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NewsletterPresident's MessageSCA Newsletter - February 2002
Cooperation is the Name of the Game - Perioperative Echocardiography Training Guidelines Approved"Nothing is as frustrating as arguing with someone who knows what he is talking about." - Sam Ewing
The long awaited training guidelines in perioperative transesophageal echocardiography have been finalized by the Board of Directors of the Society of Cardiovascular Anesthesiologists (SCA) and the Board of Directors of the American Society of Echocardiography (ASE). These guidelines were the result of several years of effort by a task force of both Societies. Chaired by Michael Cahalan MD, the members included Martin Abel MD, Martin Goldman MD, Alan Pearlman MD, Pamela Sears-Rogan MD, Isobel Russell MD, Jack Shanewise MD, William Stewart MD, and Christopher Troianos, MD. The guidelines will be published in full text in both anesthesia and cardiology journals in the near future and can be accessed by going to the Society of Cardiovascular Anesthesiologists' web site at www. scahq.org. The road leading to these cross-specialty training guidelines has not always been smooth. In the mid 1980s, cardiac ultrasound became an increasingly important modality in the perioperative evaluation of the cardiovascular patient. A variety of factors, including institutional culture, level of training in echocardiography technique, quality of the TEE evaluation, and the availability of expensive TEE equipment, resulted in a spectrum of collaboration between anesthesiologists and cardiologists performing TEE ranging from complete cooperation to outright antagonism. The lack of clear consensual guidelines, developed at a national level, between the two Societies having a primary interest in perioperative echo - the SCA and the ASE, was certainly a factor in this variability. Since each of these organizations was dedicated to improving patient care and promoting their membership's interests, it was obvious that a need existed for cooperative interaction in order to foster the highest quality care in the practice of perioperative TEE. By 1993, in response to a perceived need by the anesthesia community, the SCA and the American Society of Anesthesiologists established the Task Force on Practice Parameters for Transesophageal Echocardiography. The ASE indirectly had a hand in this Task Force with the designation of Alan Pearlman MD, President Elect of the ASE at that time, as the official ASE representative. From this Task Force, came a series of recommendations including a delineation of the indications and contraindications for performance of perioperative TEE, as well as suggested training requirements associated with performance of TEE at both a Basic and an Advanced level. Concurrent with the ASA/SCA efforts to develop guidelines, the ASE also developed a number of guidelines and recommendations in association with a variety of national organizations, including the American Heart Association and the American College of Cardiology. Unfortunately there was no formal request by the ASE for SCA input into the development of these cardiology guidelines. Therefore, in the mid 1990's, the SCA and the ASE were traveling on different roads, though both in the same general direction. As might be expected, having different sets of training standards and practice guidelines by two different specialty organizations was not well received by either the Joint Commission for Hospital Accreditation or by individual hospital credentialing committees. Realizing this increasingly difficult problem, in 2000 the SCA and ASE came together on the Task Force on Guidelines for Training in Perioperative Echocardiography. The result of this collaborative effort has recently come to fruition with finalization by our two Societies of specific training guidelines which cross specialty lines. This agreement which has been ratified by the Board of Directors of both the SCA and ASE will have positive repercussions on the training of all practitioners in both anesthesia and cardiology for many years to come. As with any collaborative process, there was a significant amount of communication and interaction necessary to finally achieve a mutually acceptable document. A key feature of the training guidelines is the lack of a specified duration of training. Instead, the guidelines "emphasize the goals of training and the number and diversity of cases required to meet these goals". Therefore, the time it will take to fulfill the training requirements will vary based on the volume and diversity of the experience offered at a specific institution. A prerequisite is being a licensed physician who has either completed or is enrolled in an accredited residency program. The essential components of training include a combination of independent work, supervised activities and assessment programs. There is a division in skills to two categories: Basic and Advanced. Basic training requires the performance of at least 150 complete examinations under supervision and 50 of these personally performed, interpreted and reported by the trainee. At the Advanced level a total of 300 exams need to be performed with 150 of these being personally performed, interpreted, and reported by the trainee. The exams performed to fulfill the Basic requirements can be used toward the Advanced level of training. In both cat-egories, having the immediate availability of an advanced practitioner is essential. For physicians not in an official training program, it is suggested that in addition to the numerical requirements in study performance, that 20 hours of continuing Medical Education credits, specifically in Echocardiography, be obtained at the Basic level and 50 hours at the advanced level. The collaborative nature of this Task Force provided credibility to the final result and will help ensure the highest level of training and quality in patient care for all practitioners. The ASE/SCA cooperative efforts have continued to benefit both of our memberships and will continue to do so, long into the future. Expected areas that we can continue to help one another include continuing medical educational programs, support of research, and ensuring proper recognition and reimbursement for our specialties. By working together both organizations can further our continued growth and health. Working together, we are a much stronger force, than when working separately. Roger A. Moore, MD Table of Contents
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