RWANDA ALLIED HEALTH PROFESSIONS COUNCILrahpc.org.rw/storage/documents/January2018/Cr6UXIIDnHz5jkdApo… · 1.2. Non-physician anaesthesia practice is concerned with the integration

SCOPE OF PRACTICE FOR NON-PHYSICIAN

ANAESTHETISTS

RWANDA ALLIED HEALTH PROFESSIONS COUNCIL

Office of the Registrar

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Foreword

Anaesthesia is regulated within a statutory framework in Rwanda and registration is a statutory

requirement for legal practice as a Non Physician Anaesthetist in both Rwanda and EAC Partner Sates.

A person must be registered if they want to practise as an anaesthesia practitioner and/or refer to

themselves as a “Non-Physician anaesthetist

Although this document sets out threshold competence for Registrants Non Physician anaesthetists in

both Rwanda and EAC partner states, different legislation applies in each country and Non Physician

Anaesthetist must be registered in Rwanda for him/her to practice.

In Rwanda, statutory regulation creates ongoing requirements for Non Physician Anaesthetist to maintain

their registration beyond the initial requirements for registration. These ongoing requirements include

compliance with licensing standards, maintenance of professional competence and engagement in

continuing professional development.

In Rwanda, Non Physician Anaesthetists are regulated by the Rwanda Allied Health Profession Act, 2013.

They must be registered with the Rwanda Allied Health Professions Council. More information about

registration and regulation of Non Physician Anaesthetist in Rwanda is available at www.rahpc.org.rw


Rwanda Allied Health Professions Council.

First Edition 2016

Kigali-Rwanda

All rights reserved ©RAHPC 2016.

http://www.rahpc.org.rw/

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About these benchmark standards Non Physician Anaesthetists are members of the anaesthetic care team, trained both in the underlying scientific

and medical knowledge pertinent to anaesthesia, and in the skills of administering anaesthesia. Their core

responsibility is to provide anaesthetic services to patients requiring pre-, intra- and post-operative anaesthesia

care to meet the needs of patients undergoing surgery (Lewis SR, et al, 2014).

For the purpose of this document, and to avoid confusion, the word “physician anaesthetist” is used for all personnel

who are medically qualified, and “non-physician anaesthetist” (NPA) for all those who provide anaesthesia without

a medical qualification. This includes a change of terms for discussion regarding some countries, for example, in

the United States of America they are normally referred to as “anesthesiologists” and “certified registered nurse

anesthetists” (or CRNAs), respectively. There are considerable differences in the organization of anaesthetic teams

across Europe and internationally (Egger,2007; Meeusen, 2010), where anaesthetics may be administered by

physician anaesthetists working alone or as part of an anaesthetic team, or by NPAs who in turn may be working

alone or as part of an anaesthetic team (Bacon, 2002). Between countries there are also significant differences in

the length of training of personnel (Egger, 2007; Matsusaki, 2011; Meeusen, 2010).

Non-physician anaesthetists (NPAs) in developing countries, low and middle income countries, with large

populations living in rural locations, have few physician anaesthetists with ratios of less than one per 100,000

population. For example, Uganda has approximately one physician anaesthetist per two million population

(Dubowitz, 2010), Rwanda has approximately twelve physician anaesthetist per 12 000 000, as opposed to the UK

which has 12,000 per 64 million, that is 1:5000 (Walker, 2007). These countries have been using non-physician

personnel to deliver many anaesthetic services, for example, Kenya’s nurse anaesthesia training programme

(Newton, 2010).

The major component of clinical anaesthesia in which they are responsible for include but not limited to respiratory

care, cardiopulmonary resuscitation and/or other emergency, life sustaining services within the anaesthesia, wider

theatre and critical care environments and teaching and research. Non Physician Anaesthetists cadres are

categorized according to education levels they possess.

The range of practice of Non Physician Anaesthetists extends from preoperative assessment to postoperative

anaesthetic care. However, the role is primarily defined by the scope of work undertaken in the operating theatres

where in a supervised capacity, participate in induction, maintenance and reversal of anaesthesia using skills and

knowledge that are based on an in-depth understanding and application of physiology and pharmacology

(MaAuliffe Ms & Henry B,1996).

A non-physician anaesthetist may either work independently as a first-line practitioner or in association with

anaesthesia care team to provide optimal services for patient requiring anaesthesia care. Only graduates from

anaesthesia programmes which are accredited, and/or approved by the RAHPC are eligible to register as Non

Physician Anaesthetist without undertaking further education.

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These subject Benchmark guidelines describe the nature of study and the academic standards expected of

graduates in specific module/subject areas, and in respect of particular qualifications. They provide a general

picture of what graduates in a particular area might reasonably be expected to know, do and understand at the

end of their programme of study.

Subject Benchmark Standards are used as reference points in the design, delivery and review of academic

programmes. They provide general guidance for articulating the learning outcomes associated with the programme

but are not intended to represent a national curriculum in a subject or to prescribe set approaches to teaching,

learning or assessment. Instead, they allow for flexibility and innovation in programme design within a framework

agreed by the subject community.

Further guidance about programme design, development and approval, learning and teaching, assessment of

students, and programme monitoring and review is available in the Standards of Accreditation for Anaesthesia

Programmes/ Schools.

For some subject areas, higher learning institutions (HLIs) may need to consider other references in addition to

the standards in designing, delivering and reviewing programmes.

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Legislation HLIs are responsible for meeting the requirements of legislation and any other regulatory requirements

placed upon them.

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Table of Content

Foreword .................................................................................................................................................. 1

About these benchmark standards ........................................................................................................... 2

Legislation ............................................................................................................................................... 4

1. Introduction ..................................................................................................................................... 8

2. Guiding Principles ............................................................................................................................ 8

3. Nature and extent of anaesthesia profession for non-physicians ................................................... 10

4. Graduate and key transferable skills .............................................................................................. 11

4.1. Intellectual skills .................................................................................................................... 11

4.2. Practical and professional skills ............................................................................................. 11

4.3. Analytical, data interpretation and problem solving skills ....................................................... 12

4.4. Communication, presentation and information technology skills ........................................... 12

4.5. Professionalism, Interpersonal and teamwork skills ............................................................... 12

4.6. Management, advocacy and professional development skills ................................................. 13

5. The entry-level educational curriculum ........................................................................................... 13

5.1. Perioperative Anesthesia Care ............................................................................................... 15

5.2. Resuscitation ......................................................................................................................... 15

5.3. Scholar (or scientific inquiry and evidence-based practice) .................................................... 16

5.4. Human factor - Professionalism and ethics, inter-professional practice, management and

leadership. ......................................................................................................................................... 16

6. Foundational anaesthesia knowledge, understanding and skills .................................................... 17

6.1. Basic sciences ........................................................................................................................... 18

6.1.1. Human Anatomy..................................................................................................................... 18

6.1.2. Human Physiology ................................................................................................................. 19

6.1.3. Pathology (including Pathophysiology) .................................................................................. 19

6.1.4. Pharmacology for Anaesthesia............................................................................................... 19

6.1.5. Fundamentals of Nursing & Emergency ................................................................................. 19

6.1.6. Fundamentals of diagnostic tests. .......................................................................................... 19

6.1.7. Basics of Anesthesia Practice ................................................................................................ 19

6.1.8. Physics and chemistry applied to anaesthesia. ...................................................................... 19

6.1.9. Anesthesia Equipment ........................................................................................................... 20

6.1.10. Anaesthetic Techniques ......................................................................................................... 20

1.1. Psychosocial Sciences (or Behavioural and Social sciences) ..................................................... 20

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1.2. Professionalism and Ethics for NPA ........................................................................................... 20

1.3. Scientific Inquiry & Evidence-based Practice ............................................................................. 21

