International Board of Perioperative Medicine


Perioperative medicine is an emerging field of medicine in response to the increasing age and complexity of patients and the increase in the number of surgical procedures being performed. There is a large variation in perioperative medical practice which has led to a worldwide diversity in perioperative outcomes.

The International Board of Perioperative Medicine comprises an international group of medical professionals who are considered experts in their respective areas of Perioperative Medicine. The aim of the Board is to formulate a perioperative medicine syllabus which has worldwide applicability. Furthermore, it aims to deliver and approve cost-effective perioperative medicine education to all countries irrespective of socioeconomic status leading to an improvement in perioperative outcomes.

Proposed Structure for Interim Board (2018-2020)

Officers

  • Joint-President – Prof. Monty Mythen, Prof. Paul Myles
  • Vice Presidents – Prof. Lee Fleisher, Prof. Carol Peden
  • Secretaries – Prof. Mike Grocott
  • Treasurer - Dr. Cliff Koh, Dr. Bobby Jean Sweitzer
  • Immediate Past President - TBA

Non-Executive Directors

  • Anaesthesia - Prof. TJ Gan
  • Surgery – Dr. Henrik Kehlet
  • Physicians - Dr. Jugdeep Dhesi, Dr. PJ Devereaux

Operations

  • Admissions - Dr. Frances Chung, A/Prof. Richard Urman
  • Information technology - Dr. Maxime Cannesson, Andy Shaw
  • Education – Prof. David Walker, Dr. Joel Symons
  • Research - Prof. Ramani Moonesinghe

Representatives of stakeholder nations

  • UK – Dr. Denny Levett, Dr. Rupert Pearse
  • USA – Prof. Solomon Aronson, Prof. Matt McEvoy
  • Australia – Prof. Dave Story, Dr. Ruth Hubbard
  • Canada - TBA
  • Europe - TBA
  • Africa - Dr. Bruce Biccard
  • Asia - TBA
  • Middle East - TBA

