Study Guide For Adult Cardiothoracic Exam?

[Iso4ane]

So now that this exam has come to fruition (no matter our feelings on the matter) any idea how to study for this exam?

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[vector2]

I'm just gonna follow the outline and use some mixture of Kaplan, hensley, and uptodate articles. Probably also see if our residency coordinator can slip me a login to our institutional truelearn account and then do some of the cardiac questions.

 

[bigdan]

Rumor has it that Kaplan is putting out a cardiac anesthesia board review book. Haven’t heard any dates for release, if in fact that came to fruition.

I have the outline for the exam printed out, and will/may/hope to go through those topics in Kaplan to some degree before Dec.

 

[T-burglar]

Content outline looks stupid

 

[pgg]

Content outline looks stupid

The whole thing is stupid.

Haven't decided if I'm going to take it or not.

Credentialing where I'm at isn't going to care either way. 98% sure I'm working at my last job ever, except maybe some part time locums stuff years from now when I semi-retire. Either way - hard to believe that in the next 10 years someone won't hire or credential echo-boarded, fellowship-trained cardiac anesthesiologists who don't have the ABA's subspecialty board certification ticket.

I think my CME and study time would be better spent doing something like Echo Week.

I'm just not seeing any upside, besides bragging rights. And I'm not real motivated to be able to brag that I let the ABA scam me out of a couple thousand dollars and 30 or 40 hours of study time that could be better spent reading something else, or getting drunk.

 

[ucladoc2b]

Anyone fining this to be mandatory anywhere?

 

[vector2]

The whole thing is stupid.

Haven't decided if I'm going to take it or not.

Credentialing where I'm at isn't going to care either way. 98% sure I'm working at my last job ever, except maybe some part time locums stuff years from now when I semi-retire. Either way - hard to believe that in the next 10 years someone won't hire or credential echo-boarded, fellowship-trained cardiac anesthesiologists who don't have the ABA's subspecialty board certification ticket.

I think my CME and study time would be better spent doing something like Echo Week.

I'm just not seeing any upside, besides bragging rights. And I'm not real motivated to be able to brag that I let the ABA scam me out of a couple thousand dollars and 30 or 40 hours of study time that could be better spent reading something else, or getting drunk.

I would say probably the majority of the impetus the ABA has for creating these exams (and MOCA) is based on money and not actually on the premise that these tests ensure the knowledge of the testee, but I think there's a couple points regarding the exam that are worthy of consideration.

The first is that the aPTE is sponsored by the NBE and SCA, and those orgs are separate from the ABA. To a third party observer it's odd that the exam which qualifies you as a fellowship trained cardiac anesthesiologist is not sponsored by your certifying board.

Second, the aPTE is not explicitly a test about cardiac anesthesia. It's just not. I was able to come into the cardiac ORs and do about a hundred TEEs as an ICU fellow, read Mathew, do PTE masters, and get 90th+ %ile on the exam. All without spending one day during fellowship actually doing bonafide cardiac anesthesia. Now you might say the fact that you became NBE certified and did 150 exams during ACTA fellowship means the inherent cardiac anesthesia knowledge must be there, and I think for the vast majority of fellows you're probably right. But that still segues into my third point, which is:

Every other ACGME anesthesiology fellowship still has an ABA specific exam to become certified in that specialty even if presumably (like most ACTA fellows) they acquired the sufficient subspecialty knowledge during that fellowship. Say for instance I'm interested in critical care, particularly CTICU, and I do an ACGME fellowship where I get heavy CTICU and echo experience. I qualify to take the critical care echo exam and become NBE certified. Great. I still have to take the ABA CCM exam. And if we compare this situation to people in another specialty, like say those who used to do the majority of intraop TEE before anesthesiologists took over most places, they still have to become boarded in IM, cards, and echo even if they spend the vast majority of their time in an echo lab reading room.

That being said, the way the ABA is going about this is pants-on-head dotarded. It's essentially unacceptable that with the ever-multiplying exams the ABA has come up with that they didn't liaise with the NBE/SCA to roll the aPTE or the vast majority of TEE covered into the exam into the cardiac anesthesiology exam, make the test two sequential days or whatever, and decrease the price of the exam so it's less than taking both of them separately.

 

[abolt18]

I would say probably the majority of the impetus the ABA has for creating these exams (and MOCA) is based on money and not actually on the premise that these tests ensure the knowledge of the testee, but I think there's a couple points regarding the exam that are worthy of consideration.

