TEE Certification

[erasmus31]

Hi all,

Can anybody give me some insight as to whether or not it is possible to get TEE certified without doing a CT fellowship. I have heard all the rumors that if graduate after 09, you will need to do a fellowship, but a well respected attending who actually got his TEE certifcation a couple of years ago w/o doing a fellowship recently told me this didn't go through yet, and people are still fighting it.

Can anybody tell me any recent updates, or where I can find this info???

Thanks in advance.

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[proman]

From what I understand, after 09, you can still take the test but won't be board eligble. Probably only an issue for those in academics.

 

[leaverus]

I don't think they are simply rumors. Here is the link to the actual application for certification:
http://www.echoboards.org/certification/pte/documents/PTE-FINAL.pdf

On page 10, it clearly states "the practice experience pathway will not be available to those finishing core residency training after June 30, 2009"

so, yeah, you will pretty much need to do a cardiac fellowship in order to be echo "board-certified" and not simply a "testamur," which they define to be someone who passes the exam but does not meet the criteria for certification.

 

[bubalus]

Your well-respected attending is wrong. The info you have here is correct. If you graduate after June 30, 2009, you must do a fellowship for "certification". Although the organization is called the National Board of Echocardiography, it's not part of the American Board of Medical Specialties. Those who finish the certification process are called diplomates.

IMO, it's more important what you know and can do than whether you've done the paperwork to go from testamur to diplomate. I know some amazing echocardiographers who are testamurs. You can go to the NBE web site and search for individuals and see their status.

Anyone can take the echo boards (PTE or ASC). You just need an unrestricted license to practice medicine and pay the fee.

 

[erasmus31]

Thanks for the replies...certainly makes more sense now and is helpful.

Just an additional question: How beneficial would taking and passing the test be without doing the fellowship, and therefore not being certified. Does passing the test make you more marketable? Does it allow you to write official echo reports? Will it help in terms of medical-legal...ie. if you tell a CT surgeon the new valve looks good, and the pt later has a complication, will it matter that you passed the test but aren't certified?

Thanks again.

 

[InductionAgent]

Thanks for the replies...certainly makes more sense now and is helpful.

Just an additional question: How beneficial would taking and passing the test be without doing the fellowship, and therefore not being certified. Does passing the test make you more marketable? Does it allow you to write official echo reports? Will it help in terms of medical-legal...ie. if you tell a CT surgeon the new valve looks good, and the pt later has a complication, will it matter that you passed the test but aren't certified?

Thanks again.

Just my opinion, the obvious answer: passing the exam will probably help in terms of getting credibility, but it won't go as far as actually being certified. If nothing else, studying for the exam will expand your knowledge base, but keep in mind you probably won't have the same level of experience starting out.

 

[positraction]

Please be reminded that the rules seem to change frequently from this board, which as mentioned before, is not a part of the ABMS. Just getting the knowledge level of passing the PTE exam itself is a great feat. These are skills for the future that no one can take away from you.

The future is now!

 

[bubalus]

Thanks for the replies...certainly makes more sense now and is helpful.

Just an additional question: How beneficial would taking and passing the test be without doing the fellowship, and therefore not being certified. Does passing the test make you more marketable? Does it allow you to write official echo reports? Will it help in terms of medical-legal...ie. if you tell a CT surgeon the new valve looks good, and the pt later has a complication, will it matter that you passed the test but aren't certified?

Thanks again.

Does passing the test make you more marketable? Depends on the group, how much echo they do, what their needs are, how involved cardiology is in intraop echo, size of the hospital, academic vs private, etc. I've got a fair bit of echo training, and some groups were very interested. Others didn't care.

Value of testamur vs diplomate will depend entirely on your place of work. You can do whatever you're allowed to. Where I did my residency, most of the staff were testamurs, simply because they didn't jump through the hoop of doing the paperwork to become a diplomate. No one cared. If you know your stuff and you do the right thing, you shouldn't have a problem. With the hypothetical patient above, if you have done a thorough evaluation of the new valve with appropriate clips saved to document your decision, and you make the right call, you've done your job. That's all knowledge, skill, and experience. It doesn't have to do with testamur vs diplomate status. I'm sure there are plenty of testamurs out there who are far better than some of the diplomates.

