Because of the nature of the role of the anesthesiologist, the ACVA diplomate must be able to deal with emergent life-threatening situations in a rational, independent and timely fashion and thereby assume individual responsibility for all aspects of anesthesia-related care. Freedom from the influence of or dependency on chemical substances that impair cognitive, physical, sensory or motor functions also is an essential characteristic of the ACVA-certified veterinary anesthesiologist.

B. Program Goals and Objectives

The goal of a residency in veterinary anesthesiology is to prepare the individual to function as a qualified practitioner of veterinary anesthesiology at the highest level of performance that society expects of an individual identified as a specialist.

The program must provide:

1. Opportunity for residents to learn in depth the fundamentals of basic science as applied to the practice of anesthesiology.

2. Experience in preanesthetic, perianesthetic and immediate postanesthetic care for animals in areas that constitute the components of veterinary anesthesiology.

3. A suitable environment to facilitate training expectations. Such an environment requires a commitment by faculty, support staff and administration, appropriate resources and facilities, and appropriate animal caseload.

Clinical activity, undergraduate and graduate veterinary education, and other teaching activities and service commitments should not compromise the resident's training.

C. Duration and Scope of Education

Three contiguous (with or without a graduate academic degree) years of focused clinical training in veterinary anesthesiology following graduation from veterinary school (i.e., receiving a DVM, VMD or equivalent degree) is considered the minimum amount of time required for acquisition of the necessary knowledge, technical skill and judgement. To provide an adequate clinical base of knowledge and skill, at least one year of clinical practice of veterinary medicine or equivalent experience following graduation from veterinary school but before submitting credentials for examination, is required.

The clinical activities portion of an approved residency in veterinary anesthesia must include at least 60% of full-time effort in the anesthetic management of animals (i.e., a minimum of 94 weeks out of the total 156 week training period). Vacation will be taken in accordance with the rules and regulations of the institution/training program and there will be no more than two weeks per year of sick leave during each year of training. Any absence from training in excess of those specified will require that the trainee’s total training time be lengthened to the extent of absence.

The residency should provide intensive training in veterinary anesthesiology primarily through animal care, but also supplementing the program with complementary library study, didactic course work, seminars, and laboratory or clinical investigation. Within the residency, the individual should have experience in the practice of anesthesia and the management of pain in various species including companion, food, sporting, laboratory, free-ranging and captive animals. The individual should have managed anesthesia in such animals under a variety of conditions including different disease processes in various species. Upon completion of training, the individual should have:

1. A broad understanding of veterinary anesthesiology and pain management.

2. An understanding of the changes in physiology induced by diseases and abnormalities of various organ systems and their effects on anesthetic management and life support.

3. An understanding of the anesthetic and adjuvant or supportive drugs and equipment used in the:

a. Anesthetic management and life support of various animals to facilitate surgical, diagnostic and therapeutic procedures

b. Management of pain

c. Management of cardiopulmonary resuscitation

d. Management of mechanically ventilated animals

e. Management of the unconscious animal

f. Management of fluid, electrolyte and metabolic disturbances

g. Capture, physical restraint and chemical immobilization of various species including captive and free-ranging animals

h. Management of common experimental procedures

II. Institutional Organization

Resident training programs should have sufficient physical facilities, equipment and breadth of anesthetic management experiences within the framework of their institution to provide an adequate training program (see IV.A-D). An institution that cannot provide sufficient resources and clinical experience within its own boundaries may make arrangements with other institutions to provide resources and experiences for the trainee. In these cases, the majority of the training should be at the sponsoring institution. All arrangements for training outside of the parent institutional facilities should be formally documented in writing and include a clear description of the duration of time the resident will spend at the affiliated institution, the intended experience gained during this time and the name of the individual responsible for supervising the resident and assuring that goals of the training experience will be met. If the sponsoring institution's program deficits require resident training at other institutions in excess of a total of 12 weeks, the training program will be classified as an alternate program (see description in section V.B.).

The program leader must seek prior approval from the ACVA for any training in outside institutions that is necessary to meet minimum residency training guidelines.