The first is that the aPTE is sponsored by the NBE and SCA, and those orgs are separate from the ABA. To a third party observer it's odd that the exam which qualifies you as a fellowship trained cardiac anesthesiologist is not sponsored by your certifying board.

Second, the aPTE is not explicitly a test about cardiac anesthesia. It's just not. I was able to come into the cardiac ORs and do about a hundred TEEs as an ICU fellow, read Mathew, do PTE masters, and get 90th+ %ile on the exam. All without spending one day during fellowship actually doing bonafide cardiac anesthesia. Now you might say the fact that you became NBE certified and did 150 exams during ACTA fellowship means the inherent cardiac anesthesia knowledge must be there, and I think for the vast majority of fellows you're probably right. But that still segues into my third point, which is:

Every other ACGME anesthesiology fellowship still has an ABA specific exam to become certified in that specialty even if presumably (like most ACTA fellows) they acquired the sufficient subspecialty knowledge during that fellowship. Say for instance I'm interested in critical care, particularly CTICU, and I do an ACGME fellowship where I get heavy CTICU and echo experience. I qualify to take the critical care echo exam and become NBE certified. Great. I still have to take the ABA CCM exam. And if we compare this situation to people in another specialty, like say those who used to do the majority of intraop TEE before anesthesiologists took over most places, they still have to become boarded in IM, cards, and echo even if they spend the vast majority of their time in an echo lab reading room.

That being said, the way the ABA is going about this is pants-on-head dotarded. It's essentially unacceptable that with the ever-multiplying exams the ABA has come up with that they didn't liaise with the NBE/SCA to roll the aPTE or the vast majority of TEE covered into the exam into the cardiac anesthesiology exam, make the test two sequential days or whatever, and decrease the price of the exam so it's less than taking both of them separately.

One correction, OB and Regional anesthesia are ACGME accredited and, as far as I know, do not have an exam. Possibly others I'm not thinking of.

 

[vector2]

One correction, OB and Regional anesthesia are ACGME accredited and, as far as I know, do not have an exam. Possibly others I'm not thinking of.

Sorry, I meant to say the ACGME anesthesiology fellowships worth doing

 

[pgg]

I would say probably the majority of the impetus the ABA has for creating these exams (and MOCA) is based on money and not actually on the premise that these tests ensure the knowledge of the testee, but I think there's a couple points regarding the exam that are worthy of consideration.

The first is that the aPTE is sponsored by the NBE and SCA, and those orgs are separate from the ABA. To a third party observer it's odd that the exam which qualifies you as a fellowship trained cardiac anesthesiologist is not sponsored by your certifying board.

Second, the aPTE is not explicitly a test about cardiac anesthesia. It's just not. I was able to come into the cardiac ORs and do about a hundred TEEs as an ICU fellow, read Mathew, do PTE masters, and get 90th+ %ile on the exam. All without spending one day during fellowship actually doing bonafide cardiac anesthesia. Now you might say the fact that you became NBE certified and did 150 exams during ACTA fellowship means the inherent cardiac anesthesia knowledge must be there, and I think for the vast majority of fellows you're probably right. But that still segues into my third point, which is:

Every other ACGME anesthesiology fellowship still has an ABA specific exam to become certified in that specialty even if presumably (like most ACTA fellows) they acquired the sufficient subspecialty knowledge during that fellowship. Say for instance I'm interested in critical care, particularly CTICU, and I do an ACGME fellowship where I get heavy CTICU and echo experience. I qualify to take the critical care echo exam and become NBE certified. Great. I still have to take the ABA CCM exam. And if we compare this situation to people in another specialty, like say those who used to do the majority of intraop TEE before anesthesiologists took over most places, they still have to become boarded in IM, cards, and echo even if they spend the vast majority of their time in an echo lab reading room.

That being said, the way the ABA is going about this is pants-on-head dotarded. It's essentially unacceptable that with the ever-multiplying exams the ABA has come up with that they didn't liaise with the NBE/SCA to roll the aPTE or the vast majority of TEE covered into the exam into the cardiac anesthesiology exam, make the test two sequential days or whatever, and decrease the price of the exam so it's less than taking both of them separately.

I see where you're coming from but I don't completely agree -

CCM and pain deserve/need their own subspecialty board exam because practice in those subspecialties involves fundamentally different skill and knowledge sets compared to a generalist anesthesiologist. There are pain and CCM guys who don't ever set foot in an OR. Peds is still fundamentally anesthesia, but there are enough not-just-small-adult issues and congenital weirdness that a peds specific exam isn't unreasonable.