Current Board Members

Paul Myles is Professor and Director of the Department of Anaesthesia and Perioperative Medicine at the Alfred Hospital in Melbourne, and at Monash University, Australia. He is an Australian NHMRC Practitioner Fellow, a Fellow of the Australian Academy of Health and Medical Science, an Editor of the British Journal of Anaesthesia, an Editorial Consultant for The Lancet, and an editorial board member of Anesthesiology and Anaesthesia and Intensive Care. The main focus of his research has been on patient quality of recovery and large multicentre trials in perioperative medicine.
Professor Paul Myles
Smiths Medical Professor of Anaesthesia and Critical Care at University College London; Elected Council Member of the Royal College of Anaesthetists; Chair, Evidence Based Perioperative Medicine (EBPOM). Founding Editor-in-Chief of Perioperative Medicine; Editorial Board British Journal of Anaesthesia; Founding Editor-in-Chief TopMedTalk; Founding Director Perioperative Quality Initiative (POQI).
Professor Michael (Monty) Mythen
Joel Symons is a Specialist Anaesthetist and Head of Perioperative Medicine Education International Collaborations in the Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia. He was instrumental in setting up the first Short Course and Master of Perioperative Medicine through Monash University. He is co-editor of the textbook “Perioperative Medicine for the Junior Clinician” (Wiley). He is on the executive of the Perioperative Medicine Special Interest Group and working group for the Perioperative Medicine Fellowship Programme at the Australian and New Zealand College of Anaesthetists. He is currently completing a PhD in iron responsiveness in anaemic patients in the perioperative period.
Dr Joel Symons
David is a Professor in the Centre for Perioperative Medicine, UCL. He was an undergraduate at Southampton University, before training in Medicine and Anaesthesia in Oxford, Toronto and London. On completion of a period of research and higher intensive care training he was appointed consultant in Anaesthesia & Critical Care Medicine at University College London Hospitals. He has a professional interest in improving care for the high-risk surgical patient & Medical Education and leads both the UCL Masters Programme in Perioperative Medicine and a clinical fellowship at UCLH.
Professor David Walker
Dr Shaw is Chairman, Department of Anesthesiology and Pain Medicine at The University of Alberta, Edmonton, Alberta and Zone Clinical Department Head for Anesthesia, Alberta Health Services Edmonton Zone. He is a Fellow of the Royal College of Anaesthetists (UK), a Fellow of the American College of Critical Care Medicine and a Fellow of the Faculty of Intensive Care Medicine (UK). He also holds a Master’s Degree in Healthcare Management from Vanderbilt University. He has practiced cardiothoracic anesthesiology and critical care medicine for more than 20 years in the UK, USA and Canada, and has authored 4 textbooks and more than 175 original publications. His clinical practice is cardiothoracic anesthesia, critical care and perioperative medicine. His translational research interests include biomarker discovery in acute illness and injury. His clinical research interests include observational and pragmatic interventional trials of candidate interventions to prevent and treat adverse outcomes following cardiac surgery, in particular the role of intravenous fluid therapy in acute kidney injury. His research has been funded by the National Institutes of Health, the US Department of Defense, private philanthropy and by industry.
Professor Andrew Shaw
Professor. Carol Peden MB ChB, MD (Res), FRCA, FFICM, FFMLM, MPH is Executive Director of the Center for Health System Innovation and a Professor of Anesthesiology at the Keck School of Medicine of the University of Southern California. Carol has designed and lead quality improvement projects around the world in perioperative care and patient safety. She was named Public Health Innovator of the Year in 2016 by Harvard School of Public Health for her work in improving outcomes for high risk surgical patients. She is dually accredited in Anesthesiology and Intensive Care Medicine. She gained her medical degree and research doctorate at the University of Edinburgh, and has an MPH from Harvard.
Professor Carol Peden
Professor David Story is Foundation Chair of Anaesthesia at the University of Melbourne; and Head of Anaesthesia, Perioperative and Pain Medicine, and Deputy Director, within the University Centre for Integrated Critical Care. He promotes research and teaching at the 15 hospitals affiliated with the University of Melbourne, and engages the broader community on perioperative care. His research interests include strategies to reduce perioperative complications. His clinical work involves perioperative care for most surgical specialties including liver transplantation.
Professor David Story