1.3.1. Research ................................................................................................................................ 21

1.3.2. Scientific Communication ...................................................................................................... 22

1.3.3. Health care systems, professional leadership and management ............................................. 22

1.4. Inter-professional Practice ......................................................................................................... 22

2. Professional or core anaesthesia knowledge, understanding and skills ......................................... 22

3. Core Anaesthesia Practice ............................................................................................................. 24

3.1. Essentials of Anaesthesia Practice............................................................................................. 24

3.2. Preoperative assessment ........................................................................................................... 24

3.3. Enhanced Anaesthesia Outcomes .............................................................................................. 24

3.4. Pain Management and Regional Anesthesia ............................................................................... 24

3.5. Critical Care ............................................................................................................................... 24

3.6. Clinical practicum ...................................................................................................................... 24

1. Areas of specialisation in Anaesthesia ........................................................................................... 25

2. Bachelor’s Degree with Honours in Anaesthesia ............................................................................ 25

2.1. Students profile and admission criteria .................................................................................. 25

2.1.1. Direct entry ........................................................................................................................ 25

2.1.2. Mature entry ....................................................................................................................... 26

2.2. Minimum Modules/areas......................................................................................................... 26

Scientific Inquiry & Evidence-based Practice ......................................................................................... 26

3. Learning, teaching and assessment ............................................................................................... 27

3.1. Learning and teaching support............................................................................................... 27

3.2. Teaching faculty ..................................................................................................................... 28

3.3. Assessment strategies ........................................................................................................... 28

4. Benchmark standards on completion ............................................................................................. 29

4.1. On graduating in anaesthesia, the graduate must have the following core knowledge,

understanding and skills: .................................................................................................................. 29

4.2. On graduating the graduate must have the following specialist knowledge, understanding and

skills: 29

STANDARDS OF EDUCATION AND TRAINING GUIDANCE ..................................................................... 32

SET 1: Level of qualification for entry to the Register ......................................................................... 32

SET 2: Programme admissions .......................................................................................................... 32

SET 3: Programme management ........................................................................................................ 32

SET 4: Curriculum .............................................................................................................................. 33

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SET 5: Practice placements ................................................................................................................ 34

SET 6: Assessment ............................................................................................................................ 35

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1. Introduction

These subject benchmark standards define the subject area of Anaesthesia practice relating to academic

award of bachelor's degrees with honours in Anaesthesia.

This document is not a syllabus and no form of prescription is intended in the amount of time devoted to

each component or the order in which the material is presented, or the titles of subject/module areas

which comprise Anaesthesia science. It is expected, therefore, that providers of Anaesthesia

programmes will combine, teach and assess the subject matter in different ways.

Creativity and diversity are encouraged. The standards will provide, however, an inventory of content,

delivery method and assessment of programmes, thus enabling identification of vital components of

Anaesthesia science.

This document has been developed in close collaboration with professionals from various specialities of

Anaesthesia profession. As such the Anaesthesia standards and standards of accreditation for

Anaesthesia schools/programmes should together be of value to inform the full range of programmes

readily available in Rwanda.

2. Guiding Principles

1.1. The programme in anaesthesia profession for non-physicians is designed to provide graduates

with a comprehensive understanding of the scientific basis of human health and interaction with

anaesthesia. Graduates from these programmes have knowledge, skills and qualities which

enable them to critically make the appropriate decisions in multifaceted and unpredictable

circumstances and exercise their job on high level of professionalism either independently or

under anaesthesia care team.

1.2. Non-physician anaesthesia practice is concerned with the integration of comprehensive

subjects/module such as, Anatomy, Physiology, Pharmacology, recognising human

medical/surgery conditions.

1.3. In-depth understanding of health conditions and related modifying factors such as

pharmacological products, type of surgery and sub-specialities comes from the study of clinical

anaesthesiology specialities, such as anaesthesia in gynaecology & Obstetrics, ENT,

cardiothoracic surgery, Neurology, traumatology, orthopaedics, paediatrics and fluid therapy.

This enables a non-physician anaesthesia practitioner to understand the science of normalcy,

the medical/surgery process, consequences, diagnosis and appropriate

anaesthesia/resuscitation plan(s).

1.4. Non-physician anaesthesia practice plays a critical role in healthcare. Most of the component

subjects are at the forefront of modern science which attract cutting edge research investments.

This means that non-physician anaesthesia profession is a fast developing field and need critical

judgement on the existing arguments and findings of modern life such as physical inactivity

lifestyle and comorbidity of non-communicable diseases which will have an influence on the

choice of anaesthesia plan(s), pharmaceutical products to maximize patient safety and overall

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outcome. It is also critical to the understanding of major biological processes such as ageing,

hormonal effects, and global trends of health problems such as, cardiovascular disease and

metabolic diseases.

1.5. Non-physicians professionals in anaesthesia cross the threshold of fast changing employment

environment in which lifetime learning plays an essential role. Many graduates of undergraduate

degree programmes in anaesthesia manage to follow additional qualifications including

professional master's degrees (MSc) in some sub-specialities (i.e. anaesthetist specialise in

paediatric, Local regional anaesthesia, neurosurgery etc.).Moreover, research and teaching

doctoral degrees attract many in the field.

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3. Nature and extent of anaesthesia profession for non-physicians

3.1. Study of anaesthesiology for non-physician encompasses a multidisciplinary approach and the

understanding of the interactions of human health conditions and other factors on normal human

systems and describe the role of anaesthesiology on management of these conditions in

changing anaesthetic risk.

3.2. Graduates have knowledge of why and how anaesthesia is conducted, how health conditions

and anaesthesia affect the normal functions of the human systems and anticipates on

appropriates measures to counteract them and maintain the life.

3.3. The Overall complex and fast evolution of non-physician anaesthesia profession requires

evidence based practices with regular in depth research applied to anaesthesia to inform

decision making. Depending upon the focus of their programme, non-physician students at

undergraduate level are expected to integrate the knowledge base of numerous key areas to

promote their understanding of the medical/surgery conditions, their investigative assessment,

related appropriate anaesthesia plan(s) and monitoring, resuscitation and critical care, as well

as quality improvements through research.

3.4. Critical thinking and defining the importance of research, knowledge of research, design and the

suitable use of statistical analyses to enable a valid interpretation of results of human health

research is expected of graduates. Students undertake appropriate practical (and clinical)

education and/or fieldwork throughout their programmes; these aspects are progressive in

nature and designed to supplement other academic learning. By the end of their programme

students are equipped with the skills necessary to enable them to plan and perform a research

project and be aware of the need for good practice and, if relevant, survey design and execution,

health and safety, and legal and ethical aspects of research design and analysis.

3.5. Undergraduate degree programmes in anaesthesiology for non-physician in Rwanda exist in

one form which is bachelor’s level with honours. It consist of professional and practical training

in order to satisfy legislative and/or qualification requirements of the Council. Some integrated

master's programmes are being projected, which may involve more sub-specialities through an

intensive clinical/practical and research works.

3.6. Non-physician anaesthesiology training may either be full or part-time where academic study is

incorporated with work-based learning in an approved health facility with convenient

anaesthesiology services.

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4. Graduate and key transferable skills

The curriculum content of study in anaesthesia programme will include the opportunity to develop a range

of more generic graduate and transferable skills (detailed in this section) along with core anaesthesia

knowledge, understanding and skills (detailed in the following section) and specialist, discipline specific

knowledge, understanding and skills.

These include:

1) Discipline and module-specific skills associated with anaesthesia practice; 2) Research skills, including ethics, governance, audit, experimental design, statistical analysis,

literature searching, and scientific communication; 3) Key transferable skills, including communication, IT and data analysis.

4.1. Intellectual skills

Anaesthesia graduates should at least be able to:

Recognise and apply subject-specific theories, paradigms, concepts or principles.