I (and generalist anesthesiologists) are totally unqualified to run an ICU, do interventional pain, or take care of FLK neonates. There sure are a whole lot of non-ACTA trained anesthesiologists doing cardiac however ... albeit often with the crutch of a cardiologist coming to the OR to do or opine on TEEs.

Cardiac anesthesia, and I say this with all respect to myself and other ACTA grads, is mostly just general anesthesia on sick old vasculopaths undergoing procedures that benefit from advanced TEE knowledge. I think the NBE exam is sufficient.


Part of my reluctance is just obstinance. I'm barely tolerating this stupid MOCA game, and doing TWO cardiac subspecialty exams makes me nauseous. I resent the ABA more and more, every year. These are the people who conjured the absolutely idiotic OSCE part of the oral exam for (apparently) the sole purpose of justifying the construction of a big sim center. Or maybe they really are dumb enough to believe that OSCEs have value, or maybe they didn't want the clowns running the USMLE to be the only ones milking that cow.

I'm looking for the value in playing along and I'm just not finding it.

 

[TexBlazer2106]

I plan on taking the exam even knowing full well that it's a racket. It's another layer to show hospitals, payers, patients that you're "special." I agree with others who say we've really just become anesthesiologists for the sick patients.

Cardiac reimbursement is interesting though because our payer mix is so bad, yet gasworks and all of my previous interviews gives me the impression that we command a premium on the market. It makes for some interesting group dynamics, especially with the ones who do a lot of OB.

 

[Iso4ane]

Cardiac anesthesia, and I say this with all respect to myself and other ACTA grads, is mostly just general anesthesia on sick old vasculopaths undergoing procedures that benefit from advanced TEE knowledge. I think the NBE exam is sufficient.

Funny thing you say that, I just came across a blurb in JCVA, that states the major differentiator between a cardiac and general anesthesiologist is the ability to use TEE (in addition to being maybe having a little more comfort with the really bad cardiomyopaths and vasculopaths, but this would really be hospital dependent). And the previous testing expectation reflects that.

Cardiac reimbursement is interesting though because our payer mix is so bad, yet gasworks and all of my previous interviews gives me the impression that we command a premium on the market. It makes for some interesting group dynamics, especially with the ones who do a lot of OB.

I recently got a locums email that offered 60K-80K/month for a cardiac anesthesiologist in the midwest, so the need is there in some locales.

 

[vector2]

Cardiac anesthesia, and I say this with all respect to myself and other ACTA grads, is mostly just general anesthesia on sick old vasculopaths undergoing procedures that benefit from advanced TEE knowledge. I think the NBE exam is sufficient.

Funny thing you say that, I just came across a blurb in JCVA, that states the major differentiator between a cardiac and general anesthesiologist is the ability to use TEE (in addition to being maybe having a little more comfort with the really bad cardiomyopaths and vasculopaths, but this would really be hospital dependent). And the previous testing expectation reflects that.

I get where you guys are coming from, but all I can do is speak from my personal experience, which is as someone who was pretty good at general anesthesia upon graduation from residency, pretty knowledgeable about TEE upon graduation from CCM fellowship, but who still was not the equivalent of someone ACTA fellowship trained at that point.

Even though I was doing hearts from the time I finished, I really think it took another year or two (plus ongoing learning to this day) to fill in a lot of practical and knowledge gaps that someone with extensive cardiac experience or fellowship training has.


@nimbus what do you think as someone who was a generalists who took aPTE, did hearts,.and then stopped doing them later in your career?

 

[TexBlazer2106]

I recently got a locums email that offered 60K-80K/month for a cardiac anesthesiologist in the midwest, so the need is there in some locales.

I saw this advertisement too. Obviously it's not as straightforward as making 700k minimum, however most other advertisements that I've seen have have cardiac paying 50-100k more than generalists.

 

[vector2]

I recently got a locums email that offered 60K-80K/month for a cardiac anesthesiologist in the midwest, so the need is there in some locales.

There's a FT cardiac opening a couple hrs away from me at a place where I had done some locums a few yrs ago. The FT doc there is an acquaintanc of mine and says she's leaving cause she's going take one of the 40-50k per week locums offers she's been getting.

 

[pgg]

I get where you guys are coming from, but all I can do is speak from my personal experience, which is as someone who was pretty good at general anesthesia upon graduation from residency, pretty knowledgeable about TEE upon graduation from CCM fellowship, but who still was not the equivalent of someone ACTA fellowship trained at that point.