III. Faculty Qualifications and Responsibilities

A. Program Leader

Usually the program leader will be a veterinarian certified by the ACVA. As an alternative in some pre-approved circumstances the leader may not be an ACVA Diplomate but have veterinary medical qualifications in the discipline of veterinary anesthesiology [e.g. Diploma in Veterinary Anaesthesia (DVA.), Diplomate of the European College of Veterinary Anaesthesia (Dipl. ECVA)]. Frequent changes in, or prolonged temporary program leadership over, the course of the resident’s training program may adversely affect the quality of the educational program and therefore is not encouraged.

The program leader is the single person responsible for the satisfactory conduct of residency training program.

B. Faculty

The faculty’s primary responsibility is to maintain a scholarly environment. The faculty must be well qualified to create and maintain such an environment. They are responsible for the direction and execution of the program. Didactic and clinical teaching must be provided by faculty with documented interest and expertise in the discipline or aspects of the discipline.

It is recognized that a critical mass of discipline faculty is necessary for a successful training program. Since this is a clinical training program, the core faculty must be comprised of faculty with a minimum of 25% of full time effort committed to clinical anesthesia/critical animal care responsibilities within the institution’s veterinary health care facility. In this regard, two ACVA certified faculty (or faculty possessing suitable qualifications, as determined by the ACVA) are a minimum staffing level for an approved residency program with a single resident in training. The program leader may count as one of the two. For each additional resident, one additional faculty member within the discipline is necessary to a total of 4 faculty (i.e., 3 residents in training). Beyond this number of faculty, the ratio of residents to faculty may be increased to 1 faculty per 2 residents. While it is desirable to meet minimum numbers beyond the core critical mass ratio (4 faculty for 3 residents) with ACVA diplomates (or individuals with medical or veterinary medical qualifications in the discipline of anesthesiology), faculty with expertise in basic sciences supportive of the clinical training program may qualify in special circumstances to meet the minimal faculty number standard. Consideration of these special circumstances will be reviewed and acted upon by the ACVA on a case by case basis.

If the program includes responsibilities at another institution, a faculty member with appropriate expertise and qualifications must be designated at that institution to assume responsibility for day-to-day activities of the program at that institution. Overall coordination of the program at all teaching sites remains the responsibility of the Program Leader as noted above.

Regarding management of animals by residents, it is important to note that the ACVA considers the faculty engaged in this program as having an ethical responsibility for the overall care of the individual animal managed by their trainee as well as for the supervision of the resident involved in the care of that animal. The resident must have immediate access to direct faculty support during the first year of their training program. It is recognized that residents more senior in the training program should require less direction and direct supervision than an entry-level resident. Extending graded authority to the residents in matters of animal care and assignment of increasing responsibility to them as experience is gained is appropriate. Judgement on delegation of this responsibility should rely heavily on the opinions of those faculty (and perhaps other individuals) that directly observe and otherwise have knowledge of a resident’s skill and clinical ability. The Program Leader should use this information to make decisions regarding the level of responsibility given to each resident.

C. Other Program Personnel

Programs must be provided with additional professional, technical and clerical personnel needed to support and sustain the educational quality of the program.

The integration of non-veterinarian personnel with special knowledge and skills into the training program is appropriate and usually strengthens the overall program. However, exclusive clinical instruction of residents by non-veterinarian or specialist physician personnel usually is not appropriate. It is also inappropriate to encourage excessive supervision of junior residents by residents more senior in the program.

IV. Facilities and Resources

A. Space and Equipment

Hospital facilities (i.e., diagnostic and therapeutic) to satisfy appropriate resident training must be available and functioning. Clinical experiences in ambulatory care (e.g., associated with large animals and/or zoological species) and free ranging circumstances is appropriate.

Appropriate anesthetic delivery, monitoring and life-support equipment must be readily available and represent the current acceptable level of technology in veterinary anesthesia/critical animal care.

In addition to library facilities (described further below), space for teaching conferences, and facilities for research are also necessary.

Clinical records that document animal care must be maintained and these records must be accessible to related personnel at all times; the guiding philosophy must be that such records facilitate a high level of animal care and resident education.