Obtain and integrate several lines of subject-specific evidence to formulate and test hypotheses.

Apply subject knowledge and understanding to address familiar and unfamiliar problems.

Recognise the moral and ethical issues of clinical anaesthesia practice and appreciate the need

for ethical standards and professional codes of conduct

4.2. Practical and professional skills


Undertake sufficient practical work to ensure competence in the basic experimental skills

appropriate to anaesthesia practice.

Demonstrate knowledge and application of quality assurance and quality control principles as

part of an awareness of the need for quality management systems and a culture of continued

quality improvements of relevance to anaesthesia practice.

Engage with the client and relevant others to plan and implement an efficient, effective and

culturally responsive client-centred anaesthesia assessment using clinical reasoning/judgement

and incorporating relevant diagnostic tests, assessment tools and outcomes measures.

Undertake clinical anaesthesia practice in a responsible, safe and ethical manner:

o Consult with the client to obtain information about his/her health, associated history,

previous health interventions, and associated outcomes; and collect assessment data

relevant to the client’s needs and anaesthesia practice.

o Analyse assessment findings, and establish anaesthesia diagnosis to determine suitable

choice of anaesthesia techniques.

o Develop and recommend anaesthesia intervention strategy, and implement the

intervention.

o Evaluate the effectiveness of interventions, and Complete anaesthesia services.

o Use a reflective approach to practice

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o Be committed to practice supported by best available evidence and seek to acquire new

knowledge

4.3. Analytical, data interpretation and problem solving skills


Receive and respond to a variety of sources of information: textual, numerical, verbal and

graphical.

Carry out anaesthesia assessment and treatment of patients for surgical procedures.

Advise a patient/family or guardian on anaesthesia risks and possible complications and

outcomes according to specific disease or condition.

Engage in self-assessment of outcomes of own practice against relevant professional

benchmarks, take action to continually improve own professional practice and contribute to the

development of the profession through research and enquiry.

Seek professional support, including peer review, to evaluate learning needs and engage in

relevant continuing professional development.

Seek to proactively apply principles of quality improvement and risk management to practice

Obtain, record, document and analyse data using appropriate practical techniques working

individually or in a group/groups.

Reflect on own professional practice, recognise situations that are outside the scope of expertise

or competence and take appropriate action.

4.4. Communication, presentation and information technology skills


Develop and maintain professional relationships through effective communication.

Gather and share information related to client care.

Employ effective and appropriate communication strategies.

Communicate about their subject appropriately to a variety of audiences using a range of

formats and approaches using appropriate scientific language.

Cite and reference work in an appropriate manner, including the avoidance of plagiarism

Use a range of relevant media critically as a means of communication and a source of

information.

4.5. Professionalism, Interpersonal and teamwork skills


Make informed and appropriate decisions about acceptable professional and ethical behaviour

supported by best available evidence and always behave professionally and ethically

Establish and maintain inter-professional relationships, which foster effective collaborative

practice.

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Empower self and others through education

Seek opportunities to lead the education of others, including anaesthesia students, as

appropriate within the anaesthesia setting

Prevent, manage, and resolve conflict related to client-centred care.

Identify individual and collective goals and responsibilities and perform in a manner appropriate

to these roles, in particular those being developed through anaesthesia practical field studies.

Recognise and respect the views and opinions of other team members

Use negotiating skills.

Evaluate their own performance as an individual and a team member.

Evaluate the performance of others with the team framework.

Develop appreciation of the interdisciplinary nature of science and of the validity of different

points of view.

Respect the individuality and autonomy of the client.

Contribute to the development of anaesthesia profession.

Recognise the need for and implement appropriate self-care strategies to manage own

physical and mental health and resilience.

4.6. Management, advocacy and professional development skills

Anaesthesia sciences graduates should at least be able to:

Develop the skills necessary for self-managed and lifelong learning (for example working

independently, time management, organisational, enterprise and knowledge transfer skills)

Manage individual practice effectively.

Manage and supervise personnel involved in the delivery of anaesthesia care services.

Participate in activities that contribute to a safe working environment and effective anaesthesia

practice.

Identify and work towards targets for personal, academic, professional and career

development.

Develop an adaptable, flexible and effective approach to study and work.

Deal effectively with potential and actual conflict.

Work collaboratively to identify, respond to, and promote the health needs and concerns of

clients.

Organise workload and resources effectively, efficiently and autonomously and, where relevant,

as a member of a team manage self and lead others effectively and efficiently within relevant

professional, ethical and legal frameworks.

Advocate for respect to clients’ rights when receiving anaesthesia care.

5. The entry-level educational curriculum

The entry-level educational curriculum includes, but is not limited to, the study of:

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Biological sciences (e.g. human anatomy, human physiology, pathology); clinical sciences (e.g.

fundamentals of anaesthesia practice, loco-regional anaesthesia, anaesthesia in specialities, etc.);

scientific inquiry (e.g. research, statistics, literature reviews) and professionalism and ethics (e.g.

health policy, legislation and regulation, interdisciplinary practice, management). Psychosocial

sciences (e.g. psychology, sociology, cultural anthropology) are also foundational to an

anaesthetist’s education.

The Clinical Anaesthesia Practice is anchored upon four major interconnected thematic areas:

1. Perioperative Anesthesia Care

2. Resuscitation

3. Scholar ( or scientific inquiry and evidence-based practice)

4. Human factor - Professionalism and ethics, inter-professional practice, management and

leadership.

The pillar of anaesthesia practice educational curriculum

Scholar

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5.1. Perioperative Anesthesia Care

The Perioperative Anesthesia Care is the main area of practice of Non physician anesthetist (NPA). It includes the whole anesthetic science pertaining or relating to theperiod of timesurrounding a surgicalprocedure, including thepreoperative, intraoperative, and postoperative periods.

This is a specialized area as it pull in, clinical practitioner to deliver his expertise for a short period. One needs to be well equipped to respond to the expectations of the surgeon, the patient and the family.

In preoperative, the NPA will assist in diagnosis and preparation or optimization of the patient for surgery which may end to signing consent. It requires knowledge in basic sciences, such as biology, anatomy, physiology, integrated pathology, pharmacology and different applied therapeutics. Special expertise in Anesthesia science will be needed for decision making and communication with different stakeholders like surgeons, Obstetricians, physicians who have been primary attendants and/or new other attendant like pathologist, interventionists (Cardiologist, etc.) for more diagnostic tests or optimization.

During the per-operative and post-operative period, the Clinical NPA is compared to the airplane pilot

during the three phases: Induction, maintenance and recovery. Operations are different and patient are

not the same. This big range of differences oblige the NPA to master a wide range of material both in

basic and subspecialized science of perioperative medicine including but not limited to biology, physics,

chemistry, pathology, pharmacology, to apply different anesthetic considerations in: pediatrics, obstetric,

elderly…different type of surgery: brain, cardiothoracic, abdominal, obstetrics and gynecology,

orthopedics and trauma.

5.2. Resuscitation

Resuscitation is theprocess of sustainingthevitalfunctions of a person in any threatening situation whilerevivinghim or her by usingtechniques of artificial respiration and cardiac support, correcting imbalances, and treating the cause of failure.

Resuscitation is central to the practice of anaesthesia and patient’s health, wellness and safety. It reflects the integration of Foundations (see foundations section) and perioperative anesthesia care sciences and crosses all areas of anesthesia clinical practice. It encompasses a wide range of therapeutic strategies, interventions, methods and techniques that span the scope of anaesthesia practice considered in different specialties.

Resuscitation approaches address all vital systems of the body from the Central Nervous System, Cardiopulmonary and others, in order to keep all cells perfused.

