Fellowship vs training on the job

[deleted697535]

Any comments on this?
A staff colleague has left his job of 3-4 years to go back and do a fellowship.

From what I can see, all he's doing different is taking a massive pay cut. He has to do 3 approx lists unrelated to his fellowship, and teaches residents about his fellowship(echo). Then when a case arises he sticks in a toe or does tte.

So like could I/he/anyone do the same as a staff through various cme courses, master's or projects?

I want to do cardiac/echo and some critical care.

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[deleted126335]

It depends.
In a good job market, skills mean as much or more than credentials. Can't say we have a good job market in too many places in anesthesia right now. 10-15 years ago nobody cared if you did a cardiac fellowship if you had strong TEE skills. Now the fellowship is pretty much mandatory for a good job. 15 years ago the same was true for pain. If you had the skills, including implantable devices, the world was your oyster. The oyster is starting to close on pediatrics too. 5-10 years ago if you were comfortable and good with sick neonates, lack of a fellowship didn't matter. Now it does.
Your colleague's choice is not unreasonable. Nobody knows what the future holds. But having lots of formal education and training is perceived as a good ace to hold.

 

[Man o War]

Any comments on this?
A staff colleague has left his job of 3-4 years to go back and do a fellowship.

From what I can see, all he's doing different is taking a massive pay cut. He has to do 3 approx lists unrelated to his fellowship, and teaches residents about his fellowship(echo). Then when a case arises he sticks in a toe or does tte.

So like could I/he/anyone do the same as a staff through various cme courses, master's or projects?

I want to do cardiac/echo and some critical care.

I did this too for cardiac, except I'd been out longer. Worked out very well for me despite the massive pain in the rear trying to get back into trainee mode and taking another set of Initial boards exams as an old guy.
I gained access to PP groups I would not have had otherwise.

 

[Twiggidy]

And it depends on what your career outlook....

i will say this, in my experience (even if it's very little) finding a pure "CV" position out there is pretty hard, even in academics. some people may do ICU because enjoy the more academic side of things and a week or two in the unit is nice change of pace. peds people are the pros at peds and the way medicine is moving (especially since the field has become boarded) you may in the future see a requirement of a peds fellowship ( at a least) a strongly recommendend. regional, i'd say may be worth it if you want to be awesome at blocks, especially obscure ones. no offense to those currently completing one, but i argue an OB fellowship is a waste unless you want to be chair of an OB anesthesia division in academics. there's absolutely no reason for an OB anesthesia fellowship in PP. sorry. i stand by that

 

[pgg]

I was out for 7 years before going back for CT fellowship. It was the right thing to do. I hadn’t been doing cardiac anesthesia though - would’ve been tough to get back into it without the fellowship.

Also, the practice pathway to echo certification closed in 2009.

 

[sevoflurane]

I did the practice pathway to advanced echo certification.
To be honest, things just lined up correctly for me during my career.
I did a ton of extra echo and hearts during residency.
When I applied for a PP job, I only looked at places that needed anesthesiologists to do cardiac as my plan was to accumulate the 300+ echos I needed to get certified in echocardiography.
Fortunately, my first PP was bread and butter cardiac. Mainly 70/30 Cabgs/Valves + your middle of the night crash and burn cases (ie type A dissections). For the first month I was mentored in the cardiac rooms. That was nice. Did that for about 7 years. It got me real comfortable with all sorts of cardiac cases.
Now fast forward to my current gig. I rarely if ever do CABGs unless it's an emergency case on cardiac call. My practice now is mainly valves, redo's, ascending aneurysms, rarely adult congenital and a good amount of structural heart procedures (TAVR, Mitral Clips, Watchmen, etc.). I also read and bill all my own TTE when doing sedation cases in the TAVR room and pre/post op TTE's.
I have put A LOT of extra time inside and outside of the cardiac ORs to get to where I am.
So it's doable. Having the practice pathway under my belt has certainly helped to achieve a minimum standard.