B. Support Services

There should be readily available, clinical laboratory, diagnostic imaging, electrophysiologic and other diagnostic and therapeutic facilities pertinent to support the clinical practice of anesthesia and critical animal care in a broad range of animal species and clinical circumstances.

C. Animal Population

Program leaders and faculty have some discretion in regard to numbers of animal species and conditions managed by the resident, but in defining the limits of their program they must be guided by the principles given immediately below:

1. Experience and technical skill and breadth of animal species and conditions (including disease) are essential for the specialist in veterinary anesthesiology.

2. Animal species must be available in sufficient numbers for training purposes in operating room, intensive care, diagnostic, ambulatory and other settings. Anesthesia experience with birds, reptiles, fish and other species should be represented in the resident's training experiences sufficient to fulfill the objectives itemized in Appendix A. However, it is expected that the primary arena of training will be with mammals.

3. The physical status and disease states of the animals managed should encompass the usual spectrum seen in clinical practice in North America for the particular species in question.

4. Over the course of the residency training period the volume and variety of a resident’s experience must be such to ensure an education balanced by sufficient number and distribution of species and complexity of animal management. Specific numbers of species and physical status/disease states personally managed (as opposed to those clinical circumstances in which the trainee supervised the management) within the residency program time frame will receive emphasis in successful credentials review for ACVA Diplomate status.

When personal experience justifies a teaching role, the resident may act as a teaching assistant overseeing the simultaneously conducted anesthetic management of more than one animal. In these circumstances, experience must be clearly identified as supervisory. It is envisioned that such animal management experience will occur in the later stages of the individual's training program.

D. Library, Computer and Other Educational Facilities

Residents must have access to a major health science library. This may be at the institution of training or in a convenient nearby institution. There must be access to an on-site collection of appropriate textbooks and journal articles. This collection should be readily available during nights and weekends.

Computer support for teaching, learning, data analysis and manuscript preparation must be available. Residents must also have Internet services available to them to facilitate literature searches, and allow them access to various anesthesia servers and electronic resources.

E. Evaluation of Facilities and Resources

The teaching staff must periodically evaluate the resources available to the program; including the financial and administrative support, facilities and equipment, volume and diversity of animal experiences available to ensure a quality training program. Ideally, these reviews should be done no less frequently than once every 5 years and may be done concurrently with the program evaluation (see p. 10 C.3.). Alternatively, these periodic reviews may be accomplished by a broader institutional review as occurs in some larger, university-based, teaching hospital residency programs. Ideally, perceived deficits will be addressed by the program faculty to eliminate the deficiencies that affect the standard of training.

V. The Educational Program

An acceptable program must provide education, training and experience in an atmosphere of mutual respect between the faculty and residents so that trainees will be stimulated and prepared to apply acquired knowledge and skills independently.

A. Residency Program

1. Program Design

Anesthesiology encompasses the full spectrum from the theoretical background to the clinical management of animals. Accordingly, the program must be a balance between clinical care obligations and didactic education. During the first year of clinical training experience basic anesthesia training must emphasize the fundamental aspects of anesthesia and species-specific anesthetic principles. There should be identifiable periods of time associated with basic anesthetic management of small companion animals and large domestic animals. The majority of this basic experience should occur in the first 9-12 months of training. More advanced training which includes experience in more complex domestic animal cases and laboratory, zoological and free ranging animals should occur after the first year of residency training but may also occur as individual opportunities arise during the first year of the program. The second year of clinical training consists of advanced anesthesia training, and may include considerably more commitments to supervisory roles in anesthetic management. At some time during the residency, experience should be obtained in an established critical care facility to gain knowledge and experience in basic approaches to critical care management. Species orientation of such an experience is of secondary importance to the quality of the learning environment and experiences offered.