Even though I was doing hearts from the time I finished, I really think it took another year or two (plus ongoing learning to this day) to fill in a lot of practical and knowledge gaps that someone with extensive cardiac experience or fellowship training has.


@nimbus what do you think as someone who was a generalists who took aPTE, did hearts,.and then stopped doing them later in your career?

Yeah I don't want to sell myself short here - I certainly feel like I bring something to the heart room that non fellowship trained / "practice pathway" people don't. And I'm very wary of Dunning-Kruger and I try to underestimate what I'm capable of, at least internally.

I just feel like the fact that there is a "practice pathway" for generalists to adequately and safely do cardiac most places (+/- intraop cardiologist backup), and there really isn't one for generalists to go do interventional pain or CCM, means something. I know, lots of generalists are out there doing pain procedures, but I think they're dumber than their patients and the people referring patients to them. Not a state of affairs one should aspire to. For CCM sure there are generalists in ICUs ... but not really outside of podunk community places where hospitalists and ER and FP and peds docs are also the intensivists. Generalists aren't doing unhealthy or malformed neonates ... typically hospitals won't even credential a non-peds trained person to touch a kid under 30 days, even a healthy one.

What is the key non-core privilege for cardiac anesthesia that hospital credentialing cares about? TEE. And there are practice pathways for some degree of certification there - beyond the basic exam, there's advance testamur status. Until 2009 there was even a practice pathway for full advanced periop TEE cert from NBE.

When I'm asked by a cardiac-doing but not-cardiac-trained anesthesiologist for something with CABG or valve they're doing, it's always a TEE question. Always a what-do-you-think-of-this-valve kind of question. Sometimes they don't know what views to get or measurements to make to evaluate a prosthetic. And yes there's some knowledge background there and some subtleties, e.g. the thread we had recently about intervening on a tricuspid that's incidentally noted to be "bad" while doing something else. But the lion's share of that is TEE related knowledge.

Hence my view that the NBE exam is appropriate and sufficient.

I don't know. If someone talks me into taking this stupid exam, or I talk myself into doing it, I'll probably learn something new preparing for it, and maybe adjust my opinion.

 

[vector2]

Yeah I don't want to sell myself short here - I certainly feel like I bring something to the heart room that non fellowship trained / "practice pathway" people don't. And I'm very wary of Dunning-Kruger and I try to underestimate what I'm capable of, at least internally.

I just feel like the fact that there is a "practice pathway" for generalists to adequately and safely do cardiac most places (+/- intraop cardiologist backup), and there really isn't one for generalists to go do interventional pain or CCM, means something. I know, lots of generalists are out there doing pain procedures, but I think they're dumber than their patients and the people referring patients to them. Not a state of affairs one should aspire to. For CCM sure there are generalists in ICUs ... but not really outside of podunk community places where hospitalists and ER and FP and peds docs are also the intensivists. Generalists aren't doing unhealthy or malformed neonates ... typically hospitals won't even credential a non-peds trained person to touch a kid under 30 days, even a healthy one.

What is the key non-core privilege for cardiac anesthesia that hospital credentialing cares about? TEE. And there are practice pathways for some degree of certification there - beyond the basic exam, there's advance testamur status. Until 2009 there was even a practice pathway for full advanced periop TEE cert from NBE.

When I'm asked by a cardiac-doing but not-cardiac-trained anesthesiologist for something with CABG or valve they're doing, it's always a TEE question. Always a what-do-you-think-of-this-valve kind of question. Sometimes they don't know what views to get or measurements to make to evaluate a prosthetic. And yes there's some knowledge background there and some subtleties, e.g. the thread we had recently about intervening on a tricuspid that's incidentally noted to be "bad" while doing something else. But the lion's share of that is TEE related knowledge.

Hence my view that the NBE exam is appropriate and sufficient.

I don't know. If someone talks me into taking this stupid exam, or I talk myself into doing it, I'll probably learn something new preparing for it, and maybe adjust my opinion.

I agree with what you're saying regarding the non-OR based fellowships being so distinct as to require separate boards, but I think with cardiac you're focusing in the chipshots, whereas with peds you've mostly been mentioning neonates/congenital/sick kids, despite the fact that there are plenty of generalists who are doing a fair amount of non-neonate kids in their practice, and grandfathered non-fellowship-trained peds folks doing the full gamut of peds anesthesia. And many hospitals are going in the direction of requiring peds boards to do kids period, assuming they have that kind of labor supply in their area.

