TEE certification

[Idiopathic]

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When do anesthesiologists usually do this? During residency or after? What kind of compensation is available? Can you do the certification as part of your residency training (i.e. like elective months?)

Thanks.

 

[UTSouthwestern]

When do anesthesiologists usually do this? During residency or after? What kind of compensation is available? Can you do the certification as part of your residency training (i.e. like elective months?)

Thanks.

Can be at any point in your training or in practice, but would be exceptionally difficult to learn in your first two years of residency. I have learned it this past year as a CA-3, but having the cardiac numbers I have had has been key to truly understanding what echo entails.

Many residencies including my own offer TEE rotations. Don't think you can learn it all in one month, because you can't. You need to read, read, read, then use every opportunity to "drive the car" in the OR. I place TEE's in all of my cardiac and major vascular cases and have used it in several traumas as an extra diagnostic monitoring device. It takes that kind of determination to really get comfortable with echo.

The benefit, in my mind, is a better understanding of CV physiology. Financially, medicare pays about $300-400 for an intraop exam while private insurance pays around $2,000.

There is a move to restrict who can become TEE certified and I believe that by 2008, if you have not taken the TEE exam, you will have to have done a CV fellowship to be eligible.

 

[Carm]

UTSouthwestern, do you still plan to sit for the TEE exam? I know speaking to you earlier (on a rotation and reading your posts) you planned on it. As of this time, what are the restrictions of using TEE in private practice? What if you have not sat for the exam? I play basketball with a CV guy who did his fellowship 6-7 years ago who has not taken the exam but uses TEE on almost every case. He said he guesses he was just "grandfathered" in. Just wondering what all the details are.

 

[UTSouthwestern]

UTSouthwestern, do you still plan to sit for the TEE exam? I know speaking to you earlier (on a rotation and reading your posts) you planned on it. As of this time, what are the restrictions of using TEE in private practice? What if you have not sat for the exam? I play basketball with a CV guy who did his fellowship 6-7 years ago who has not taken the exam but uses TEE on almost every case. He said he guesses he was just "grandfathered" in. Just wondering what all the details are.

I waited too long to register and they ran out of spots. No one said that there was a limit on the number of people who could take the test each year. I am working with one guy who does not feel he is prepared for the test and if he decides to drop out, I will ask the board if it will be possible to substitute myself for him. Doubt they will allow that though, so it looks like next May.

There are really no restrictions in using TEE in private practice. Different institutions can impose site specific limitations (you have to be TEE certified, have documented numbers of TEE exams, only for valve surgery, only for cardiac surgery, etc.) but the trend is toward having only certified echocardiographers using TEE. This seems to make good sense, but the reality is that non-certified anesthesiologists use it very often as an extra monitor as well as diagnostic tool.

Whether or not a grandfather clause will come into effect by 2008 is anyone's guess, but I still plan to sit for the exam and continue to advanced certification as it provides something that you can present in writing that testifies to your skill level with the machine.

 

[Carm]

Glad to hear that there is no end to the red tape dance in medicine 🙂 Just try not to slit your wrists that you do not get to drop a bill and take the Step II CS test.

 

[Tenesma]

the issue w/ certification is that even though you may understand TEE and done a lot of them... you have to do 150 cases and have read another 150 cases in order to be fully certified... that is a lot, and in fact there are some cardiac fellowships where those numbers aren't attained and they have to be certified after a few months of extra exposure during private practice...

 

[UTSouthwestern]

I am SOOOOOOOOOO glad I didn't have to go through that clinical skills test crap. One of our soon to be interns was telling me about the nightmare of scheduling that crap and the money he's had to spend on it.

Tenesma brings up a very good point regarding the numbers issue. Also of note is that all of the cases you do as a resident do not count, which I did not realize. That hurts me because I will leave with almost 200 CPB cases and 32 off pump cases, in which I performed a TEE exam in almost all of them, yet none will count toward the numbers for certification.

I have make arrangements with my group to get more cardiac cases to get the process complete in the next two years.

 

[sevoflurane]

Wait a minute.... Number of TEE's you do as a resident don't count toward TEE certification? I know to get the numbers is a hurdle in and of itself, never mind the exam, but there was more than one program that I visited during my interview season that told me it was "possible" to get TEE certified. Some actually told me that they had residents that actually had attained it in the past (during the end of their 3rd year of course). I've also heard of the mini-fellowship where people stay at their program for an extra 4-6mo. to get the numbers and sit for the test. Maybe some of these programs were not aware of the new guidelines for TEE cert.??? Is there a website out there where I can get the real deal??? 😕

 

[UTSouthwestern]

Wait a minute.... Number of TEE's you do as a resident don't count toward TEE certification? I know to get the numbers is a hurdle in and of itself, never mind the exam, but there was more than one program that I visited during my interview season that told me it was "possible" to get TEE certified. Some actually told me that they had residents that actually had attained it in the past (during the end of their 3rd year of course). I've also heard of the mini-fellowship where people stay at their program for an extra 4-6mo. to get the numbers and sit for the test. Maybe some of these programs were not aware of the new guidelines for TEE cert.??? Is there a website out there where I can get the real deal??? 😕

Residents getting certified in TEE likely refers to basic certification or testamur status, which is largely just taking the written exam. You don't have to have any set numbers to sit for the exam. Mini-fellowships can get you numbers toward advanced certification.

If I am mistaken, someone please correct me, but my conversations with faculty and ASE certified echocardiographers have indicated that residency examinations do not count. Again, I hope that is not true, as I would have the 150 examinations completed and getting the reads would be a chip shot.

 

[Tenesma]

there are two types of TEE certification - basic and full certification... Any resident can do the basic during residency - not a big deal... However full certification requires cases post residency... so UT is right on the money...

and the cardiac jobs out there that want TEE certification are referring to full not the basic stuff.