Professor in Perioperative Medicine and Critical Care at the University of Southampton and a Consultant in Perioperative Medicine at Southampton University Hospital NHS Foundation trust (UHS). Denny leads the perioperative medicine service at UHS including a pre-operative CPET service, a perioperative anaemia service, a surgery school, and prehabilitation. Denny has extensive clinical and research experience in cardiopulmonary exercise testing (CPET). She is president of the Perioperative Exercise Testing and Training Society (POETTS) (www.poetts.co.uk) and she established and has chaired the National Perioperative Cardiopulmonary Exercise Testing course in the UK biannually since 2009. She is part of the Fit 4 Surgery research group in Southampton, investigating exercise and nutritional optimisation before major surgery. She is the clinical CI for the multi-centre INSPIRE trial evaluating inspiratory muscle training before surgery as a means of reducing post-operative complications. She is one of the CI’s at the perioperative medicine clinical trials unit at the Royal College of Anaesthetists in the UK. Denny was the Association of Anaesthetists Research Fellow and her PhD thesis involved evaluating exercise capacity at up to 8000m on Mount Everest as a member of the climbing team on the Caudwell Xtreme Everest Expedition. She was the Deputy Research Leader for this altitude field study of hypoxia adaptation and the follow up expedition Xtreme Everest 2, investigating exercise efficiency in Sherpas (www.xtreme-everest.co.uk)
Professor Denny Levett
Professor of Surgery and of Perioperative Therapy Copenhagen, Denmark. Research within surgical pathophysiology, acute pain physiology, and postoperative recovery, condensed into the concept of ‘fast-track surgery’. Published about 1,000 scientific articles with > 300 invited lectures at international scientific meetings, including several honorary lectures. ASA Excellence in Research Award 2014.
Professor Henrik Kehlet
Dr Jugdeep Dhesi trained in Leicester and the South East Thames region. Completed PhD examining the role of vitamin D in neuromuscular function in older people who fall. Appointed Consultant Physician in General and Elderly Medicine in 2005 and has since been the clinical lead for the POPS (Proactive care for Older People undergoing Surgery) service. The POPS service has been recognised as an innovative, award winning service delivering high quality medical and multidisciplinary care to older elective and emergency surgical patients. NCEPOD lead for the British Geriatrics Society, chair of POPS SIG at the BGS and council member of Age Anaesthesia Association. Research focuses on health service delivery, frailty and delirium.
Dr Jugdeep Dhesi
Lee A. Fleisher, MD, is the Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care and Professor of Medicine, University of Pennsylvania Perelman School of Medicine. His research focuses on perioperative cardiovascular risk management, health policy, decision making and quality of care and has published 152 original articles, over 200 editorials, reviews and book chapters, and 9 books. He is Chair of the Perioperative Brain Health Initiative. He is a member of the Task Force on Practice Guidelines for the ACC/AHA. In 2007, he was elected to membership of the National Academy of Medicine (formerly Institute of Medicine).
Professor Lee Fleisher
Dr. McEvoy is Professor of Anesthesiology and Vice-Chair of Education at the Vanderbilt University Medical Center (VUMC). He is also the Program Director for the Perioperative Medicine Fellowship and Chief of the Perioperative Consult Service. His academic career has been focused on developing methods by which to provide clinicians and patients with real-time, point of care, evidence-based information that can inform clinical decisions. This has involved partnering with a surgeons and a multidisciplinary team of clinicians to implement evidence-based systems of care, including the Enhanced Recovery Program and Hi-RISE (High-Risk Surgical Encounter) Service at VUMC. Dr. McEvoy is also currently involved with several ongoing trials to evaluate the utility of cardiac biomarkers in risk stratification and improving patient outcomes in the perioperative period.
Professor Matthew McEvoy
Mike Grocott is the Professor of Anaesthesia and Critical Care Medicine at the University of Southampton and an NIHR Senior Investigator (2018-2022). He is UK NIHR Clinical Research Network national specialty lead for Anaesthesia, Perioperative Medicine and Pain (2015-2020) and chairs the board of the UK National Institute of Academic Anaesthesia. Mike is an elected council member of the Royal College of Anaesthetists (2016-2022) and chairs the Education Training and Examinations Board. He is joint editor-in-chief of Perioperative Medicine. He is an adjunct professor of Anesthesiology at Duke University School of Medicine, USA and leads the Xtreme-Everest Oxygen Research Consortium.
Professor Mike Grocott
Professor Mike Irwin
