube is secured adequately.
    4. The student shows a working knowledge of endobronchial tube ventilation principles.
  • Successful placement of nasogastric tubes by the second tube pass given the following criteria:
    1. The appropriate size tube is chosen.
    2. The appropriate nares is chosen.
    3. No epistaxis is noted.
    4. The tube is secured adequately at the appropriate depth.
  • Anesthetic management of patients for monitored anesthesia care as a member of an anesthesia care team.
  • Anesthesia management of adult patients for outpatient surgery as a member of an anesthesia care team.
  • Anesthetic management of patients for cardiac surgery as a member of an anesthesia care team.
  • Anesthetic management of patients for thoracic surgery as a member of an anesthesia care team.
  • Anesthetic management of patients for obstetrical procedures as a member of an anesthesia care team given the following criteria:
    1. Vaginal deliveries including:
  • placement of epidural
  • management of labor
  • present for delivery
    1. Cesarean sections including:
  • placement of epidural and/or induction of general anesthesia
  • management of the case
  • Anesthetic management of pediatric patients for all types of surgery as a member of an anesthesia care team (patients included in this category can also be counted toward requirements in other categories).
  • Anesthetic management of patients for neurosurgery as a member of an anesthesia care team.
  • Anesthetic management of patients for trauma surgery as a member of an anesthesia care team.
  • Anesthetic management of patients for vascular surgery as a member of an anesthesia care team.
  • Anesthetic management of geriatric patients for all types of surgery as a member of an anesthesia care team (patients included in this category can also be counted toward requirements in other categories)