IMO, the PTEexam is not the best test of your clinical skill at using TEE to guide surgery/therapy. For example, I don't believe there was a single image of a perivalvular leak on my exam, but they did show a cor triatriatum. I do a lot of echo, and I've seen far more perivalvular leaks than cor triatriatums, and it's more important to be able to identify the perivalvular leak and judge whether it needs immediate attention or will resolve with protamine than it is to be able to identify cor triatriatum.

The difficulty of the PTEexam will depend on your echo education and the amount of study you put into it. There aren't too many places where residents routinely take it. If you've got good teachers and a couple months to really study Sidebotham, Perrino, and know the math from "Conquer the PTEexam" you've got a good chance. Bored Stiff TEE is pretty useless other than as an intro to TEE for the first day of a TEE rotation, so I don't think it's worth the money. Do not forget ultrasound physics. Passing the exam without knowing physics would be challenging, but the physics isn't all that hard.

If you're really serious about echo (more than just passing the PTEexam), add Oh's The Echo Manual, and the books by Catherine Otto.

 

[DrBom]

Does passing the test make you more marketable? Depends on the group, how much echo they do, what their needs are, how involved cardiology is in intraop echo, size of the hospital, academic vs private, etc. I've got a fair bit of echo training, and some groups were very interested. Others didn't care.

Value of testamur vs diplomate will depend entirely on your place of work. You can do whatever you're allowed to. Where I did my residency, most of the staff were testamurs, simply because they didn't jump through the hoop of doing the paperwork to become a diplomate. No one cared. If you know your stuff and you do the right thing, you shouldn't have a problem. With the hypothetical patient above, if you have done a thorough evaluation of the new valve with appropriate clips saved to document your decision, and you make the right call, you've done your job. That's all knowledge, skill, and experience. It doesn't have to do with testamur vs diplomate status. I'm sure there are plenty of testamurs out there who are far better than some of the diplomates.

IMO, the PTEexam is not the best test of your clinical skill at using TEE to guide surgery/therapy. For example, I don't believe there was a single image of a perivalvular leak on my exam, but they did show a cor triatriatum. I do a lot of echo, and I've seen far more perivalvular leaks than cor triatriatums, and it's more important to be able to identify the perivalvular leak and judge whether it needs immediate attention or will resolve with protamine than it is to be able to identify cor triatriatum.

The difficulty of the PTEexam will depend on your echo education and the amount of study you put into it. There aren't too many places where residents routinely take it. If you've got good teachers and a couple months to really study Sidebotham, Perrino, and know the math from "Conquer the PTEexam" you've got a good chance. Bored Stiff TEE is pretty useless other than as an intro to TEE for the first day of a TEE rotation, so I don't think it's worth the money. Do not forget ultrasound physics. Passing the exam without knowing physics would be challenging, but the physics isn't all that hard.

If you're really serious about echo (more than just passing the PTEexam), add Oh's The Echo Manual, and the books by Catherine Otto.

bubalus, did you find any good review sources to prepare for the video portion of the pteexam

 

[joshmir]

pain guy with just a question out of curiosity:

what is the bare minimum needed to bill for intraop TEE interpretation?

 

[ProRealDoc]

pain guy with just a question out of curiosity:

what is the bare minimum needed to bill for intraop TEE interpretation?

thought you had to be a diplomate to bill.

 

[2win]

thought you had to be a diplomate to bill.

No - you can bill without to be a "diplomate".

 

[boggy]

The echo board is de facto certification requirement for cardiac anesthesia--if you want to do cardiac anesthesia over the long term better to get certified---there is no way around it---testamur may be fine for now but I suspect that in time certification will be mandatory if you want to interpret echos in the OR or perhaps even be permitted to work with cardiac patients---not that I think this is necessary it is just the way things are working in medicine these days

 

[periopdoc]

The echo board is de facto certification requirement for cardiac anesthesia--if you want to do cardiac anesthesia over the long term better to get certified---there is no way around it---testamur may be fine for now but I suspect that in time certification will be mandatory if you want to interpret echos in the OR or perhaps even be permitted to work with cardiac patients---not that I think this is necessary it is just the way things are working in medicine these days

Maybe (and that is a big maybe) that will be the truth in larger towns sometime in the course of our careers, but the vast majority of cardiac anesthesia is currently provided by non-fellowship trained, non TEE testamured/ certified anesthesiologists and fellowships are not turning out fellows at a rate that could significantly alter that arrangement for the foreseeable future.

I might agree with you if the rules reverted to allowing non fellowship trained residents to become TEE certified, but given the current requirements...

- pod