UCLA Advanced Transesophageal Echocardiography Training Program

Program Overview

Introduction

Among the numerous recent advances in medicine in general and anesthesiology in specific is the introduction of Transesophageal Echocardiography as a diagnostic and monitoring tool. TEE is increasingly becoming an integral modality in monitoring patients undergoing major cardiac, thoracic, transplant (heart, lung, liver) procedures and patients with significant cardiovascular pathology (coronary artery disease, valvulopathy, myocardial dysfunction) undergoing intracranial, major abdominal, and vascular procedures. It is also an important diagnostic tool in patients with acute, persistent, life threatening hemodynamic instability either in the OR or in the ICU. To learn more about the TEE service that our department provides, please click here.

Anesthesiologists and Critical Care staff who are in practice for a long time or recent graduates who did not have adequate training in TEE and feel the need in proficiency in performing a complete TEE exam and interpreting the results in order to help them provide a high level of patient care have few options available to them to acquire these skills. It is either through attending review courses or observing colleagues perform studies and possibly being supervised by them or self training.

To meet these needs we have developed a unique and educational program. The principal goal of this program is to provide a hands-on supervised educational experience for anesthesiologists or critical care staff to assess and improve their skills and knowledge in this area.

Training Program

Training is provided at UCLA Ronald Regan Hospital, a 500 bed acute care hospital located in West Los Angeles. All medical and surgical services that constitute a modern hospital are available at UCLA hospital and hence are available to anesthesiologists in training. Board certified Anesthesiologists appointed to the program are designated fellows in the Advanced Specialty Training (AST) Program in Anesthesiology at UCLA. The training period will be 2 days a week for 1 month, but may be extended upon request (based on the trainee’s comfort in performing and interpreting studies) and approval prior to the end of the period. Fellows will train separately, each on two days per week, with a maximum of 2 fellows enrolled simultaneously at any time. If in a specific time period only one fellow is enrolled he/she may opt to do the training 4 days a week for 1 month. Generally, a final decision regarding the length of the fellowship is revised after a period of time in the program and an opportunity to evaluate the skills of the fellow. Fellows will not take night calls.

We offer this course from January to May each year. This is due to several reasons:

  1. To prevent interference with the training of our cardiothoracic anesthesia fellows.
  2. Obtaining a California license may take up to 6 months and hospital credentialing may take up to 3-4 months so this provides applicants ample time to submit their documents for respective licensing and credentialing prior to their start date.

Fellows will be in the operating room performing hands on Echo under direct supervision of the cardiac anesthesia staff but will not be involved in patient care. They will be exposed to multiple faculty members and cardiac anesthesia fellows and hence different ideas and techniques. They also may be paired with the cardiac anesthesia fellow responsible to perform echoes in the cardiac catheterization laboratory and ICUs in that month so they can be exposed and perform studies in those settings. Teaching will be conducted in the operating room/Cath lab/ICU and through different conferences conducted by the division of Cardiac Anesthesia which include Thursday afternoon echo rounds, journal clubs and resident/fellow lectures. In the operating room teaching will be focused on hands on performance of a complete exam, performing appropriate calculations related to the case, interpretation of the findings, and clinical decision making based upon the findings. Fellows also are permitted to practice with TEE simulator to get more facile in obtaining the appropriate views. Echo review sessions can also be arranged so the fellows can review the studies performed by other staff members in the previous week. In echo rounds selected interesting cases or topics are presented by our cardiac anesthesia fellows and their clinical and anesthetic implications are discussed.

There are a few important issues that the applicant must consider prior applying to this program. This program does not qualify nor fulfills the requirements for board certification by the National Board of Echocardiography. This program is most suitable for applicants with some knowledge and experience in transesophageal echocardiography The applicant must read a textbook (i.e. "A practical approach to transesophageal echocardiography by Perrino" or "Practical perioperative transesophageal echocardiography by Sidebotham") and/or complete an on-line TEE course (SCA, University of Toronto)

Evaluation of Performance

Fellows will be evaluated on the basis of:

  • Daily performance in the operating room
  • Performance at rounds and conferences

Computerized records of echoes performed will be kept. The fellows must achieve a satisfactory clinical competence evaluation from the faculty and the director at the completion of the training program to qualify for certification as a graduate of the Fellowship in Advanced Transesophageal Echocardiography Training at UCLA.

Separation / Termination

The AST Program is entirely voluntary on the part of the UCLA Department of Anesthesiology and the AST Fellow. Either party may terminate the arrangement at any time without cause. If the Department of Anesthesiology terminates the arrangement, the fellow will be refunded the pro-rated fee for the remainder of the month. If the AST fellow terminates the arrangement, any unused portion of fees paid will not be refunded.

Fees

There will be a onetime, non-refundable, Credentials Verification Office (CVO) fee of $575, check made payable to the UC Regents to accompany the Application. The fee for this program is $4000/month per fellow for 2 days a week or $8000/month per fellow for 4 days a week. Checks are made payable to the UC Regents and must be received prior to the start of the applicable month. The department of Anesthesiology Business office will provide a billing invoice and return envelope to the Fellow 15 days prior to the beginning of each month.

The Fellow is expected to provide for his own living quarters, incidental expenses, and health and malpractice insurance costs. Modest rentals are available in the UCLA area, and help in this regard can be obtained through the UCLA Housing Services: is open to assist customers Monday through Friday, 9:00 a.m. - 11:30 a.m. and 12:30 p.m. to 4:00 p.m. Our office phone number is (310) 206-7011. Our email to reach us through Ask Housing is uclahousing@housing.ucla.edu.




See also: Application Process