 

[sevoflurane]

Echocaridography has come a long way since I graduated residency.
The 3D stuff is really amazing and a ton of fun to learn and get good at.
If I had to do it all over, I would likely do a fellowship.

 

[sevoflurane]

What about regional? I want to get really good but don’t want the pay cut with a fellowship. Are workshops, CME courses a good substitute?

Unless you come a residency that has little regional I think a regional fellowship is not a good fellowship to do (might be up for debate).
It will, however, likely open some doors into some private practices.
Placing SS blocks and catheters fast and efficiently is not very difficult if you come from a regional heavy residency.

Regional and Cardiac make up 85% of my practice and I did not do a fellowship in either.

 

[sevoflurane]

To put things into perspective for those thinking of doing either fellowship:
My days in the cardiac rooms are relatively easy days with the occasional difficult case that may pose some clinical and/or diagnostic challenges.
My ortho days are just super fast and super busy with hardly any down time.

 

[partydoc]

How many blocks during residency is adequate? (40 is the ACGME minimum)

At least 5 times that

 

[nimbus]

At least 5 times that

How many blocks during residency is adequate? (40 is the ACGME minimum)

In an average MD only PP there are days when you’ll do 5-8 blocks. If you supervise you probably do a lot more. So 40 seems inadequate even to get the mechanics and logistics down and see variations in anatomy let alone gaining proficiency and learning subtleties of technique.

 

[nimbus]

Lol. And if you’re not close to that? Can workshops and CME courses replace fellowship?

Ask to do more during residency. It’s the obligation of the program if they want to be considered even below average.

 

[nimbus]

Unless you come a residency that has little regional I think a regional fellowship is not a good fellowship to do (might be up for debate).
It will, however, likely open some doors into some private practices.
Placing SS blocks and catheters fast and efficiently is not very difficult if you come from a regional heavy residency.

Regional and Cardiac make up 85% of my practice and I did not do a fellowship in either.

Sounds like a fantastic job. Cardiac and orthoregional are the 2 funnest parts of anesthesia.

 

[Lecithin5]

How many blocks during residency is adequate? (40 is the ACGME minimum)

I trained at a strong program where arguably the only weakness was regional. I graduated with maybe 70 blocks. I now do every block/catheter quickly and effectively. You just need to do enough in residency to understand image acquisition, and then the technical aspect will improve with practice, be in residency if you are lucky enough to do a lot, or in your practice. My point is, there is hope for a program that is weak in regional!

 

[partydoc]

Lol. And if you’re not close to that? Can workshops and CME courses replace fellowship?

If you want to do pp don't go to a program weak in regional

If you're gonna do academics it probably doesn't matter

 

[POW16]

Ask to do more during residency. It’s the obligation of the program if they want to be considered even below average.

Not always as simple. If there is a block team aka people on a dedicated block rotation, you can't just take their procedures.

 

[partydoc]

Lol. It’s as if one has a choice where they match!

Sure you do, don't be a $hitty applicant

 

[psychbender]

That doesn’t help if you already are where you are. Just asking for advice after the fact

Any skill can be improved upon. Once you are comfortable with the mechanics of doing USD guided blocks, you just need the knowledge of anatomy (and anatomic variants) to become very comfortable with most blocks, in general. If your residency doesn't give you this level of comfort, then make sure that you acquire it in your first job. Learning should not stop when you leave residency. Pick the brains of your peers (whether in residency or in your post-residency job). Scan patients when you have downtime, even if you don't plan on doing a block. Watch videos of blocks, particularly if they show probe/needle positioning on half the screen, so you can see how they obtained those images. From watching a lot of people who are not comfortable with USD trying to do USD guided blocks, one of the hardest things to learn is how to visualize the desired structure, and the entire needle, in one image. Once you have that down, you just have to figure out how to image the intended structure, and you're golden.