This area is based on cell’s oxygen delivery principles. It requires basic knowledge of biological and basic sciences (anatomy, physiology, and equipment), taking in account the underlining pathology, incident or accident encountered, or drugs and other equipment in use.

Decisions regarding the selection and application of resuscitation incorporate foundational knowledge (e.g. biological and basic sciences), principles of best practice (including, but not limited to, critical appraisal of the evidence), clinical expertise (e.g. indicator conditions), clinical reasoning and professional judgment as well as patient/client defined values, needs and goals.

The Clinical NPA should also be trained in Resuscitation to be equipped for managing or preventing any

complication which may occur during anesthetic care or elsewhere.

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Curriculum content in this area elaborates the knowledge requirements identified in the Foundations

section and integrates it with the skills and behaviors associated with the elements/topics of biophysics,

biochemistry, Pathology, Pharmacology, Equipment and Health system management.

5.3. Scholar (or scientific inquiry and evidence-based practice)

As Scholars, NPA demonstrates a lifelong commitment to excellence in practice through continuous learning and by teaching others, evaluating evidence, and contributing to scholarship.

NPA acquire scholarly abilities to enhance practice and advance health care. NPA must pursue excellence by continually evaluating the processes and outcomes of their daily work, sharing and comparing their work with that of others, and actively seeking feedback in the interest of quality and patient safety. Using multiple ways of learning, they must strive to meet the needs of individual patients and their families and of the health care system.

NPA must strive to master their domains of expertise and to share their knowledge. They recognize the need to continually learn and to model the practice of lifelong learning for others. As teachers they facilitate, individually and through teams, the education of students and other professionals, the public and others.

NPA are able to identify pertinent evidence, evaluate it using specific criteria, and apply it in their practice and scholarly activities. Through their engagement in evidence-informed and shared decision-making, they recognize uncertainty in practice and formulate questions to address knowledge gaps. Using skills in navigating information resources, they identify evidence syntheses that are relevant to these questions and arrive at clinical decisions that are informed by evidence while taking patient values and preferences into account.

Finally, NPA’s scholarly abilities allow them to contribute to the application, dissemination, translation, and creation of knowledge and practices applicable to health and health care.

5.4. Human factor - Professionalism and ethics, inter-professional practice, management

and leadership.

Human factors examines the relationship between human beings and the systems with which they interact by focusing on improving efficiency, creativity, productivity and job satisfaction, with the goal of minimizing errors. A failure to apply human factors principles is a key aspect of most adverse events in health care. Clinical Anesthesia require safety. NPA, like other operating theatre stakeholders, surgeons and emergency room physicians, work in a complex, rapidly changing, time-constrained and stressful work environment. The anesthesia domain is in many ways similar to aircraft cockpits, air traffic control rooms, and combat information centers where effective performance demands expert knowledge, appropriate problem-solving strategies, and fine motor skills. The safe administration of anesthesia requires vigilance (e.g., detection of changes in patient condition),time-sharing among multiple tasks, and the ability to rapidly make decisions and take actions. The NPAviews his/her task as managing a single highly interactive system composed of the patient, clinical equipment, surgeons, other operating room (OR) personnel, and the broader OR environment. Primary goals include protecting the patient from harm and facilitating surgery.

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Among human factors during training, few can be enumerated such as Leadership, management, communication skills, inter-professional practice, Health advocator to mention a few.

6. Foundational anaesthesia knowledge, understanding and skills

Graduates in Anaesthesia shall have at least the following knowledge, understanding and skills:

A broadly based core covering the major elements defined by Anaesthesia profession and

providing the wider context required for the content area, together with specialised in-depth study

(which may be career related) of some aspects of the subject/course area. Whatever the level or

programme, there is a need for an interdisciplinary and (where appropriate) multidisciplinary

approach in advancing knowledge and understanding of the processes and mechanisms of life,

from the molecular and cellular levels through to those of the whole body and the environment

in which a person lives.

Engagement with the essential facts, major concepts, principles and theories associated with the

anaesthesia practice

Competence in the basic assessment and treatment skills appropriate to anaesthesia practice

Understanding of information and data within the context of anaesthesia practice, accompanied

by critical analysis and assessment to enable understanding of the subject/module area as a

coherent whole

Familiarity with terminology, nomenclature and disease classification systems, as appropriate

Methods of acquiring, interpreting and analysing anaesthesia information with a critical

understanding of the appropriate contexts for its use through the study of texts, original papers,

reports and data sets

Awareness of the contribution of their subject/course to the development of knowledge about the

complexity of human health and disease

Knowledge of a range of communication techniques and methodologies relevant to Anaesthesia

practice, including data analysis, information technology and the use of statistics

Engagement with current developments in anaesthesia profession, its applications, and the

philosophical and ethical issues involved

Awareness of the contribution of anaesthesia profession to debate and controversies, and how

this knowledge and understanding forms the basis for informed concern about the quality and

sustainability of health and well-being

Understanding of the applicability of anaesthesia profession to the careers/specialisation to

which graduates may wish to pursue.

The following modules/domains form the foundation for the more in-depth and advanced knowledge specific to Anaesthesia profession:

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Biological (Basic) Sciences and Behavioural, social Sciences refer to knowledge in a wide range of

scientific and pedagogical fields, some of which may be acquired prior to admission to the anaesthesia

education program.

Content in the Biological Sciences area must strongly be related to the anaesthetics and rescussitation

domains of the Anaesthesia Clinical Practice Dimension.

In particular, human anatomy, human physiology and pathology content are essential elements of the

curriculum.

Content in the Behavioural Sciences lays the foundation for the guidelines in the anaesthesia professional

interactions dimension

The emphasis in each element attempts to balance the present and evolving needs of anaesthesia

practice in the future. As such, the content elements/topics listed are not exhaustive and are intended

to provide guidance rather than prescribe minimum knowledge requirements.

6.1. Basic sciences

6.1.1. Human Anatomy

Anatomy is the science of the structure of the body.An anesthesia provider is requested to know the

humany body anatomy to be able to accomplish his/her duties of administering Anesthesia. This

components focuses on: The Locomotor System,the central Nervous System ,respiratory system

,cardio vascular system,digestive system with emphasis on maxilo facial bones,spinal cord

anatomy,upper and low airway,cardiac and lungs anatomy,tharacic anatomy,abdomen and pelvis

Basic Sciences

( Biological)

Scientific inquiry( Research &

Scientific communication)

Behavioural & Social Sciences

Professionalism

& Ethics

https://www.dartmouth.edu/~humananatomy/part_1/chapter_2.html

https://www.dartmouth.edu/~humananatomy/part_1/chapter_3.html

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anatomyand with lesser emphasis on related body systems, including urogenital system& the

integumentary system. Gross, functional and applied anatomy are essential, with an emphasis on

structure and function in health and diseases related to anesthesia practices

6.1.2. Human Physiology

This section focuses on the body systems most relevant to Anesthesia practices both for Adult,pediatric

and neonates.It should focus more on, the functional of central nervous and hormonal system

physiology,cardio respiartory physiology,body organs physiology including

liver,kidney,intestines,digestive tract.

6.1.3. Pathology (including Pathophysiology)

This part of anesthesia programme addresses the nature of diseases,development and complications

related to anesthesia both in per op and post op.The Anesthesia provider should be able to know the

special considerations in anesthesia related to different pathologies during anesthesia provision.

6.1.4. Pharmacology for Anaesthesia

The content must address pharmacokinetics, pharmacodynamics and drug bio-availability. Mechanism,

actions and dosages of drugs used in anesthesia including Analgesics. Effects and interaction between

pharmacology and anaesthetic interventions. Medical and Adjunct Therapies: Mechanism, actions and therapeutic

implications. The study of prescription and/or over-the-counter medications used in the management of a variety

of patient conditions encountered during patient management must be addressed. The Anesthesia provider

should be highly proficient and knowledgeable in all drugs used in anaesthesia.