The same has been happening to cardiac, where increasingly many jobs, even ones that don't have ECMO, LVAD, tx, etc, are requiring cardiac fellowship training and NBE certified status. I know this from experience looking at the FT/locums cardiac market. One of my residency classmates who's ACTA trained lives in a place where there are two big practices that do cardiac, and both of them require fellowship + cert despite mostly having what could be described as a community+ case mix.

Which again kind of begs the question, why are there so many practices transitioning to this requirement if, as some of you are saying, cardiac anesthesia essentially just requires a good generalist who knows something about TEE? Sure, some of the answer is that credentialing administrators love when applicants can check all the potential boxes (superfluous or not), but as I alluded to earlier, some of it is that there absolutely is a practical and theoretical knowledge base that really only comes from fellowship training + reading about the topics mentioned in the content outline of the test no one wants to take.

I remember when you were talking about your ACTA application process, you mentioned that you were more interested in do-the-case fellowships vs do-the-echo-while-the-resident-does-the-case fellowships. I remember your stated reasoning, but what you said then doesn't seem exactly congruent with what you're saying now. You were already a solid generalist with many years of practice before going back to fellowship, so really all you needed was a cush year that would let you get echo cert, right?

 

[TexBlazer2106]

Good points vector, MCS is another separator too. Most reasonable generalists want nothing to do with MCS either in stock patients or ones with VADs coming in for routine procedures.

 

[psychbender]

This is going to be an unpopular opinion, but as a person in a similar position as Vector (CCM, Advanced PTE testamur, doing cardiac cases), I'm planning on taking this exam, as insurance for the future. While I hope that my current practice remains my final one, I know from previous job searches that my lack of ACTA fellowship would prevent me from doing the cases I've done for over a decade since residency at some places (even at some low volume/low acuity heart programs). Nearly all of my CME is already cardiac, echo, and critical care topics, my ICU time is almost exclusively in the CVICU (though half my patients are more MICU in nature, any given week), and I'm trying to expand my role in MCS here (since I think we do it poorly, and I have more experience than anyone else in the CCM department). Costs for the exam and any prep needed will come from my professional fund, so it's mostly a matter of the time cost in studying.

 

[pgg]

Which again kind of begs the question, why are there so many practices transitioning to this requirement if, as some of you are saying, cardiac anesthesia essentially just requires a good generalist who knows something about TEE?

I think it's hard - not impossible, but hard - for anyone to get the requisite exams and (just as important) the proctored reads without doing an ACTA fellowship. There are some who manage to do it in CCM fellowships, though NBE is pretty explicit about the requirement for advanced certification is a fellowship year dedicated to the treatment of cardiac surgical patients. Which per the letter of the requirement, isn't any CCM program, though in practice NBE has been happy to take their money.

So the credentialing committees who demand TEE certification are essentially requiring ACTA graduates.

I remember when you were talking about your ACTA application process, you mentioned that you were more interested in do-the-case fellowships vs do-the-echo-while-the-resident-does-the-case fellowships. I remember your stated reasoning, but what you said then doesn't seem exactly congruent with what you're saying now. You were already a solid generalist with many years of practice before going back to fellowship, so really all you needed was a cush year that would let you get echo cert, right?

Well a big part of that was because I'd spent the previous 7 years as a generalist and hadn't done a single heart in that time. I felt like I needed or at least would benefit from the OR time managing those patients start to finish.

And to be truthful I felt like the first few months of fellowship I was somewhat behind my peers, because almost all of them (about a dozen - there was one who'd practiced for a year) were exiting residencies in which they'd just done a whole lot of cardiac anesthesia. I don't think I'd have been well served by an "echo fellowship" in which I popped from room to room reading TEEs while residents did the cases.

Anyway, I think there's no denying that TEE is one of the core elements of the fellowship, even the workhorse sit-your-own heart every day ones. An attending held echo rounds every day at my program. Weekly academics were largely echo related. The department Christmas tree was decorated with printed TEE images (color M-mode makes some pretty pictures).

If it's not obvious I'm still deciding what I think about all of this. Some of my posting in this thread is thinking aloud, tempered with some venting and my default bad attitude toward the ABA.

Odds are I'll take the stupid thing. I've spent the last 30 years of my life sequentially clawing at one more bit of bling for my CV, why stop now? Even if I suspect some of it is mental illness. Also, if my ACTA partners are going to take it, much less one of those CCM guys, well, I can't let them get that one up on me.