 

[pjl]

Any skill can be improved upon. Once you are comfortable with the mechanics of doing USD guided blocks, you just need the knowledge of anatomy (and anatomic variants) to become very comfortable with most blocks, in general. If your residency doesn't give you this level of comfort, then make sure that you acquire it in your first job. Learning should not stop when you leave residency. Pick the brains of your peers (whether in residency or in your post-residency job). Scan patients when you have downtime, even if you don't plan on doing a block. Watch videos of blocks, particularly if they show probe/needle positioning on half the screen, so you can see how they obtained those images. From watching a lot of people who are not comfortable with USD trying to do USD guided blocks, one of the hardest things to learn is how to visualize the desired structure, and the entire needle, in one image. Once you have that down, you just have to figure out how to image the intended structure, and you're golden.

Some say you need 50 blocks of each type to have the imaging down, 150 to be an expert. Obviously many people are better at learning than that, and skills in one block translate to others though. I don't think many would be slower at learning than that.

In PP I do 5-50 blocks a week depending on the rooms I am in. It is pretty easy to get quite facile in that environment, so other than a faster startup when you first graduate I don't see a fellowship helping all that much. Just make sure you do some of every block you have ever heard of during residency.

 

[AdmiralChz]

Some great stuff here, I agree with the majority of posters here. Regional should be largely taught in residency, at least ultrasonographic guidance for techniques - anyone can teach the newer (largely esoteric) blocks but if you aren't familiar with how to do ultrasound-guided regional it's going to be an uphill climb. There may be opportunities for regional fellowship graduates to come into PPs to start home catheter programs (and allowing surgeons to push the limit on outpatient surgeries, like TKAs), but even that is under debate with Exparel becoming more and more used.

In 2017 jobs requiring a large degree of subspecialty work (peds, cardiac) will and should require a fellowship. There was a time 10+ years ago this wasn't necessarily the case but since then the fellowships have proliferated and there are no shortage of graduates. Every major children's hospital will pretty much require a new graduate to have fellowship training.

For cardiac, while Sevo has an awesome setup and a great opportunity to learn cardiac that practice seems to be more of a rarity than a rule. You really don't know what you don't know until you get into it, and in the middle of my cardiac fellowship I see more than ever the utility of doing one. If you want to be an expert in intraoperative echo, do a fellowship.

The other fellowships out there, namely neuro/OB/"informatics"/"preoperative care"/"Insert random facet here"/simulation, are pretty much designed for academic, tenure-track positions. I don't see much use for then in a PP setting.

 

[GA8314]

Some great stuff here, I agree with the majority of posters here. Regional should be largely taught in residency, at least ultrasonographic guidance for techniques - anyone can teach the newer (largely esoteric) blocks but if you aren't familiar with how to do ultrasound-guided regional it's going to be an uphill climb. There may be opportunities for regional fellowship graduates to come into PPs to start home catheter programs (and allowing surgeons to push the limit on outpatient surgeries, like TKAs), but even that is under debate with Exparel becoming more and more used.

In 2017 jobs requiring a large degree of subspecialty work (peds, cardiac) will and should require a fellowship. There was a time 10+ years ago this wasn't necessarily the case but since then the fellowships have proliferated and there are no shortage of graduates. Every major children's hospital will pretty much require a new graduate to have fellowship training.

For cardiac, while Sevo has an awesome setup and a great opportunity to learn cardiac that practice seems to be more of a rarity than a rule. You really don't know what you don't know until you get into it, and in the middle of my cardiac fellowship I see more than ever the utility of doing one. If you want to be an expert in intraoperative echo, do a fellowship.

The other fellowships out there, namely neuro/OB/"informatics"/"preoperative care"/"Insert random facet here"/simulation, are pretty much designed for academic, tenure-track positions. I don't see much use for then in a PP setting.

GE has a TTE which calculates EF for you. Echo will become highly automated and anyone thinking that TEE alone won't lend itself ever more to the masses via automation is probably fooling themselves.

