Faculty: Drs. Ben Byrd, Michael Baker, Geoffrey Chidsey, Andre Churchwell, Keith Churchwell, Julie Damp, Waleed Irani, Lisa Mendes, Adam Prudoff

Transcription

1 Rotation: Echocardiography: Transesophageal Echocardiography (TEE) ors: Benjamin Byrd III, MD Lisa Mendes, MD Faculty: Drs. Ben Byrd, Michael Baker, Geoffrey Chidsey, Andre Churchwell, Keith Churchwell, Julie Damp, Waleed Irani, Lisa Mendes, Adam Prudoff Duty Hours: Mon Fri, 8 am to 5 pm, and as mandated by the ACGME work hour guidelines Learning s Patient Care 1. Obtain pertinent medical histories, including review of patient medical records, and perform accurate examinations with an emphasis on cardiac findings relative to the TEE examination., 2. Learn the proper technique for performing a comprehensive TEE 3. Perform TEE maintaining patient comfort, privacy and safety Hands on experience Simulation Hands on experience with sonographers,, Skills, Skills

2 4. Recognize and assist in the management of all complications associated with TEEs 5. Complete accurate reports of the TEE examination including summary of findings, procedure description, management of any complications, and notification of attending physician regarding results when appropriate. experience with attending supervision experience with attending supervision Medical Knowledge 1. Learn standard views for complete TEE examination including Doppler examination and use of contrast agents. Hands on experience Simulation, Skills 2. Learn proper operation and storage of examinations Hands on

3 on both the Phillips and Acuson ultrasound machines. Learn proper care and maintenance of the TEE probe. 3. Master core areas of TEE including but not limited to: a. assessment of chamber size, wall motion and ejection fraction b. assessment of native and prosthetic valve function: normal and abnormal c. endocarditis d. intracardiac masses e. pericardial disease f. aortic disease g. congenital heart disease h. intracardiac devices, pacemakers/icds i. Guidance of catheterization procedures: valvuloplasty, septal ablation, closure devices experience, Skills Professionalism Demonstrate accountability and professional behavior towards patients, family members, and members of the health care team and adherence to ethical principles Demonstrate compassion and respect for others, including patients from a diverse cultural, social, and religious backgrounds,,, from, from

4 Interpersonal and Communication Skills Communicate effectively with patients, families, and members of the health care team, including findings and diagnoses when appropriate to both patients and consulting physicians Echocardiographic examination reports and associated procedures and complications will be available for review in the computerized medical record the same day the procedure is performed. Stat or urgent studies will be read as soon as study is available for review and results communicated to the provider.,,, from Practice Based Learning and Improvement Identify both strengths and gaps in knowledge and expertise and set appropriate learning goals. Accept constructive criticism in order to improve skills and knowledge set Utilize information technology to effectively locate, appraise, and utilize evidence based medicine with in current literature to improve patient care

5 Utilize quality improvement methods to implement changes within the practice environment Systems Based Practice Work effectively as a member of the echocardiography laboratory and the health care team, including coordination of patient care, performance of examination and reporting of results Demonstrate understanding of cost effectiveness and risk benefit analysis of echocardiography as it compares to other forms of cardiac imaging and incorporate these into patient care Advocate for and work towards patient safety and improved quality of care Role models Role models, from, from

6 Identify system errors within the echocardiography laboratory and work towards methods to improve and/or resolve problems. Rotation Format and Responsibilities: a. Second and Third Year Fellows: The second and third year fellows will be responsible for all transesophageal echocardiograms (TEEs) performed during working hours. The fellow performing the TEE will review the patient s medical record and obtain a directed history and exam from the patient to assure the test is indicated. The fellow will review the procedure with the patient, answer all questions and obtain informed consent. Any concerns regarding conscious sedation in a patient will be discussed with the anesthesia team and echo attending. All TEEs will be performed under the direct supervision of an experienced TEE attending. Following the procedure, the fellow will review results with the patient and contact the primary team and/or attending of the results. A preliminary report will be generated by the fellow, reviewed by the supervising attending and electronically sent to the medical record the same day as the procedure. b. First Year Fellows: The fellows are encouraged to observe and assist with transesophageal echocardiograms as time allows. All on call fellows will be responsible for setting up and performing off hour and emergent TEEs (as their level of training allows) with the on call echo attending. Fellows should be familiar with how to access equipment during off hours and arrange for cleaning of the probe after the study is completed (covered by the Heart Station). Requirements for Certification for Transesophageal Echocardiography Minimum number of esophageal intubations: 25 Minimum number of TEEs completed: 50

7 The fellows goal should be to complete at least 100 studies during their fellowship training with an additional 100 studies (200 total) for those individuals who aim to direct an echocardiography lab in the future. Evaluation and : Fellows are evaluated at the end of the rotation with a competency based evaluation system Fellows are directly observed and given real time on their performance Fellows participate in structured case discussions during echocardiography conference and one on one teaching in the laboratory