6.1.5. Fundamentals of Nursing & Emergency

The NPA should be able to perform all basics of nursing and emergency care procedures with emphasis

on those related directly to anesthesia and with less emphasis on general nursing knowledge.

6.1.6. Fundamentals of diagnostic tests.

The NPA requires knowledge on laboratory diagnostic test requisition and interpretation of various

laboratory results encountered in the practice of anaesthesia. He/she should be able to know when to

request special investigation such as cardiac investigations (ECG), and imaging tests and its

interpretation.

6.1.7. Basics of Anesthesia Practice

The NPA learner should be able to define key terminologies commonly encountered in anesthesia and

the major component of anesthesia practice. This includes anesthesia evaluating the patient before

surgery and to be familiar with the whole operating team.

6.1.8. Physics and chemistry applied to anaesthesia.

The content shall address but not limited to basic concepts in gases laws, properties of liquids and vapours, heat and anaesthetic vaporizers, electrical, fire, explosion and radiation hazards in operating theatres, ionising radiation etc.

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6.1.9. Anesthesia Equipment

The NPA must have a sound knowledge of basic anaesthesia equipment used at different levels of hospitals. These may include but not limited to equipment used in pre-anaesthesia assessment clinics, operating theatres and PACU and those used for resuscitation. The following shall be considered: stethoscope, multi-parameter vital signs monitors, pulse oximetry, Capnography, temperature monitoring devices, oxygen monitor of the gases (inspired and expired), automatic ventilator and breathing circuits, peripheral nerve stimulator to monitor neuromuscular function, glucometers for blood sugar, anaesthetic machine, intra-arterial/IV pressure monitoring, Anaesthetic gas analyser, suction machine etc.

6.1.10. Anaesthetic Techniques

The content shall focus on various types of anaesthesia techniques - general anaesthesia such as total intravenous anaesthesia, general anaesthesia with intubation, face mask, laryngeal mask airway etc., and regional anaesthesia (Spinal, epidural and caudal anesthesia), nerve blocks, local anaesthesia and topical anaesthesia etc.

1.1. Psychosocial Sciences (or Behavioural and Social sciences)

The content of curriculum focuses key aspects of cultural anthropology especially those related to

culturally competent/sensitive, client-centred practice.

Psychology including Cognitive and Behavioural sciences and Psycho-Social sciences. This include

Cognitive sciences e.g. learning, memory, perception, coping, self-efficacy, attention/motivation.

Behavioural sciences e.g. related to change (health behaviours), social participation, communication.

Interaction between psycho-social development, anaesthesia and the most common indicator conditions

pertinent to anaesthesia practice e.g. pain.

Social science aspects such as quality of life, social determinants of health, support systems, social

policy, disability and function, culture and social theories related to change.

Psychosocial Theories of Lifespan Development- Theories of psychological development and aging;

relationship with health, injury, disease and disablement across the lifespan and End of Life.

Learning and Education- Learning principles informed by cognitive and behavioural psychology and the

social sciences. Education principles related to the role of Anaesthesia providers as educators of

clients/patients, families, other professionals and students.

1.2. Professionalism and Ethics for NPA

As part of the foundation for the curriculum at large, the Professionalism and Ethics domain addresses

the theoretical knowledge required of the entry-to-practice student, which characterizes her/him as a

professional and forms the basis for professional practice. Professionalism involves accepting the

responsibilities that come with the privilege of membership in a profession and the ensuing accountability

to society.

https://en.wikipedia.org/wiki/Anesthesia#Spinal.2C_epidural_and_caudal_anesthesia

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This domain focus on Professional competencies and responsibilities with emphasis on Familiarity with

the Essential Competency. Practice that is autonomous, reflective, evidence-based, culturally competent

and sensitive, and integrates critical thinking and moral/ethical reasoning into clinical decision-making.

The value and importance of best practices, effective communication strategies (e.g. in difficult

situations), teamwork and interprofessional collaboration, safety/security (e.g. for client, self, workplace),

and life-long learning/continuous professional development.

It also includes ethical theories and reasoning models, bioethics. Rationale for codes of ethics,

therapeutic relationships and professional boundaries and professional values (e.g. integrity, honesty,

compassion). Issues related to informed consent, conflicts of interest and ethical business practices.

In addition it addresses professional legislation and Regulations to include legislative requirements

regarding health care delivery, professional regulation of practice (licensure) and issues of scope,

delegation, professional misconduct, records, client/consumer rights, privacy/confidentiality, consent,

health and personal information management.

1.3. Scientific Inquiry & Evidence-based Practice

Anaesthesia practice integrates the principles of scientific inquiry. Learners are expected to have the

knowledge and skills related to scientific inquiry in terms of a) how new knowledge is generated from a

research perspective and b) how to find, evaluate and apply research findings within anaesthesia practice

as competent practitioners. Students are therefore expected to have experience with generating new

knowledge, although not at the level of independent researchers and as competent practitioners, they

are expected to be very skilled “consumers” of research.

The first content area of Scientific Inquiry curriculum addresses the generation of new knowledge and

includes skills and knowledge needed in order to develop answerable questions; systematically search

and critically appraise the literature; determine the best design; collect and analyse the data; and interpret

and disseminate the results.

The second content area of Scientific Inquiry curriculum, the explicit use of evidence, includes the

knowledge and skills necessary to gather, appraise and apply scientific information, and evaluate its

impact, resulting in best practice.

Evidence based practice is a term that has been used to describe this process: it involves the

determination of the best evidence, consideration of the uniqueness and wishes of the client (individual

to organization to society) and application of the expertise/ clinical experience of the practition

The content for these two related areas of the Scientific Inquiry curriculum overlap and are organized into

three Elements: Research and Scientific Communication.

1.3.1. Research

Research designs relevant to Anaesthesia practice including quantitative and qualitative designs. Principles of the

ethical conduct of research e.g. Knowledge of provincial & federal/national ethical and legal standards. Intellectual

property rights. Basic research methods.

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1.3.2. Scientific Communication

Mechanics of undertaking a literature review using specified methods and criteria. Methods to critique the quality

of the evidence (including grey literature, websites/internet information). Decision-making methods that incorporate

psychosocial and other factors (e.g. related to the client) with the best available evidence. Principles of preparing

and disseminating a research proposal, scientific paper, scientific abstract or a scientific poster. Rationale for

authorship and appropriate acknowledgement of authors, contributors, advisors, funding bodies, etc. in a scientific

presentation or publication. Principles of argument presentation, information synthesis, use of graphics.

1.3.3. Health care systems, professional leadership and management

Effective delivery of anaesthesia services requires that the anaesthetist recognizes and responds to the influence

of social, cultural, economic, legislative and demographic factors impacting the continuum of general health and

anaesthesia care not only locally, but globally. Understanding the development of health and social policy and the

related funding/delivery phenomena is fundamental to practicing effectively in the national health setting, whether

in the private or public sector.

Curriculum content in the Health Care systems area addresses but not limited to the Knowledge, Skills and

Behaviours associated with the global health environment and national health system including policy, legislation,

funding, allocation and service delivery models.

It includes also the Knowledge, Skills and Behaviours necessary for a anaesthetist to contribute to effective

program management and practice management. Business principles, enterpreneurship, organizational

principles, management principles form the backbone of the curriculum.

1.4. Inter-professional Practice

Interprofessional practice refers to the Knowledge, Skills and Behaviours required of the entry-to-practice NPA, in

a range of professional relationships associated with being a team member, including education, delegation,

supervision, conflict management, collaboration, consultation and referral practices. An important component of

this area is familiarity with the scope of practice of a range of other health care professionals and their contribution

to the health of the client/patient.