Ramani is Professor of Perioperative Medicine and Head of Department at UCL, and an honorary consultant anaesthetist at UCL Hospitals. Her research interests centre on improving the quality of perioperative healthcare through the use of data, and the evaluation of innovation. She has contributed material to the POM MSc. Courses at UCL, Monash and Brighton/Sussex Medical School. She has had several senior leadership positions nationally in the UK, including being the current Associate National Clinical Director for Elective care at NHS England, a former Council member of the Royal College of Anaesthetists (RCoA) and and the current Director of the Health Services Research Centre at the RCoA.
Professor Ramani Moonesinghe
Richard D. Urman, MD, MBA, CPE, FASA is an anesthesiologist at the Brigham and Women’s Hospital (BWH) in Boston, MA and Associate Professor of Anesthesia at Harvard Medical School. He serves as the Director (Anesthesia) of the interdepartmental Center for Perioperative Research and directs the Perioperative Medicine Fellowship. He also serves as Chief of Anesthesia Service at the BWH Care Center at Chestnut Hill, and as Medical Director of Sedation for Interventional Medicine, where his responsibilities include overseeing all hospital procedural sedation areas (adults and neonates), quality assurance, education and credentialing programs.
A/Professor Richard Urman
Rupert Pearse graduated in 1996 from St George’s Hospital Medical School, London, UK. His clinical duties are based on the busy intensive care unit at the Royal London Hospital where he oversees the care of patients suffering from critical illness of various causes. In 2006, Rupert was appointed Senior Lecturer in Intensive Care Medicine at Queen Mary University of London and was promoted to Professor in 2014. He is an active member of several national and international societies for anaesthesia and intensive care medicine. He has been Director of the UK Perioperative Medicine Clinical Trials Network since June 2015. Rupert’s main research interest is in improving outcomes for high-risk patients following major surgery. Rupert plays a leading role in many large multi-centre studies including EPOCH, PRISM and OPTIMISE II.
Professor Rupert Pearse
Solomon Aronson, MD, MBA, FASA, FACC, FACCP, FAHA, FASE is a tenured professor at Duke University in Anesthesiology and Population Health. He is the Executive Vice Chairman in the Department of Anesthesiology and serves as vice chair on the board of directors and director of business development for the Physicians Diagnostic Clinic (PDC), the physician practice group at Duke. He also serves on the board of managers for the Duke clinical integrated network. He is a recognized expert in perioperative medicine and population health, perioperative echocardiography and blood pressure management and risk. Dr. Aronson continues to serve on the FDA as a consultant after having served as a member of the Anesthesia and Life Support Advisory Committee and Anesthetic and Analgesic Drug Products Advisory Committee. In 2017, he was honored with an adjunct professor appointment from the University College London. He served on the Economic Committee of the American Society of Anesthesiologists and currently serves on their committee for future models in anesthesia practice. He previously served on the board of directors and was president of the intraoperative council in the American Society of Echocardiography and served on the board of directors and was president for the Society of Cardiovascular Anesthesiology. He was a founding trustee member of the National Board of Echocardiography and has served on their board of directors.
Professor Solomon Aronson
Dr. Timothy E. Miller MB ChB FRCA is an Associate Professor of Anesthesiology, Chief of the Division of General, Vascular and Transplant Anesthesia, and Director of the Perioperative Medicine Fellowship at Duke University Hospital. Dr. Miller’s clinical and research interests are Enhanced Recovery and Perioperative Medicine. Dr. Miller is a founding member and President-Elect of the American Society for Enhanced Recovery.
A/Professor Timothy Miller
Dr. TJ Gan is Professor and Chairman of the Department of Anesthesiology at Stony Brook Medicine in Stony Brook, New York. He has attained licensure in acupuncture from the British College of Acupuncture and a Master in Clinical Research from Duke University as well as a Master in Business Administration (MBA). Dr. Gan is the Founding President of the American Society for Enhanced Recovery (ASER), a Past President of The Society for Ambulatory Anesthesia (SAMBA) and International Society for Anesthetic Pharmacology (ISAP). Dr. Gan is also a Council Member of the Association of Academic Anesthesiology Chairs (AAAC). He has published over 230 manuscripts in peer-reviewed journals and numerous books and books chapters. Dr. Gan has served as principal investigator for over 100 clinical trials, focusing on perioperative medicine, enhanced recovery, postoperative nausea and vomiting as well as pain, fluid and hemodynamic management.
Professor TJ Gan