Now, the experiences, level of acuity, and case complexity of a CT fellowship, I'll never deny. But, echo is probably the one major facet of our field set to become a highly automated, easier modality to use than it is currently. Some may see this as "dumbing down" the technology, and others will call it progress.

 

[deleted697535]

I've been thinking about this after talking to one of my mates who did an ob fellowship. He still mainly does ob but doesn't get paid any more for it than anyone else. He also does everything bar hearts and peds on random days... So why do a fellowship at all?

I'm thinking the only fellowships that actually add any value to yourself as a product is cardiac or chronic pain. Maybe ICU too. They're the only ones that are sufficiently specialist enough that other non fellowships can't or at least shouldn't do them...

 

[Twiggidy]

I've been thinking about this after talking to one of my mates who did an ob fellowship. He still mainly does ob but doesn't get paid any more for it than anyone else. He also does everything bar hearts and peds on random days... So why do a fellowship at all?

I'm thinking the only fellowships that actually add any value to yourself as a product is cardiac or chronic pain. Maybe ICU too. They're the only ones that are sufficiently specialist enough that other non fellowships can't or at least shouldn't do them...

and the can of worms is open......(i agree with you btw)

 

[vector2]

GE has a TTE which calculates EF for you. Echo will become highly automated and anyone thinking that TEE alone won't lend itself ever more to the masses via automation is probably fooling themselves.

Now, the experiences, level of acuity, and case complexity of a CT fellowship, I'll never deny. But, echo is probably the one major facet of our field set to become a highly automated, easier modality to use than it is currently. Some may see this as "dumbing down" the technology, and others will call it progress.

This reminds me of the discussion about AI in radiology and computers being able to read a CT. Automated (and accurate) EF by 3D volumetric contour analysis is definitely coming within the next few years, but fortunately for CT anesthesiologists, interpreting EF is a very small part of a larger comprehensive exam, plus it's probably going to take a decade+ before a machine will be able to integrate the clinical and echocardiographic information required to competently evaluate a complex mitral valve repair intraop.

 

[GA8314]

This reminds me of the discussion about AI in radiology and computers being able to read a CT. Automated (and accurate) EF by 3D volumetric contour analysis is definitely coming within the next few years, but fortunately for CT anesthesiologists, interpreting EF is a very small part of a larger comprehensive exam, plus it's probably going to take a decade+ before a machine will be able to integrate the clinical and echocardiographic information required to competently evaluate a complex mitral valve repair intraop.

I was simply pointing out that echo will be substantially more user friendly in the future than now. This will increase it's applicability and user base IMO.

 

[nimbus]

I was simply pointing out that echo will be substantially more user friendly in the future than now. This will increase it's applicability and user base IMO.

Doubtful. Are there any non academic, non cardiac anesthesiologists using TEE in the real world? Seems like most have zero interest in learning or even touching it.

 

[Twiggidy]

Doubtful. Are there any non academic, non cardiac anesthesiologists using TEE in the real world? Seems like most have zero interest in learning or even touching it.

Much of it depends on where you practice. Some places will want your input on the TEE whereas some places the CV surgeon could care less what you think and only rely on the opinion of the cardiologist or the echo tech. obviously in my biased opinion i'm not a fan of the latter. i understand the logic where they "simply want you to take care of the patient" and not play with the echo.

most of us can drop a probe and look at function but it's the odd stuff where CV anesthesiologists shine. for instance, i still have to show people how to find the view to evaluate a saddle embolus and various other of the essential 20 views. that's the difference between anesthesiologist with "cardiac experience" and a "cardiac anesthesiologists"

 

[psychbender]

Doubtful. Are there any non academic, non cardiac anesthesiologists using TEE in the real world? Seems like most have zero interest in learning or even touching it.

Yes. I know several (and am one).

Sent from my SM-G930V using SDN mobile

 

[anes121508]

To put things into perspective for those thinking of doing either fellowship:
My days in the cardiac rooms are relatively easy days with the occasional difficult case that may pose some clinical and/or diagnostic challenges.
My ortho days are just super fast and super busy with hardly any down time.