2. Professional or core anaesthesia knowledge, understanding and skills Graduates in Non-physician anaesthesia program shall have at least the following knowledge,

understanding and skills:

Perform and document a thorough preanesthesia assessment and evaluation.

Obtain and document informed consent for the planned anesthetic intervention from the patient or

legal guardian, or verify that informed consent has been obtained and documented by a qualified

professional.

Formulate a patient-specific plan for anesthesia care.

Implement and adjust the anesthesia care plan based on the patient’s physiologic status.

Continuously assess the patient’s response to the anesthetic, surgical intervention, or procedure.

Intervene as required to maintain the patient in optimal physiologic condition

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Monitor, evaluate, and document the patient’s physiologic condition as appropriate for the type of

anesthesia and specific patient needs. When any physiological monitoring device is used, variable

pitch and threshold alarms shall be turned on and audible. The NPA should attend to the patient

continuously until the responsibility of care has been accepted by another anesthesia professional

Document pertinent anesthesia-related information on the patient’s medical record in an accurate,

complete, legible, and timely manner.

Evaluate the patient’s status and determine when it is safe to transfer the responsibility of care.

Accurately report the patient’s condition, including all essential information, and transfer the

responsibility of care to another qualified healthcare provider in a manner that assures continuity of

care and patient safety.

Adhere to appropriate safety precautions as established within the practice setting to minimize the

risks of fire, explosion, electrical shock and equipment malfunction. Based on the patient, surgical

intervention or procedure, ensure that the equipment reasonably expected to be necessary for the

administration of anesthesia has been checked for proper functionality and document compliance.

When the patient is ventilated by an automatic mechanical ventilator, monitor the integrity of the

breathing system with a device capable of detecting a disconnection by emitting an audible alarm.

When the breathing system of an anesthesia machine is being used to deliver oxygen, the NPA

should monitor inspired oxygen concentration continuously with an oxygen analyzer with a low

concentration audible alarm turned on and in use.

Verify that infection control policies and procedures for personnel and equipment exist within the

practice setting. Adhere to infection control policies and procedures as established within the practice

setting to minimize the risk of infection to the patient, the NPA, and other healthcare providers

Participate in the ongoing review and evaluation of anesthesia care to assess quality and

appropriateness.

Respect and maintain the basic rights of patients.

The following areas form the core clinical dimension of non-physician anaesthesia practice:

PERI-OPERATIVE ANAESTHESIA CARE RESUSCITATION

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3. Core Anaesthesia Practice

3.1. Essentials of Anaesthesia Practice

The Core content of this area is mainly system-based anesthesia with extensive discussion of anatomy, physiology, pathophysiology, anesthesia considerations for various diseases, and relevant surgical operations.

Each sub-section is expected to review the relevant anatomy, physiology, and pharmacology. The following sections are used to explore pre-operative evaluation (including and special diagnostics tests), various disease states, anesthesia considerations, management plan and relevant surgical procedures. The following body systems must be addressed appropriately: ccardiovascular, respiratory, nervous system, genito-urinary, gastrointestinal and hepatic, metabolic, endocrine, hematologic and immunologic (and infectious disease). Other specialties shall need special anesthetic considerations due to special populations, background or site of surgery. These shall include obstetrics, pediatrics, airway, ENT and ophthalmology, trauma, burns and musculoskeletal.

3.2. Preoperative assessment

The NPA should be able to assess the patient to undergo a surgery.The pre-operative assessement

should focus on general informations on the patient, medical history which is obtained and recorded by

the NPA by taking a formal history, which may be supplemented with a questionnaire; Previous or present

illnesses; Previous anaesthetics or surgery; Medication; Other aspects and Further history. The Physical

examination is of very significant importance must be considered including psecial investigations for

classifing the patient fitness for anesthesia or recommend methods of optimization.

3.3. Enhanced Anaesthesia Outcomes

The practice of anesthesia may encounter different complications and side effects of adverse drugs or techniques.

Even uncontrolled pain may lead to very severe postop complications during anesthesia, in PACU including post-

operative period such as chronic pain after surgery.

This Section will outline the multidimensional nature of enhanced recovery programs, Identify procedures

associated with risk for persistent post-surgical pain. Describe factors in the pre-operative, intraoperative and

postoperative periods that lead to enhanced recovery. Identify adjuvant analgesics that can be used in the

perioperative period. Consider implementation of an enhanced recovery program.

3.4. Pain Management and Regional Anesthesia

This section shall address topics on Pain management in different condition such as Chronic Cancer and non-

Cancer conditions using Multimodal strategies. Anatomy, Physiology and Assessment and Methods must be

considered. Regional Anesthesia is also a method for Chronic and Acute Pain Management. The NPA should learn

how to prevent Complications, and emphasis on Ultrasound as it is becoming a gold standard.

3.5. Critical Care

While practicing Anesthesia, the NPA should be familiar with “Essentials of critical care” to be able either to

recognize when to transfer or how to management a critical care patient when called upon or assigned for surgery.

Essential knowledge of oxygenation, ventilation, cardiovascular support principles, sepsis, Neurology and Toxins.

The NPA will focus on Multisystem illness, Ethics, Communication, Optimizing Health for critically ill-patients

(nutrition, positioning, ethical issues).

3.6. Clinical practicum

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This section forms the backbone of anaesthesia practice and shall be divided into two part mainly nursing care related to anaesthesia and clinical anaesthesia practicum. The nursing care such as taking vital signs, infection control methods –aseptic techniques, nursing barriers and isolation, hand washing, scrubbing, gowning and gloving, securing IV access and calculation of drip rates, lifting and positioning of patients, ordering items and securing patients bills, rights of patients and relatives, injections and calculation of drug dosages, sterilization and packaging of sterile packs etc. are of critical importance to anaesthesia practice. The clinical anaesthesia practicum shall focus on administration of anaesthetics, anaesthetic considerations taking into anaesthetics, resuscitation, teaching and research.

1. Areas of specialisation in Anaesthesia

The Non Physician Anesthetists may choose to advance professionally by specializing in the following areas:

Pediatrics

Obstetrics

Cardiovascular

Plastic

Dental

Neurosurgical anesthesia. Others also can hold credentials in fields such as

Critical care nursing

Respiratory care.

2. Bachelor’s Degree with Honours in Anaesthesia

2.1. Students profile and admission criteria

2.1.1. Direct entry

The national minimum requirements for admission to Higher Learning Institutions shall apply. Candidate shall have the Certificate of Secondary Education Examination awarded by the Rwanda Examination Board (REB) or its equivalent with principal passes in at least any two course relevant subjects (i.e. chemistry and Biology).

A student wishing to join the program of Anaesthesia should comply with the following conditions:

Have completed six years of secondary education with the following minimum qualification:

i. Advanced Certificate awarded by the Rwanda Education Board (REB) or its equivalent from a recognized institution with at least two principal passes in any of the following subject combinations:

o Physics-Chemistry-Biology (PCB),

o Mathematics-Chemistry-Biology (MCB),

o Biology-Chemistry-Geography (BCG)

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2.1.2. Mature entry Applicants with advanced diploma in both Anaesthesia and Nursing shall be considered on the basis of the content covered.

This shall be done on the basis of credit transfer system as recommended by the National Qualifications Framework.