 

[T-burglar]

I plan on taking the exam even knowing full well that it's a racket. It's another layer to show hospitals, payers, patients that you're "special." I agree with others who say we've really just become anesthesiologists for the sick patients.

Cardiac reimbursement is interesting though because our payer mix is so bad, yet gasworks and all of my previous interviews gives me the impression that we command a premium on the market. It makes for some interesting group dynamics, especially with the ones who do a lot of OB.

Everyone parrots this “payor mix is **** in cardiac surgery “ but I can never find anything on hospital reimbursement data searches to corroborate it. Cardiac surgery is consistently the highest grossing service in any hospital.

That’s why cardiac anesthesia is in demand and gets paid a premium . I’ll probably never do this exam because I have better things to do .. like play with my balls

 

[vector2]

Everyone parrots this “payor mix is **** in cardiac surgery “ but I can never find anything on hospital reimbursement data searches to corroborate it. Cardiac surgery is consistently the highest grossing service in any hospital.

That’s why cardiac anesthesia is in demand and gets paid a premium . I’ll probably never do this exam because I have better things to do .. like play with my balls

I dont know why the payor mix would be different than any other surgery in the hospital. It's the same patient base (old people).

What can be a killer is having a slow CT surgeon. The extra startup units from a pump case won't make it that much more lucrative if you're only doing one case a day. Someone doing 5 or 6 gastric sleeves with a fast surgeon will start passing you on total units on any given day...

 

[T-burglar]

Yes, that’s true. I’ve seen a profitable cardiac surgery service reduced to ashes with the addition of bad slow surgeons.

It’s not like general surgery where, if the surgeon is bad, they can still usually do a timely enough chole or appy without draining the blood bank and filling the ICU for days. Cardiac surgeons need to be good enough that the bulk of their case volume works out to be at least 2 pump cases a day that are out of the ICU in 48 hrs, transfused little if any, and aren’t readmitted soon after discharge. That’s Not as easy.

 

[TexBlazer2106]

My understanding for our group is that the payer mix for the cardiac people is roughly 70% Medicare. At the advance meeting a couple of weekends ago, they said the 33% problem we have with Medicare is now a 25% problem. So if we get a quarter of our market rate/u from the government then our collections as a group are pretty miserable. I can’t imagine a much worse payer mix for a group or division.

But I agree that cardiac has a market, just look at gasworks, the most lucrative jobs in the same markets are the cardiac ones, at least superficially.

I do think most of our value from the hospital side comes from working in the EP lab, structural heart cases (esp TAVRs) and HF although I don’t have any data to support this.

 

[nimbus]

I get where you guys are coming from, but all I can do is speak from my personal experience, which is as someone who was pretty good at general anesthesia upon graduation from residency, pretty knowledgeable about TEE upon graduation from CCM fellowship, but who still was not the equivalent of someone ACTA fellowship trained at that point.

Even though I was doing hearts from the time I finished, I really think it took another year or two (plus ongoing learning to this day) to fill in a lot of practical and knowledge gaps that someone with extensive cardiac experience or fellowship training has.


@nimbus what do you think as someone who was a generalists who took aPTE, did hearts,.and then stopped doing them later in your career?

I agree with you. My hiatus was fairly long. I did hearts for 1 year in academics immediately after residency without a fellowship because that was pretty common at the time. I did maybe 20-30 cases that year because I wasn’t really cardiac faculty, just a warm body to do hearts when they needed an extra person. But then I had a 12-13 year hiatus in private practice. When I restarted hearts in PP, we had a great need so I had a lot of support from both my partners and the surgeons. Even with that, it look a lot of deliberate study and frequent leaning on my partners for advice for during the first 1-2years. That said, most people who have ACTA fellowship still need a couple years to get up to speed. And I’d say everybody is better after 5 years of practice.


Tangentially when the peds boards came out, we had a lot of folks who practiced pediatric anesthesia for 20+ yrs. A good number of them were already boarded in peds, anesthesia, and PCCM. Those folks didn’t bother to take the peds anesthesia boards and some of the older folks close to retirement also did not bother to take the exam.

 

[Maloose]

I'm just gonna follow the outline and use some mixture of Kaplan, hensley, and uptodate articles. Probably also see if our residency coordinator can slip me a login to our institutional truelearn account and then do some of the cardiac questions.

Are you interested in starting a study group to share the content outline topics and share cardiac questions?
The content outline is extensive and fairly broad, and not much time left. Questions are key to studying.