Love this quote. Couldn’t be more true.

 

[anes121508]

GE has a TTE which calculates EF for you. Echo will become highly automated and anyone thinking that TEE alone won't lend itself ever more to the masses via automation is probably fooling themselves.

Now, the experiences, level of acuity, and case complexity of a CT fellowship, I'll never deny. But, echo is probably the one major facet of our field set to become a highly automated, easier modality to use than it is currently. Some may see this as "dumbing down" the technology, and others will call it progress.

Have you ever “fact checked” the AI on these automated programs? The Siemens machine with e-sie valve has a long long long way to go. The best AI is likely EF, but to be honest this is not really what you do a fellowship for. Probably the last question the surgeon/interventional cardiologists needs answered. To think that AI coming down the pipeline is a reason to not do a cardiac fellowship is bogus. Some AI will be helpful, but understanding how to obtain a good 3-D volume and the underlying limitations is a must. It’s like using a blood pressure cuff and not knowing how to put it in the patient or that the surgeon leaning on it could lead to errors. Either way...My feeling is that no matter how good AI gets, it’s always going to have some element of user dependency and won’t replace expert knowledge gained during fellowship (or in sevo’s case, spare time).

 

[anes121508]

Much of it depends on where you practice. Some places will want your input on the TEE whereas some places the CV surgeon could care less what you think and only rely on the opinion of the cardiologist or the echo tech. obviously in my biased opinion i'm not a fan of the latter. i understand the logic where they "simply want you to take care of the patient" and not play with the echo.

most of us can drop a probe and look at function but it's the odd stuff where CV anesthesiologists shine. for instance, i still have to show people how to find the view to evaluate a saddle embolus and various other of the essential 20 views. that's the difference between anesthesiologist with "cardiac experience" and a "cardiac anesthesiologists"

Very very very true. I’d even argue the difference is far beyond being able to find the whale’s tale. Id also argue that cardiac fellowship folks have the chance to be far more versed than cardiologists when it comes to 3-D in the perioperative setting. I mean pt is asleep and not gagging on the echo. You can take 500+ clips of the mitral valve with different settings to figure out what works and what doesn’t. Then, as a fellow, you sit on bypass and manipulate the image, play with q-lab, and explore anything you want during the academic center 90 min cpb time. The cardiology fellow is rounding and writing notes? Ok a bit of an exaggeration, but you get the point. Time as a fellow is golden, if you take advantage.

 

[Nivens]

Id also argue that cardiac fellowship folks have the chance to be far more versed than cardiologists when it comes to 3-D in the perioperative setting.

I imagine some of this is dependent on where you train, no?

 

[GA8314]

Have you ever “fact checked” the AI on these automated programs? The Siemens machine with e-sie valve has a long long long way to go. The best AI is likely EF, but to be honest this is not really what you do a fellowship for. Probably the last question the surgeon/interventional cardiologists needs answered. To think that AI coming down the pipeline is a reason to not do a cardiac fellowship is bogus. Some AI will be helpful, but understanding how to obtain a good 3-D volume and the underlying limitations is a must. It’s like using a blood pressure cuff and not knowing how to put it in the patient or that the surgeon leaning on it could lead to errors. Either way...My feeling is that no matter how good AI gets, it’s always going to have some element of user dependency and won’t replace expert knowledge gained during fellowship (or in sevo’s case, spare time).

Let me be clear. And perhaps I have confused this issue unintentionally. But, in no way am I suggesting that a future ease of use of echo, or even highly automated echo (AI if you want to call it that), which has the ability to be useful to a broader array of anesthesiologists is reason to not do a cardiac fellowship.

As a bit of an aside, we tried out the GE Venue POC US machine with the TTE probe and the visualization (as well for PNB's) is remarkable.

