Perioperative and Critical Care Echocardiography Executive Medical Fellowship (EMF) Program

Many practicing anesthesiologists are not in a position to stop their existing practice or delay entering a practice so they can participate in a traditional fellowship program. However, this does not mean that many of these same physicians are not interested in expanding their skills, especially with emerging technologies that have been shown to improve patient outcomes.

The University of Utah Department of Anesthesiology Perioperative and Critical Care Echocardiography EMF program consists of 5-day, on-site sessions that are customized post-graduate training programs tailored to physicians who want to further their education and career without compromising their existing practice. Specifically, the EMF program offers an alternative to traditional methods for learning perioperative echocardiography. In general, the EMF program covers the following topics.

Ultrasound core concepts and principles.
Technical skills related to transesophageal echocardiography and transthoracic echocardiography.
Perceptual detection skills to identify features in medical imaging, also called visual sensitivity or visual recognition.
Image recognition skills to simultaneously perform the necessary technical procedures and identify normal and abnormal structures.
Knowledge and skills necessary to accurately and effectively report the medical imaging findings.

A new EMF course format is being introduced starting in December 2007. The new format requires attendance at the first two, 5-day onsite sessions (Weeks 1 and 2), with Week 3 and Week 4 being optional sessions. The two required, 5-day onsite sessions (Weeks 1 and 2) cover the perioperative and critical care echocardiography core curriculum and must be attended at least 30 days apart and both weeks must be completed within one year.

Week 3 and Week 4 sessions are optional, but cannot be attended without first attending both Weeks 1 and 2. You may attend either Week 3 or Week 4, or both; it is not required that you attend both Week 3 and Week 4. The three EMF program options and program requirements are outlined in Table 1 and the curriculum for each program is outlined in Table 2.

Schedule of Available weeks

Table 1. Perioperative and Critical Care Echocardiography EMF Programs

Program	Program Title	On-site Sessions	Simulated Diagnostic exercises	In-Practice Studies to be Reviewed
A	Perioperative and Critical Care Core Competencies program	Week 1 & Week 2	100	50
B	Surgical Applications Program	Week 3	Additional 25	Additional 25^b
C	Perioperative and Critical Care Advanced Competencies program	Week 4	Additional 25	Additional 25^b

^a All on-site sessions will be held on-site M-F at the University of Utah in Salt Lake City, UT.
^b All additional in-practice echo cases must be specific to the program taken.

Table 2. Program curriculum for EMF programs.

Programs	Sessions	Day 1	Day 2	Day 3	Day 4	Day 5
Program A: Perioperative & Critical Care Core Competencies program	Week 1	TTE examination	TEE examination	Contractile function	Valvular regurgitant lesions	Valvular stenotic lesions
Program A: Perioperative & Critical Care Core Competencies program	Week 2	Echo-guided fluid management/ Diastology	Cardio- myopathy	Hemo- dynamics	Pericardium/ non-surgical aorta	Physics applications
Program B: Surgical Applications Program	Week 3	Prosthetic valves	Masses/ Endocarditis	Valvular repairs	Traumatic injuries/ Surgical aorta	Congenital heart disease
Program C: Perioperative & Critical Care Advanced Competencies program	Week 4	Exercise and pharmacology- based stress testing	Advanced echo reading session 1	Advanced echo reading session 2	Organization of comprehensive perioperative echo service	Advanced echo reading session

Perioperative and Critical Care Echocardiography Core Competencies Program (Weeks 1 and 2)

The University of Utah Department of Anesthesiology Perioperative and Critical Care Echocardiography Core Competencies program is designed to meet or exceed the basic clinical competence requirements developed by the American College of Cardiology (ACC) and the American Heart Association (AHA) for perioperative echocardiography (2003).

The program involves attendance at two, 5-day, on-site sessions at the University of Utah for a total of 10 days on-site over the course of the 1 year or less. Between these 5-day, on-site sessions, students review or perform a minimum of 150 perioperative echocardiography studies. Of these 150 studies, at least 50 are personally performed on their own patients and 100 are performed as simulated diagnostic exercises.

Echo studies are submitted to the University of Utah’s EMF faculty using an internet-based, remote supervision software system. After completion of each diagnostic exercise, immediate feedback via the remote supervision system is provided to the student. For studies performed on the student’s own patients, the EMF faculty reviews and quality assesses each study, and then makes it available online for the student to review.

At the completion of the Core Competencies EMF program, physicians should be able to use TEE for indications that lie within the customary practice of anesthesiology. Under appropriate supervision, students will learn to place the TEE probe, operate the ultrasound machine, perform a TEE examination, and convey and document the results of the examination effectively.

Surgical Applications Program (Week 3)

The University of Utah Department of Anesthesiology Surgical Applications EMF program is designed to cover all aspects of echocardiography for making diagnoses and decisions in surgical settings.

To attend the surgical applications program, students must have already completed the Core Competencies EMF program outlined above.

The Surgical Applications program involves attendance at one, 5-day, on-site session at the University of Utah. In addition to the 150 cases required for the Core Competencies Program, completion of an additional 50 cases is required; 25 echo cases on their own patients and 25 simulated diagnostic exercises.

Cases are submitted to the University of Utah’s EMF faculty using an internet-based, remote supervision software system. After completion of each diagnostic exercise, immediate feedback via the remote supervision system is provided to the student. For studies performed on the student’s own patients, the EMF faculty reviews and quality assesses each study, and then makes it available online for the student to review.

Perioperative Stress Testing Program (Week 4)

The University of Utah Department of Anesthesiology Perioperative Stress Testing Program is designed to cover all aspects of echocardiography-based stress testing.

To attend the perioperative stress testing program, students must have already completed the Core Competencies EMF program outlined above.

The Perioperative Stress Testing Program involves attendance at one, 5-day, on-site session at the University of Utah. In addition to the 150 cases required for the Core Competencies Program, completion of an additional 50 cases is required; 25 echo cases on the students’ own patients and 25 simulated diagnostic exercises.