2.2. Minimum Modules/areas

No. Thematic areas Modules ( classification is optional) Minimum Credits

FOUNDATIONAL MODULES 1 Fundamentals of anaesthesia Fundamentals of Nursing & Emergency 10

2 Scientific Inquiry & Evidence-based Practice

Health Systems, Professional leadership, Management and Entrepreneurship

10

Research, Evidence-based Practice & Scientific communication

10

3 Behavioral & Social Sciences Professionalism, Ethics and Behavioral Sciences

15

4 Anatomy and Physiology Applied Anatomy & physiology 15

5 Pre-operative Assessment Preoperative Assessment 10

6 Equipment, Pharmacology and Techniques

Applied Physics and Chemistry 10

Anesthesia Equipment 10

Applied Pharmacology and Anesthetic Techniques

10

7 Basics of Anaesthesia Practice Basics of Anesthesia Practice 10

8 Clinical Placement Nursing Clinical Placement 30

Total 140

CORE ANESTHESIA PRACTICE

9 Essentials of Anesthesia Practice

Cardiovascular and Respiratory 15

Neurologic 10

Renal and Endocrine 10

Gastrointestinal, Hepatic and Metabolic 15

Hematologic, Immunologic and Infectious Disease

15

Obstetrics and Pediatrics 10

10 Critical Care Critical care 15

11 Anesthesia Outcomes Anesthesia Outcomes:

PACU

Management of complications

10

12 Regional Anesthesia and Pain Management

Regional Anesthesia and Pain Management 15

13 Trauma and Burns Trauma, Burns and Musculoskeletal 10

14 Airway, ENT and Ophthalmology

Airway, ENT and Ophthalmology 10

15 Clinical Anaesthesia Placement 60

16 Internship 100

295

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*One credit is equivalent to ten notional learning hours.

3. Learning, teaching and assessment

3.1. Learning and teaching support

The objective of the programme of study in Anaesthesia is to produce graduates who are competent in a range of knowledge, understanding and experience and skills appropriate to their chosen Anaesthesia degree.

The learning, teaching and assessment strategy is designed to encourage a progressive acquisition of subject knowledge and skills by moving from study methods that have a greater degree of support and assistance gradually towards more independence and self-direction.

Such progression is reinforced by a diversity of learning and teaching methods and assessment strategies that support learning and are matched to the expressed learning outcomes.

Cross-referencing of topics from one element to another is essential to ensure effective teaching and integrated learning. These strategies are designed to be enriching, stimulating, challenging, effective and enjoyable. As the programme advances students become increasingly responsible for their own learning in preparation for the rest of their professional careers (IBS, 2007).

Learning and teaching strategies in the anaesthesia practice are not static but adapt to changes in philosophy and technology. Current strategies are student-centred and incorporate group study, practical and formal academic practice, and may include:

Self-directed study and research

Work-based and other placements

Case studies and problem-based learning

Peer and collaborative learning, including the use of social media

Reflective practice and portfolio building

Research projects

Seminars, tutorials, lectures

Interactive sessions, including debates and oral/poster presentations

Use of distance-learning materials, including books, electronic multimedia, videos, recordings and broadcasts.

Lectures can convey substantial elements of the subject content, provide core themes and explanations of difficult concepts, as well as set the scene for and inspire students' independent learning. Lectures encourage and enable students to develop skills in listening and selective note taking, to appreciate how information is structured and presented, and to understand the means by which scientific information is obtained. Where appropriate, lectures will include reference to experimental evidence and arguments for and against specific hypotheses. The traditional format can be enhanced through the use of computer-based or other learning aids and interactive student participation in groups or by communication networks (QAA, 2015).

One objective of practical work is to give students an appreciation of the variation inherent in the manipulation of the human body with dignity and respect to get positive response concerning his / her problem. This may be associated with appropriate methods to deal with the reduction of pain and other painful events.

Another objective is to help students to consolidate, deepen and extend the knowledge and understanding that they have previously acquired. Above all, such classes train students in the practical skills and competencies required of their chosen subject domain.

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3.2. Teaching faculty

The term teaching faculty refers to anyone involved in teaching or facilitating student learning.

It includes, but is not limited to, academic staff, graduate teaching assistants, specialist learning support staff and technicians employed by the higher Learning Institution (HLI).

It also includes staff not employed by the HLI but who interact with students studying for one of their awards; for example, through facilitating placement learning.

Effective learning and teaching activities and practices are enabled through and depend on staff who are appropriately qualified for their role and who engage throughout their career in continuing professional development

(CPD), in the evaluation of their practice, and in developing their understanding of their subject/domain and the learning process as it relates to their subject/domain.Practices and resources that enable students to develop and achieve their academic, personal and professional potential underpin effective learning and teaching.

Note:

The teaching faculty should have appropriate professional credentials and registered with the RAHPC or other national regulatory bodies to undertake vocational modules.

The curriculum administration must be undertaken by dully qualified and registered anaesthetists with vast experience in anaesthesia.

Faculty expertise in the aggregate covers all areas of content in the curriculum.

The number of faculty exists and is balanced so that teaching loads are appropriate to ensure faculty are able to carry out their roles and responsibilities in the area of teaching, research and academic administration (for example, student counselling, development of clinical placement sites, participation in committees).

The number of full time faculty is sufficient to maintain stability and continuity in curriculum development, design and delivery.

3.3. Assessment strategies

They are designed to determine achievement of learning outcomes and competencies. These are both formative and summative and may include self and peer assessment. They provide evidence to employers of graduate attributes. Assessment is progressive in terms of level and content and leads to effective feedback to enable development of students' knowledge and skills, and may include:

Unseen examinations, seen or open-book examinations, computer-based assessments

Clinical and/or fieldwork reports

A project or dissertation report

Observed practice

Online activities, essays, summaries and assignments

Critical analysis of case-studies

Oral, poster, and other presentations such as journal article

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4. Benchmark standards on completion

The following benchmark standards indicate threshold levels of achievement, the minimal acceptable achievement

of anaesthesia graduate.

The standards required of students for this Subject Benchmark may be divided into two groups:

The first group relates to the transferable skills and knowledge associated with the core/foundation subject

area

The second group of standards relates to the transferable skills and knowledge associated with the clinical

and vocational domain

4.1. On graduating in anaesthesia, the graduate must have the following core knowledge, understanding and skills: Planning, execution and presentation of a hypothesis-driven implementation within a supported

framework in which qualities such as time management, problem solving, and independence are

evident

The ability to access and evaluate anaesthesia information from a variety of sources and to

communicate the principles both orally and in writing in a way that is organised and topical, and

recognises the limits of current hypotheses.

An appreciation of ethical issues and professional integrity and standards; and the impact on society

of advances in anaesthesia practice.

The ability to record data accurately, and to carry out basic manipulation of data (including qualitative

data and statistical analysis, whenever necessary);

Strategies which enable updating of knowledge of anaesthesia science.

4.2. On graduating the graduate must have the following specialist knowledge, understanding and skills:

Experience and competence in a broad range of appropriate practical techniques and skills relevant

to anaesthesia including pre anaesthesia assessment, analysis and interpretation of findings, ability

to plan for appropriate anaesthetic procedures and further management of anaesthetic care.

The ability to integrate the knowledge of various key disciplines to further the understanding of

monitoring of patients under anaesthetic care.

Knowledge and understanding of various therapeutic strategies applicable to anaesthesia care

management.

Awareness of the current anaesthesia equipment available for investigation, diagnosis and

monitoring of human health and disease in clinical and research environments and perform various

range of anaesthesia techniques.

An appreciation of the development and evaluation of new and current anaesthesia techniques and

therapeutic intervention strategies.

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References

1. Ash S, Dowding K, & Phillips S 2011, ‘Mixed methods research approach to the development and

review of competency standards for dietitians’, Nutrition and Dietetics 68(4):305-315.

2. Australian Commission on Safety and Quality in Health Care 2010, Australian safety and quality

framework for health care. Australian Commission on Safety and Quality in Health Care, Sydney

3. Australian Anaesthesia Council 2006, Australian Standards for Anaesthesia, Australian Anaesthesia

Council, Canberra.