Learning objectives

On completion of the syllabus, the learner would be expected to:

  1. Demonstrate a patient centered approach to the integrative multidisciplinary care of patients contemplating or undergoing surgery.
  2. Demonstrate expertise in the clinical management of patients in the perioperative period (i.e. preoperative, intraoperative, acute postoperative and postoperative transition of care periods).
  3. Ensure that perioperative services are fully integrated, consistent, and reliable and make efficient use of resources.
  4. Partner with colleagues in other disciplines, including primary care, surgeons, hospitalists, rehabilitation, geriatricians, nurses and allied health professionals.
  5. Demonstrate an advanced understanding of the importance and functioning of the pre-admission process and/or clinic.
  6. Educate the perioperative physician to risk stratify and optimize care of the patient in the perioperative period.
  7. Develop the expertise to take a lead in collaborative decision making about the suitability of high risk patients for surgery.
  8. Collaboratively manage the patient in the perioperative period, in particular high-risk surgical patients with acute or chronic medical co-morbidities that require optimization and management to improve patient outcomes.
  9. Obtain the managerial skills to lead a multidisciplinary perioperative management team
  10. Be equipped with research skills to understand perioperative medicine research.
  11. Provide teaching to colleagues of all grades (levels) and specialties.

Proposed Syllabus

  • General Topics / Introduction +
    • INT1: Introduction to Perioperative Medicine
    • INT2: The perioperative medicine physician
    • INT3: Health economics
      • INT3.1: Economic burden of healthcare provision (country specific)
      • INT3.2: Resource allocation
      • INT3.3: Impact of funding models in delivered care (e.g. fee for service)
      • INT3.4: Measuring health and economic outcomes
    • INT4: Designing Clinical pathways
      • INT4.1: Enhanced recovery after surgery pathways
      • INT4.2: Precision Perioperative Medicine for High-Risk Surgical Patients
    • INT5: Monitoring and Evaluation of Perioperative Care
      • INT5.1: Risk and case-mix adjustment.
      • INT5.2: Structure-process-outcome framework
      • INT5.3: Clinical outcomes
      • INT5.4: Resource outcomes
      • INT5.5: Patient reported outcomes (PRO) and ongoing QI
    • INT6: Quality measurement
    • INT7: Basics of Operating Room Management
    • INT8: Building and Managing a Preoperative Clinic
    • INT9: The logistics of Running a Perioperative Consult Service
    • INT10: Building and Managing a Postoperative Assessment Clinic
      • INT10.1: Targeting functional recovery
      • INT10.2: Transitions of care
  • Preoperative Assessment and Planning +

    Preoperative assessment

    • PRA1 : Models of preoperative assessment
    • PRA2 : Clinical risk assessment
      • PRA2.1 : Anemia
      • PRA2.2 : Diabetes
      • PRA2.3 : Nutrition
      • PRA2.4 : Pain
      • PRA2.5 : Obstructive sleep apnea (OSA)
      • PRA2.6 : Mental Health
      • PRA2.7 : Fitness
      • PRA2.8 : Smoking
      • PRA2.9 : Anticoagulation
      • PRA2.10 : PCN allergy testing and desensitisation
    • PRA3 : Biomarkers and organ-specific assessment
      • PRA3.1 : Cardiac (cardiac patient for non-cardiac surgery, stress testing, pacemakers)
      • PRA3.2 : Respiratory (include lung function testing)
      • PRA3.3 : Renal
      • PRA3.4 : Endocrine
      • PRA3.5 : Hematologic
    • PRA4 : Perioperative cancer care/ oncoanesthesia (impact of cancer treatments)
    • PRA5 : Perioperative genomics
    • PRA6 : Physical fitness, activity and surgical outcomes
    • PRA7 : Cardiopulmonary (CPX)/ functional capacity
    • PRA8 : Frailty and comprehensive geriatric assessment and disposition planning
    • PRA9 : Cognitive testing and other neurological assessment
    • PRA10 : Collaborative decision making
    • PRA11 : Preoperative investigations

    Preoperative intervention and optimization

    • PRI1: Lifestyle modification (including activity/ exercise, smoking/ alcohol cessation, weight loss)
    • PRI2: Optimizing preoperative nutrition
    • PRI3: Optimization of major comorbidities
      • PRI3.1: Cardiac (HTN, ischemic heart disease, heart failure)
      • PRI3.2: Respiratory (sleep apnoea, asthma, COPD, pulmonary hypertension)
      • PRI3.3: Endocrine (diabetes), preoperative glucose management
      • PRI3.4: Renal (CKD)
      • PRI3.5: Hepatic (cirrhosis)
      • PRI3.6: Anemia: Optimizing hemoglobin and patient blood management
    • PRI4: Prehabilitation- specific interventions
    • PRI5: Optimization of preoperative pain management (including chronic opioid use)
    • PRI6: Medication management (including anticoagulant management, steroids and herbal medications)

    Ethics and advanced care directives and perioperative planning

    • ETH1 : End of life care (including the very young and the very old)
    • ETH2 : Ethics of informed consent and shared decision making
    • ETH3 : Goals of Care Discussions
    • ETH4 : Do not resuscitate procedures
    • ETH5 : Ageing
    • ETH6 : Postnatal depression
  • Postoperative Assessment and Management +