2. Clinical Components

a. Minimum experience criteria - Residents should have responsibility for personally anesthetizing at least 300 animals during their training program. Recommended numbers of individual animals within the range of species categories are listed in Appendix A.

b. Anesthetic/animal management responsibility – Training program emphasis must be to provide circumstances in which animals are directly, personally managed by the resident. Faculty supervision of this care is an inherent component of a training program. The degree of direct supervision by faculty is circumstance-dependent and guided by animal and resident needs. Circumstances in which residents supervise anesthetic care administered by others (e.g., undergraduate veterinary students, and technical staff) should be in addition to the recommended minimum numbers of animals personally managed. Residents supervising anesthetic management by others should ordinarily not occur during the first year of the resident’s training program; and if necessary for local program needs, such resident activity must be limited in scope and quantity.

c. Animal management log – Residents must keep a log of clinical activities in which they have participated. The cases included in this log should only be cases that the resident has personally managed. The resident may either keep copies of anesthesia records from cases anesthetized and compile them in a folder or keep a separate log. Minimal information in this log must include animal identification number, species, gender/age/weight, procedure for which anesthesia is required, American Society of Anesthesiologists (ASA) Physical Status Code, brief description of anesthetics, anesthetic duration, post anesthetic outcome and complications associated with anesthetic management. Logs should be submitted to the program leader every 6 months during the residency. A final summary report should be submitted to the program leader upon completion of the training program.

d. Participation in other specialty programs within the institution – Resident participation in programs of other clinical or academic disciplines supportive of focused training in anesthesia sub-speciality areas is encouraged. Examples of such disciplines include cardiology, radiology, and laboratory, zoological and exotic animal clinical services.

3. Didactic Components

Didactic training during the residency program provides the resident with an organized forum for acquiring the foundation knowledge required for diplomate status in the ACVA. Didactic instruction should include information on clinical anesthetic management of a core of animal species important to veterinary medicine and related areas of basic science such as anatomy, pharmacology, and physiology. Information should also include topics from other medical and surgical disciplines. This material should demonstrate breadth of coverage of the discipline. The number and format of such teaching activities may vary among programs and program leaders have some flexibility in their design and conduct. However, there must be a consistent and committed faculty participation. It is highly desirable that the program leader and faculty seek to enrich this aspect of the training program by providing lectures and contact with faculty from other disciplines and institutions. It is recognized that for some programs to include such information concurrent participation in a formal graduate academic degree may be desired and/or facilitate this requirement. However, this is not to imply that formal concurrent participation in a graduate degree program is a required component of an approved clinical training program.

4. Conferences and Meetings

Conferences of faculty and residents must be held regularly. These should include regularly scheduled didactic conferences on information/review of basic science and applied sciences as noted above. In addition, they should include morbidity and mortality conferences, journal reviews and research seminars. Residents should be actively involved in the presentation of these conferences according to their stage of training. Attendance at multidisciplinary conferences is also strongly encouraged.

Residents should attend high quality Regional, National and/or International medical and/or veterinary medical meetings supporting advanced education in the art and science of Veterinary Anesthesiology. A suggested minimum attendance record is 1 meeting per year of residency. Specific details regarding the exact meetings selected, time away from clinical activities for attendance, and funding sources are left to the discretion of the program leader.

5. Scholarly Activity

The resident’s education should take place in an environment of inquiry and scholarship. The resident must participate in the development of new knowledge, learn general principles of "good science", learn to evaluate research findings and develop habits supporting a career of life long learning and improvement.

An environment of inquiry and scholarship is established by a competent and committed scholarly faculty and the continual refinement and improvement of a strong teaching program.

It is anticipated that the scholarly activity will result in the formulation of a research project, the results of which must be publishable. A manuscript reporting new knowledge in the area of anesthesiology, pain management or critical care must be accepted for publication in a refereed biomedical journal acceptable to the ACVA prior to examination for admittance into the College.

B. Alternative Program

An alternative method of training in veterinary anesthesiology will be considered. The program may include combined clinical training in veterinary anesthesiology and a traditional formal graduate degree or post doctoral research program. ACVA will evaluate these programs on a case-by-case basis. Program approval is required prior to the start of the training program and the program must be completed in a specified period of time. Yearly progress reports must be submitted to the ACVA documenting the activities of the clinical trainee. The clinical training portion of this program must meet the minimum ACVA residency requirements as defined in this document. The ACVA will be guided by the general sense of the residency training program guidelines noted above in acting on considerations of alternative training programs.

