Echo Boards Clarification

[Modanq]

ASCeXAM versus PTEeXAM

If you do CV anesthesiology fellowship which one do you take?
If you do combined CT and ICU can you take the ASCeXAM (te) which is for transthoracic and transesophageal?
Is ASCeXAM (c) comprehensive Which includes stress only for Cardiologists?

Very confusing.

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[deleted697127]

Perioperative Echocardiography - | University of Utah

Correct me if I’m wrong but I think Utah may still be the only program where stress echos are done by anesthesia. I am not sure how much of this their residents do or if they have been able to translate it into value in PP. I guess theoretically you could set up a stress test lab in your preop clinic but that would take a lot of motivation to set up and I’d frankly rather be in the OR.

 

[pgg]

We take the PTE exam.

A very few anesthesiologists take the ASC exam to become Testamurs. I don't believe full certification is open to us but I haven' read the requirements.

 

[LunchMD]

Correct me if I’m wrong but I think Utah may still be the only program where stress echos are done by anesthesia. I am not sure how much of this their residents do or if they have been able to translate it into value in PP. I guess theoretically you could set up a stress test lab in your preop clinic but that would take a lot of motivation to set up and I’d frankly rather be in the OR.

This is very cool, thanks for the link. I have been wondering why cardiac anes doesn't perform the 30 day preop TEE. In my very limited experience, it seems like it would be valuable to have that continuity of exams from 30 days pre-op to intraop, and would make us more valuable to help with surgical decision making.

 

[deleted697535]

Can I ask on this also? Some have said you can apply for the advanced pte exam without being on a ct fellowship? Is this true? Does one need a supervisor?

I'm hoping to start a ct fellowship probably 2020 and had it in my head that having this exam would be a bonus!

Thoughts?

 

[pgg]

Can I ask on this also? Some have said you can apply for the advanced pte exam without being on a ct fellowship? Is this true? Does one need a supervisor?

I'm hoping to start a ct fellowship probably 2020 and had it in my head that having this exam would be a bonus!

Thoughts?

Anyone can take the advanced PTE exam if they pay their money.

No fellowship + passing score = Testamur
Fellowship + 300 cases + passing score = board certification

If you have already passed the advanced exam prior to fellowship that would be great. You'd be starting from a position of knowledge, and you would get more out of every case as a fellow. You could spend more time honing the details of the skill and your knowledge, vs having to figure out how to get the basic views, how the knobs work, having to look up the criteria for mild/mod/severe _______, etc.

I wouldn't bother with the basic exam prior to fellowship.

 

[AdmiralChz]

Can I ask on this also? Some have said you can apply for the advanced pte exam without being on a ct fellowship? Is this true? Does one need a supervisor?

I'm hoping to start a ct fellowship probably 2020 and had it in my head that having this exam would be a bonus!

Thoughts?

This comes up a lot, so I'll try to summarize what the NBE says in a few places.

Start here:

FAQ

If you don't have the proper qualifications to merit "certification" then you can become a "testamur" by simply taking the test. You supply no additional information to the NBE and you simply get a check mark. Any licensed physician (maybe not even anesthesiologists?) can take the test if they want to spend a lot of cash.

Here's the Advanced PTEeXAM handbook:

http://echoboards.org/docs/AdvPTE Cert App.pdf

First point - the "Practice Experience Pathway" where docs who did a ton of echo could get certification is no longer possible for those who completed training after 2009.

The most applicable requirement (other than specific number requirements which you can reference above) in the document:

"Applicants must have a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease. Training obtained during the core residency (anesthesiology, internal medicine, or general surgery) may not be counted toward this requirement. Fellowship training in cardiothoracic or cardiovascular anesthesiology must be obtained at an institution with an ACGME or other national accrediting agency accredited fellowship in cardiothoracic anesthesiology."

I don't know how strict the National Board of Echo is on this requirement and whether one could complete a CCM fellowship to meet such a requirement - my sense is, assuming they are following the letter of this document (and why wouldn't they?) is that a CCM-only trainee would be denied certification unless they can prove 12 months of only cardiovascular surgery and ICU training with no MICU/SICU/NICU/BICU/TICU etc... Which of course isn't the purpose of a CCM fellowship.

@Newtwo it would be very strange for a Testamur in Advanced TEE to apply to a program - that person claims to already have the echo knowledge (since he or she took the test), why does he or she need a fellowship? It would raise a lot of eyebrows in a close-knit, fairly competitive field.

Fellowship + 300 cases + passing score = board certification

Close, see above.

 

[pgg]

I don't know how strict the National Board of Echo is on this requirement and whether one could complete a CCM fellowship to meet such a requirement - my sense is, assuming they are following the letter of this document (and why wouldn't they?) is that a CCM-only trainee would be denied certification unless they can prove 12 months of only cardiovascular surgery and ICU training with no MICU/SICU/NICU/BICU/TICU etc... Which of course isn't the purpose of a CCM fellowship.

There are a lot of CCM graduates who have been granted board certification by NBE, despite not meeting this requirement. They pay their money, they pass the test, their programs send letters documenting at least 150 level 1 exams and at least 300 exams total.

I agree with you that the rule is explicit. But NBE doesn't enforce it. I think the rule is dumb; anyone who passes the test and does the required 150+150 exams ought to be eligible.

I would caution people who are considering a CCM fellowship that the NBE might or might not grant them board certification.

Close, see above.

I thought it was obvious from context that I meant a CT fellowship.

 

[AdmiralChz]

I thought it was obvious from context that I meant a CT fellowship.

Hah, reading is hard...

 

[Robotic Wis-Hipple]

This is very cool, thanks for the link. I have been wondering why cardiac anes doesn't perform the 30 day preop TEE. In my very limited experience, it seems like it would be valuable to have that continuity of exams from 30 days pre-op to intraop, and would make us more valuable to help with surgical decision making.

Because the dollars don’t make sense (cents?). The Anesthesia Dept, or private practice, would have to own the machines, own or lease space, have staff to run an outpatient center, and have a cardiac anesthesiologist not in the OR doing echos somewhere offsite. For what? If you own the office space you can bill something like $180 per TEE, or $170 per TTE and if you’re operating out of a hospital space it’s about $50 less for each (by my read of 2017 CPT codes which very easily could be flawed).

So that’s a lot of overhead and logistical setup to run a preop clinic in this current billing/coding system. The math may change when everything is diagnosis/case based and we can show value by facilitating preop optimization etc but I honestly don’t see ya cutting the cardiologists out of this. The cardiologists often are the point of contact/diagnosis for a cardiac surgical patient, so they’ve already captured the patient as a billing entity. Add to that that most of us would rather be in the OR and not watching a clock in a clinic waiting for the next patient to be roomed for an echo and the fact that the majority of preop/diagnostic/surgical planning echos are TTE which we aren’t currently “boarded” in and it’s just a non-starter.