    Postoperative Pain and Sleep

    • POP1: Postoperative triage (postoperative levels of care)
    • POP2: Focusing on Optimal Analgesia to promote functional recovery
      • POP2.1: Relationship of pain/surgical stress management to co-morbidities
    • POP3: Opioid minimization and avoidance – principles and techniques
    • POP4: Management of chronic pain and opioid-dependent patients
    • POP5: Promoting normal sleep
    • POP6: Delirium: assessment, avoidance, and management
    • POP7: Postoperative Cognitive Dysfunction

    Cardiac

    • CAR1: Perioperative BP control
    • CAR2: Arrhythmias, pacemakers, AICD
    • CAR3: Aortic stenosis and other valve disorders
    • CAR4: Pulmonary hypertension
    • CAR5: Endocarditis, myocarditis, cardiomyopathy
    • CAR6: Heart and lung transplantation
    • CAR7: Adult with congenital heart disease
    • CAR8: Mechanical assist device management and evaluation
    • CAR9: Basics of echocardiography assessment  (how to read and interpret an echocardiogram)
    • CAR10: Myocardial injury and protection
    • CAR11: Heart failure

    Respiratory

    • RES1: Asthma
    • RES2: COPD
    • RES3: Other lung diseases
    • RES4: Airway management and postoperative ventilation strategies

    Fluid, Electrolytes, Nutrition, and Renal

    • FLU1: Fluids and electrolytes/ acid-base
    • FLU2: Nutritional support in the postoperative period
    • FLU3: Goal directed therapy/ advanced haemodynamic monitoring
    • FLU4: Perioperative AKI

    Endocrine

    • END1: Glycemic control
    • END2: Management of thyroid diseases
    • END3: Management of pituitary diseases
    • END4: Management of parathyroid diseases
    • END5: Management of adrenal diseases
    • END6: Management of neuroendocrine diseases (e.g. carcinoid)

    Postoperative Patient Blood Management

    • PBM1: Anemia
    • PBM2: Coagulopathy
    • PBM3: Thromboprophylaxis

    Cancer and pain

    • CAN1: Cancer and pain incl. haematological malignancies
    • CAN2: Perioperative acute and chronic pain management
    • CAN3: Perioperative care of the cancer patient

    Other organ systems

    • OTH1: Trauma and Emergency General Surgery
    • OTH2: Perioperative management of obesity
    • OTH3: Perioperative management of neurological diseases
    • OTH4: Psychiatric management
    • OTH5: Myopathies
    • OTH6: Autoimmune diseases
    • OTH7: Porphyria
    • OTH8: Acquired and inherited coagulation disorders
    • OTH9: Perioperative management of the burns patient
    • OTH10: Radiology in the acute setting
    • OTH11: Obstetrics

    Additional Topics in postoperative care

    • ADD1: Postoperative recovery (disability, quality of life, hospital readmission)
    • ADD2: Postoperative care teams (roles and relationships)
    • ADD3: Allergies and anaphylaxis/ allergy testing and desensitisation
    • ADD4: Infectious diseases
    • ADD5: Inflammation (and sepsis)
    • ADD6: Antibiotics
    • ADD7: Wound management/ surgical infection
    • ADD8: Handover
    • ADD9: Discharge disposition planning
    • ADD10: Transition care planning
    • ADD11: Hypothermia and hyperthermia
    • ADD12: PONV
    • ADD13: Alcohol and substance abuse
    • ADD14: Management of intraoperative awareness
  • Improvement Science, Research, and Value for Perioperative Medicine +

    Improvement science

    • IMP1: Leadership and team-building
    • IMP2: Process improvement
    • IMP3: Quality improvement
    • IMP4: Human factors
    • IMP5: Patient safety
    • IMP6: Writing of Institutional Policies

    Statistics, Research and Quality Improvement

    • STA1: Perioperative Medical research: understanding the literature
    • STA2: Introduction to statistics/ research
    • STA3: Ethnography
    • STA4: Research proposal
    • STA5: Research project

    Value and Monetizing (this would be country-specific)

    • VAL1: Billing and management of preoperative and postoperative consultation and services
    • VAL2: Compliance with billing and coding regulations

Courses

Department of Anaesthesia and Perioperative Medicine - Monash University

Department of Anaesthesia and Perioperative Medicine - Monash University

University College London

University College London