The evolution of preoperative evaluation and management challenges training programs to educate practitioners who can function both inside and outside the operating room. Optimal preoperative assessment depends on the skills of physical diagnosis and patient assessment, personnel and business management, and an understanding of outcome-based research in this area. It is unrealistic to expect the next generation of anesthesiologists to manage administrative and clinical functions in perioperative medicine without adequate experience during residency training. The University of Chicago was one of the first programs to offer an academic experience in preoperative medicine to trainees in anesthesiology and surgery and to medical students. We see between 6,000-8,000 patients a year. We see approximately 40% of non-hospitalized adults having surgery. Most of our patients belong to the American Society of Anesthesiologists physical status class 3 or 4, which means they have severe systemic disease or a disease that is life-threatning. Primarily our medically complex patients are same-day admissions. A small number are pediatric in-, hospital, or ambulatory surgery patients.
During the three clinical anesthesia years at the University of Chicago, a minimum of one month is spent in the Anesthesia Perioperative Medicine Clinic (APMC). This rotation is divided into 2-week segments in the CA-2 and CA-3 years. Successive experiences reflect increased responsibility and learning opportunities. Residents also can elect additional days in the APMC. Program objectives include physical assessment of the patient, interpersonal skills, effective communication, and working in a team-based clinic with medical assistants and physician extenders. An attending anesthesiologist with an interest in perioperative medicine staffs the clinic daily. Faculty publications define preoperative medicine in peer-reviewed journals and major textbooks of anesthesiology. Clinic faculty also maintain busy operating room practices, and many are dual trained in internal medicine, critical care, or pain management. The APMC evaluates patients who are referred by surgeons once surgery is scheduled or even before a decision is made to proceed with surgery is finalized. Practitioners and trainees collaborate with surgeons, oncologists, cardiologists and anesthesiologists in planning the best management perioperatively. The APMC at the University of Chicago is focused on training the next generation of physician experts and leaders in perioperative care.