C. Evaluation

1. Resident

Training programs should have clearly defined procedures for regular evaluation of resident’s knowledge, skills and professional performance, including development of professional attitudes and ethics consistent with contemporary veterinary medical practice and societal expectations. These evaluations must be made and results communicated in a personal conference with the resident at least annually, but preferably on a semi-annual basis. Provision for periodic written and/or oral examinations of the resident’s knowledge-based progress is also a highly desirable component of this process. Residents should be advanced to higher responsibility only after evidence of their satisfactory progressive scholarship and professional growth

2. Faculty and other teaching personnel

Residents should provide the local institution's residency committee (or an equivalent group/individual) with a written summary evaluation of the efforts and effectiveness of the anesthesia residency training program leader and core anesthesia-training faculty. At a minimum, such a report should be filed at or near the conclusion of the resident’s training period and should summarize the activity of the entire training period. Information should include the resident’s assessment of the teaching efforts and effectiveness of the core faculty, the faculty’s commitment to the training program, their clinical knowledge and their effectiveness as mentors.

3. Program

The effectiveness of the training program should be evaluated in a systematic manner at least once every three years. It is highly desirable that these be by an institutional faculty review committee. Residents in their final year of training or prior to departure should also review the program. The evaluations should include a review of the effectiveness of the curriculum, the extent to which the goals of the program are being met and the professional quality and competence of the individuals who have completed their training. The performance of members of the teaching faculty and staff should be included in this review process. The program should be critically reviewed by the institution and anesthesia faculty any time a trainee prematurely leaves or is asked to leave the program. It is recommended that these evaluations be used as self-assessments to improve the quality of the training program.

VI. Additional Information

Part V and Appendix A of this document will be regularly reviewed (every 3-5 years) by the ACVA to take into account changes in technology and in the standard of practice of veterinary anesthesia.

The document entitled "Expected Technical Proficiencies for ACVA Board Eligible Candidates" (Appendix A) should serve as a guideline for residents and program leaders to assure that clinical experience over the 3 year program has provided the resident with adequate exposure and opportunity to develop a broad-based expertise in veterinary anesthesiology.

The ACVA registration form (Appendix B) should be completed and submitted to the Executive Secretary of the ACVA at the start of an ACVA residency training program and whenever there is any notable change in the resident's status or program leader's status.

VII. Acknowledgements

The ACVA gratefully acknowledges the cooperation of Fred Donini-Lenhoff, Editor, Medical Education Products of the American Medical Association, Judith Arm-Bruster, Executive Director, Resident Review Committee (Anesthesiology) of the Accreditation Council for Graduate Medical Education (ACGME), Frank L. Murphy, MD, Anesthesiology Program Director, Hospital of the University of Pennsylvania and Member, Resident Review Committee (Anesthesiology) of ACGME, and Donal A. Walsh, PhD, Professor, Department of Biological Chemistry, School of Medicine, University of California, Davis, and Editor, Journal of Veterinary Medical Education, and extends appreciation for encouragement, helpful advice and suggestions for the preparation of this document.

Appendices:

A. Expected Technical Proficiencies of ACVA Board Eligible Candidates

B. ACVA Registration Form

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Expected Technical Proficiencies for ACVA Board Eligible Candidates

Appendix A

Animal Experience

Core Species (recommended minimum animal number = 250)

Over the course of the training program, it is the responsibility of the program leader to ensure that the resident acquires a requisite depth of knowledge in the anesthetic management of animals of “core" species. "Core" species are defined as domesticated dog, cat, horse and ruminant species. Ruminant species include solely or any combination of goat, sheep and cattle. At least 5% of the minimum animal number (13 animals) anesthetized must be represented in each of the core species categories listed above. To this end, the resident should demonstrate proficiency in the anesthetic management of animals within the following broad categories:

Healthy Animal Management

The resident should gain proficiency with sedation, anesthesia and pain management of a sufficient variety of healthy animals. This should include use of a variety of preanesthetic, induction, and maintenance anesthetic drugs. Familiarity should be gained with both injectable and inhalant techniques.