4. Australian Institute of Medical Scientist. Training and Assessment Guidelines. 2010.

5. Frank JR (ed) 2005, The CanMEDS 2005 physician competency framework: Better standards, better

physicians, better care, Royal College of Physicians and Surgeons of Canada, Ottawa.

6. Health and Care Professions Council. 2013. Standards of Proficiency for Anaesthetists. London. UK

7. Anaesthesia Education Accreditation Canada. 2012. Accreditation standards for anaesthesia education

programs in Canada. Available at www.peac-aepc.ca Accessed on: 30th October 2015.

8. Pathology Associations Council: Competency-based Standards for Medical Scientists. Australia.

9. Royal Dutch Society for Anaesthesia 2006, The professional profile of the physical therapist, Koninklijk

Nederlands Genootschap voor Fysiotherapie (KNGF), Amersfoort, The Netherlands.

10. The Quality Assurance Agency for Higher Education 2015- Subject benchmark for health science

professions. London. UK

11. The Quality Assurance Agency for Higher Education 2007- Subject benchmark for health professions

(Used with permission from Division Manager) for UK

12. World Health Organization 2005, Promoting Mental Health: Concepts, Emerging evidence, Practice: A

report of the World Health Organization, World Health Organisation, Geneva.

http://www.peac-aepc.ca/

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STANDARDS OF EDUCATION AND TRAINING GUIDANCE

SET 1: Level of qualification for entry to the Register

1. 1 The Council normally expects that the threshold entry routes to the Register will be the

following:

Advanced Diploma in Non-Physician Anaesthesia

Bachelor Degree with honours in Non-physician Anaesthesia

SET 2: Programme admissions

2.1 The admissions procedures must give both the applicant and the education provider the

information they require to make an informed choice about whether to take up or make an offer

of a place on a programme.

2.2 The admissions procedures must apply selection and entry criteria, including evidence of a

good command of reading, writing and spoken English.

2.3 The admissions procedures must apply selection and entry criteria, including criminal

convictions checks.

2.4 The admissions procedures must apply selection and entry criteria, including compliance with

any health requirements.

2.5 The admissions procedures must apply selection and entry criteria, including appropriate

academic and/or professional entry standards.

2.6 The admissions procedures must apply selection and entry criteria, including accreditation of

prior (experiential) learning and other inclusion mechanisms.

2.7 The admissions procedures must ensure that the education provider has equality and

diversity policies in relation to applicants and students, together with an indication of how these

will be implemented and monitored.

SET 3: Programme management

3.1 The programme must have a secure place in the education provider’s business plan

3.2 The programme must be effectively managed.

3.3 The programme must have regular monitoring and evaluation systems in place

3.4 There must be a named person who has overall professional responsibility for the programme

who must be appropriately qualified and experienced and, unless other arrangements are

agreed, be on the relevant part of the Register.

3.5 There must be an adequate number of appropriately qualified and experienced staff in place

to deliver an effective programme.

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The number and qualifications of faculty are sufficient to meet the program’s mission and goals through educational

administration, curriculum development, instructional design and delivery, research, and evaluation of outcomes.

3.6 Subject areas must be taught by staff with relevant specialist expertise and knowledge.

3.7 A programme for staff development must be in place to ensure continuing professional and

research development.

3.8 The resources to support student learning in all settings must be effectively used.

3.9 The resources to support student learning in all settings must effectively support the required

learning and teaching activities of the programme.

3.10 The learning resources, including IT facilities, must be appropriate to the curriculum and

must be readily available to students and staff.

3.11 There must be adequate and accessible facilities to support the welfare and wellbeing of

students in all settings.

3.12 There must be a system of academic and pastoral student support in place.

3.13 There must be a student complaints process in place.

3.14 Where students participate as service users in practical and clinical teaching, appropriate

protocols must be used to obtain their consent.

3.15 Throughout the course of the programme, the education provider must have identified where

attendance is mandatory and must have associated monitoring mechanisms in place.

3.16 There must be a process in place throughout the programme for dealing with concerns

about students’ profession-related conduct.

3.17 Service users and carers must be involved in the programme

SET 4: Curriculum

4.1 The learning outcomes must ensure that those who successfully complete the programme

meet the standards of proficiency for Non Physician AnaesthetistRegister.

4.2 The programme must reflect the philosophy, core values, skills and knowledge base as

articulated in any relevant curriculum guidelines.

4.3 Integration of theory and practice must be central to the curriculum.

4.4 The curriculum must remain relevant to current practice.

4.5 The curriculum must make sure that students understand the implications of the RAHPC’s

standards of conduct, performance and ethics.

4.6 The delivery of the programme must support and develop autonomous and reflective thinking.

4.7 The delivery of the programme must encourage evidence based practice.

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4.8 The range of learning and teaching approaches used must be appropriate to the effective

delivery of the curriculum.

4.9 When there is interprofessional learning the profession-specific skills and knowledge of each

professional group must be adequately addressed.

SET 5: Practice placements

5.1 Practice placements must be integral to the programme.

5.2 The number, duration and range of practice placements must be appropriate to support the

delivery of the programme and the achievement of the learning outcomes.

5.3 The practice placement settings must provide a safe and supportive environment.

5.4 The education provider must maintain a thorough and effective system for approving and

monitoring all placements.

5.5 The placement providers must have equality and diversity policies in relation to students,

together with an indication of how these will be implemented and monitored.

5.6 There must be an adequate number of appropriately qualified and experienced staff at the

practice placement setting.

5.7 Practice placement educators must have relevant knowledge, skills and experience.

5.8 Practice placement educators must undertake appropriate practice placement educator

training.

5.9 Practice placement educators must be appropriately registered, unless other arrangements

are agreed.

5.10 There must be regular and effective collaboration between the education provider and the

practice placement provider.

5.11 Students, practice placement providers and practice placement educators must be fully

prepared for placement which will include information about an understanding of:

The learning outcomes to be achieved;

The timings and the duration of any placement experience and associated

records to be maintained;

Expectations of professional conduct;

The assessment procedures including the implications of, and any action to

be taken in the case of, failure to progress; and

Communication and lines of responsibility.

5.12 Learning, teaching and supervision must encourage safe and effective practice,

independent learning and professional conduct.

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5.13 A range of learning and teaching methods that respect the rights and needs of service users

and colleagues must be in place throughout practice placements.

SET 6: Assessment

6.1 The assessment strategy and design must ensure that the student who successfully

completes the programme has met the standards of proficiency for their part of the Register.

6.2 All assessments must provide a rigorous and effective process by which compliance with

external-reference frameworks can be measured.

6.3 Professional aspects of practice must be integral to the assessment procedures in both the

education setting and practice placement setting.

6.4 Assessment methods must be employed that measure the learning outcomes.

6.5 The measurement of student performance must be objective and ensure fitness to practise.

6.6 There must be effective monitoring and evaluation mechanisms in place to ensure

appropriate standards in the assessment.

6.7 Assessment regulations must clearly specify requirements for student progression and

achievement within the programme

6.8 Assessment regulations, or other relevant policies, must clearly specify requirements for

approved programmes being the only programmes which contain any reference to an RAHPC

protected title or part of the Register in their named award.

6.9 Assessment regulations must clearly specify requirements for an aegrotat award not to

provide eligibility for admission to the Register.

6.10 Assessment regulations must clearly specify requirements for a procedure for the right of

appeal for students.

6.11 Assessment regulations must clearly specify requirements for the appointment of at least

one external examiner who must be appropriately experienced and qualified and, unless other

arrangements are agreed, be part of the recognised body.

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First Edition 2016

Kigali-Rwanda

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Documents

RWANDA ALLIED HEALTH PROFESSIONS COUNCILrahpc.org.rw/storage/documents/January2018/Cr6UXIIDnHz5jkdApo… · 1.2. Non-physician anaesthesia practice is concerned with the integration