I'm excited about bedside TTE in patients with extensive cardiac risk factors or history (ex: your typical vascular patient), and the ability to at least get a good glimpse at any major AS/AI, MS/MI, LVH, and contractility. Not to mention use in the OR, for a quick, portable (let's be honest, the large TEE machines aren't very nimble) look at the heart.

 

[GA8314]

Very very very true. I’d even argue the difference is far beyond being able to find the whale’s tale. Id also argue that cardiac fellowship folks have the chance to be far more versed than cardiologists when it comes to 3-D in the perioperative setting. I mean pt is asleep and not gagging on the echo. You can take 500+ clips of the mitral valve with different settings to figure out what works and what doesn’t. Then, as a fellow, you sit on bypass and manipulate the image, play with q-lab, and explore anything you want during the academic center 90 min cpb time. The cardiology fellow is rounding and writing notes? Ok a bit of an exaggeration, but you get the point. Time as a fellow is golden, if you take advantage.

Hell, the cardiologists where I work don't even know their "knobology". That's all done by the echo techs.

 

[nimbus]

Much of it depends on where you practice. Some places will want your input on the TEE whereas some places the CV surgeon could care less what you think and only rely on the opinion of the cardiologist or the echo tech. obviously in my biased opinion i'm not a fan of the latter. i understand the logic where they "simply want you to take care of the patient" and not play with the echo.

most of us can drop a probe and look at function but it's the odd stuff where CV anesthesiologists shine. for instance, i still have to show people how to find the view to evaluate a saddle embolus and various other of the essential 20 views. that's the difference between anesthesiologist with "cardiac experience" and a "cardiac anesthesiologists"

I think you misunderstood my post. I was merely pointing out that most general anesthesiologists I know have little interest in learning or using echo.

 

[BLADEMDA]

I've been thinking about this after talking to one of my mates who did an ob fellowship. He still mainly does ob but doesn't get paid any more for it than anyone else. He also does everything bar hearts and peds on random days... So why do a fellowship at all?

I'm thinking the only fellowships that actually add any value to yourself as a product is cardiac or chronic pain. Maybe ICU too. They're the only ones that are sufficiently specialist enough that other non fellowships can't or at least shouldn't do them...

1. Cardiac
2. Pain
3. Peds
4. Critical Care

Those are the only ones which add "value" IMHO. I highly recommend you do 1 or 2 fellowships these days. I realize number 4 isn't for everyone but it's still highly specialized and valuable in the right practice setting.

The American Board of Anesthesiology - Pediatric Anesthesiology
The American Board of Anesthesiology - Critical Care Medicine Certification

Love 'em or hate 'em the above 2 fellowships are "real" and do add value especially in academics and large tertiary private practice settings.

 

[MaximusD]

How many blocks during residency is adequate? (40 is the ACGME minimum)

I think my recorded # is somewhere around 150 excluding neuraxial and abdominal plane blocks. No additional electives. Not including outpatient pain procedures.

 

[GA8314]

I think you misunderstood my post. I was merely pointing out that most general anesthesiologists I know have little interest in learning or using echo.

I think we do some of this to ourselves. I tell residents that Echo is simply a tool. It's a monitor. As such, there are different levels of skill, ranging on a spectrum from basic, intermediate, to advanced. Where I trained, they taught almost that the ONLY way to do echo was at a very advanced level. I think this has the ability to intimidate some folks. In other words, if you make any use of echo into rocket science, then people may shy away from it. Hell, it intimidated me a bit, but I pushed through that, even doing a month long elective in TEE outside of a general cardiac rotation.

Conversely, teach it as simply another MONITOR to be utilized to any number of skill/competency levels, and I think people would embrace it more. Trans Thoracic is exciting to me and probably a good example of what I'm talking about since it's LESS about intraoperative DIAGNOSIS (hence the hard core attitude about it which extends beyond high level diagnostics) and more about a qualitative "look" at the general function of the heart. So, I think it will be embraced much more, whether for preop eval or intraop use.