Management of Animals with Specific Conditions or Diseases

The resident should gain proficiency with sedation and anesthetic management of large and small animals with preexisting disease states. It is important that the resident have a thorough understanding of the pathophysiology underlying these specific conditions and diseases and how this affects anesthetic management of the animal. The resident must be familiar with a variety of anesthetic and cardiovascular drugs used for each of the core species. Management of these animals should include expertise regarding analgesia and pain management, fluid and electrolyte therapy, blood gas and acid-base interpretation and management, and cardiopulmonary stabilization and resuscitation.

The resident should become proficient in the management of animals with specific conditions or diseases of the following systems:

Cardiovascular (including preexisting cardiac disease, intraoperative hypotension, and other conditions involving cardiovascular instability)

Respiratory (including airway obstruction, primary lung disease, and animals presenting for thoracotomy)

Neurologic (including both brain and spinal cord disease)

Ophthalmologic

Gastrointestinal

Hepatic

Renal

Endocrine

Orthopedic

Obstetric/neonatal (including Caesarian section surgery)

Pediatric

Geriatric

Emergency presentation (including GDV, hemoabdomen, diaphragmatic hernia, urinary obstruction, trauma, and colic)

Other Species (recommended minimum animal number = 50)

The acquisition of a certain breadth of knowledge and ability to extrapolate between species is also important in the training of a well-rounded veterinary anesthesiologist. Therefore, in addition to the above animal requirements in the “core” species, experience in a broad range of other species is also expected. The resident should have had experience with 2-3 species within each broad category below and a total of at least 8 different species within these 3 categories. This expectation is designed to ensure a minimum level of diversity in the clinical anesthetic experience. It is not intended to limit the residency training program or evoke any hardship on the training institution.

Other Food and Fiber Animals (pigs, camelids, birds)

Exotic Companion and Laboratory Animals (birds, reptiles, fish, rodents, guinea pigs, rabbits, ferrets, etc.)

Captive/Free-Ranging Wildlife (primates, amphibians, all zoo animals and wildlife)

Procedural Experience

The program leader should also confirm over the course of the training program that the resident is proficient in the following technical procedures in both small and large animals:

Endotracheal intubation

Tracheotomy

Arterial and venous catheterization

Monitoring (depth of anesthesia, cardiopulmonary parameters)

Neuromuscular blockade

Local/Regional blocks (including segmental anesthesia and analgesia)

Constant Rate Infusions (anesthetic agents, pressors and inotropes, antiarrhythmics)

Management of the ventilated animal

Use and maintenance of equipment for anesthesia and critical animal care

Anesthetic delivery equipment

Anesthetic machine

Infusion and syringe pumps

Ventilators

Monitoring equipment

Development of these skills is relevant to the management of all animals, especially those with specific conditions and disease states described above.

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Appendix B

American College of Veterinary Anesthesiologists

Registration of Individuals in Clinical Anesthesia Training Programs

(Regular and Alternative Training Tracks)

Application date: ___________________________

Application for registration in: ____ regular residency training program

____ alternative clinical training program

Individual information:

Trainee name: ________________________________

Trainee address: Telephone:

Home: ________________________________ voice: _____________________________

________________________________ fax: _____________________________

________________________________

Work: ________________________________ voice: ____________________________

________________________________ fax: _____________________________

________________________________

e-mail address: ________________________________________

(Please indicate preferred address and telephone number for routine correspondence)

Dates: Program started: _______________________

Anticipated completion: _______________________

Will the trainee be completing an academic degree in conjunction with the clinical training program: Yes_____, No ______.

Degree anticipated: ____________, or not applicable ___________.

Major advisor of degree program ________________________________

Address of major advisor: ________________________________

________________________________

Program information:

University affiliation: ________________________________

________________________________

Program leader: ________________________________

Address: ________________________________

________________________________

Phone number: ________________________________

e-mail address: ________________________________

Date of last program review: ____________ Date of next regular review: ____________

Individual’s prior training:

Professional degree: ____________________ Date: __________________

Degree received from: ________________________________________________

Additional degree(s)/experience: _________________________________________

_________________________________________

Professional license(s): _________________________________________

_________________________________________

Please attach a recently updated Curriculum vitae to this application

CV attached: Yes______, No________

Signature Date

Upon completion, please submit this document to the Executive Secretary of the ACVA

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