Goals and Objectives, Perioperative Transesophageal Echocardiography, CA-3 year UCSD DEPARTMENT OF ANESTHESIOLOGY PERIOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY GOALS AND OBJECTIVES, CA-3 YEAR PATIENT CARE: To provide the resident with clinical experience in the use of perioperative transesophageal echocardiography Have an advanced understanding of the indications, contraindications and risks of perioperative TEE Lecture, Simulation Exercise Learn proper techniques for safe TEE probe insertion as well as useful maneuvers in difficult insertion cases Simulation Suite Lecture, Practice and feedback, Simulation exercise Learn to successfully manipulate the probe to obtain various TEE views Lecture, Practice and feedback, Simulation exercise Perform a routine monitoring TEE including the 20 standard echocardiographic views. Lecture,,, Include color flow, pulsed wave and continuous wave Doppler interrogation for assessment of ventricular and valvular assessments. Lecture,,,, Practice oral exam Recognize normal cardiac structures and common pathological echocardiographic findings (i.e. LV function, regional wall motion abnormalities) Lecture,,, Identify and quantify valvular abnormalities Lecture,,, Determine the volume and inotropic status of patients undergoing cardiac surgery Lecture,,,
MEDICAL KNOWLEDGE: To acquire the clinical and applied science knowledge pertinent to the use of perioperative transesophageal echocardiography. Become knowledgeable of the basic physics of ultrasound in regards to 2D image acquisition and Doppler echocardiography Understand Doppler echocardiography and particular differences and uses for pulsed wave, continuous wave, color flow and tissue Doppler. Obtain a basis of cardiac anatomy knowledge for proper identification of normal variants versus pathology. Obtain knowledge of cardiac physiology as applies to echocardiography (i.e. PA pressures, diastology, etc.). This includes application of quantitative assessments of valve gradients (bernouli equation), valvular area (continuity equation), ventricular assessments (FAC, EF, Diastology), and cardiac output. Obtain knowledge of the echocardiographic appearance of aortic lesions: dissections, aneurysms, and athermatous disease. Understand the common pitfalls and misdiagnoses of transesophageal echocardiography Qualitatively and quantitatively assess valvular dysfunction Qualitatively and quantitatively assess left and right ventricular dysfunction. Calculate ejection fraction, identify wall motional abnormalities, and tricuspid annular systolic plane excursion Understand diastolic physiology and echocardiographic identification of diastolic dysfunction Obtain knowledge for use of TEE in aiding invasive line placement Room Lecture,
PRACTICE BASED : To be able to investigate and evaluate their own patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices in regards to perioperative echocardiography. Investigate and evaluate their own patient care, appraisal and assimilation of scientific evidence and improvements in patient care. Study, Operating room evaluation, Become familiar with outcome studies regarding perioperative use of TEE, Intraoperative versus preoperative assessment of valvular function, and future trends of perioperative echocardiography. Study, Operating room evaluation, Learn to apply their findings to their own scientific, evidence-based practice. Study, Operating room evaluation, To actively participate in routine TEE review sessions with trained TEE certified faculty Study evaluation, Possess the knowledgebase required for Basic Perioperative TEE certification, Simulation experience Lecture,, Direct observation
INTERPERSONAL AND COMMUNICATIONS SKILLS: Be able to demonstrate communication skills that result in effective information exchange and appropriate interaction with colleagues, surgeons, cardiologists, and critical care physicians. Maintain comprehensive, timely, and legible medical records Operating room Lecture and discussion,, skill demonstration Review of echocardiography records Convey ideas and points effectively Operating room Develop their communication skills, in particular the discussion of perioperative TEE findings with both surgical and critical care colleagues. This communication is critical in cardiac anesthesia as TEE findings may directly affect the surgical procedure Operating room,,, Practice oral exam Learn proper documentation skills for recording findings in the language of echocardiography to peroperly communicate with surgeons, critical care physicians and cardiologists. Operating room, Intensive Care Unit Review of echocardiography records Be knowledgeable of the system for documenting performance of examination and information obtained within the medical record. Operating Room Know role in crisis Postoperative care unit, Intensive Care Unit, Skill demonstration Listen and allows others to feel heard Postoperative care unit, Intensive Care Unit Practice team approach Preoperative holding area, Postoperative care unit
PROFESSIONALISM: Be able to demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Answer pages promptly Postoperative Demonstrate respect, compassion or responsiveness to patient's concerns or needs Postoperative Demonstrate independence and initiative Postoperative Be punctual and reliable Postoperative Demonstrate superior work ethic Postoperative Demonstrate commitment to professional development Postoperative Adhere to departmental and university policy and procedures Postoperative Exhibit integrity in record keeping and medical records Operating Room Lecture, Anesthesia record review Further develop their professionalism, and, in particular, their sense of the etiquette of the heart room. This will include sensitivity to the high pressure environment of the heart room and the social and emotional needs of the surgical team at various times of the surgery. Postoperative
SYSTEMS-BASED PRACTICE: Be able to demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide health care that is of optimal value Practice cost-effective health care Operating Room Case based discussion Rely on information technology tools related to patient care Preoperative evaluation clinic,, evaluation, Become familiar with the UCSD/VA Healthcare system, procedures and standard practices as related to TEE. Operating Room Case based discussion