 

[AdmiralChz]

Conversely, teach it as simply another MONITOR to be utilized to any number of skill/competency levels, and I think people would embrace it more. Trans Thoracic is exciting to me and probably a good example of what I'm talking about since it's LESS about intraoperative DIAGNOSIS (hence the hard core attitude about it which extends beyond high level diagnostics) and more about a qualitative "look" at the general function of the heart. So, I think it will be embraced much more, whether for preop eval or intraop use.

I agree with this sentiment for the most part. TEE (and TTE) is a valuable tool when things are getting pretty hairy intraop/preop/PACU. I really believe that new graduates should have some baseline understanding of the views and how to get them - and yes, I largely mean qualitative assessment (is function good/bad, are the valves OK/awful, gigantic effusion/none). You don't have to "love" it, but if all else fails know how to use it in a true emergency.

Clearly the powers that be at the ABA agree as it is frequently tested on the boards and is being incorporated into the OSCE portion of the applied exam.

 

[nimbus]

I think we do some of this to ourselves. I tell residents that Echo is simply a tool. It's a monitor. As such, there are different levels of skill, ranging on a spectrum from basic, intermediate, to advanced. Where I trained, they taught almost that the ONLY way to do echo was at a very advanced level. I think this has the ability to intimidate some folks. In other words, if you make any use of echo into rocket science, then people may shy away from it. Hell, it intimidated me a bit, but I pushed through that, even doing a month long elective in TEE outside of a general cardiac rotation.

Conversely, teach it as simply another MONITOR to be utilized to any number of skill/competency levels, and I think people would embrace it more. Trans Thoracic is exciting to me and probably a good example of what I'm talking about since it's LESS about intraoperative DIAGNOSIS (hence the hard core attitude about it which extends beyond high level diagnostics) and more about a qualitative "look" at the general function of the heart. So, I think it will be embraced much more, whether for preop eval or intraop use.

Agree 100% and the more people use it, the more they will become familiar with it and see how useful it can be.

 

[T-burglar]

TEE will never be “easy” or “automated”. You have to know cardiovascular disease inside and out to interpret the study. Just like radiologists interpreting a CT scan

 

[Twiggidy]

I think you misunderstood my post. I was merely pointing out that most general anesthesiologists I know have little interest in learning or using echo.

Oh yeah. Definitely. If you're practicing general a TEE is one of the last things you want in your practice to keep you work-life sane.

 

[Twiggidy]

I think we do some of this to ourselves. I tell residents that Echo is simply a tool. It's a monitor. As such, there are different levels of skill, ranging on a spectrum from basic, intermediate, to advanced. Where I trained, they taught almost that the ONLY way to do echo was at a very advanced level. I think this has the ability to intimidate some folks. In other words, if you make any use of echo into rocket science, then people may shy away from it. Hell, it intimidated me a bit, but I pushed through that, even doing a month long elective in TEE outside of a general cardiac rotation.

Conversely, teach it as simply another MONITOR to be utilized to any number of skill/competency levels, and I think people would embrace it more. Trans Thoracic is exciting to me and probably a good example of what I'm talking about since it's LESS about intraoperative DIAGNOSIS (hence the hard core attitude about it which extends beyond high level diagnostics) and more about a qualitative "look" at the general function of the heart. So, I think it will be embraced much more, whether for preop eval or intraop use.

A definitely argument can be made that among ALL anesthesiologists, TTE is probably more important to learn and grasp vs TEE. It's less invasive and you can get valuable information quickly. We shine often at my gig when "someone isn't looking good" late in the day or middle of the night and we have the ability to put the TTE probe on the chest and a do a quick and dirty evaluation.

 

[anbuitachi]

I find it really annoying because i really want to be good in TEE but not do a cardiac fellowship since im not interested in cardiac. However it is hard to do TEE on people as a generalist since TEE probes are expensive and has to be cleaned for each patient , and it's not always a benign procedure like TTE

Do want to also learn TTE but the chest is almost always covered by ton of drapess... unless its an ankle case. And also we only have straight linear probes for our ultrasounds