Department of Anesthesiology

Perioperative and Critical Care Echocardiography Executive Medical Fellowship (EMF) Program

Many practicing anesthesiologists are not in a position to stop their existing practice or delay entering a practice so they can participate in a traditional fellowship program. However, this does not mean that many of these same physicians are not interested in expanding their skills, especially with emerging technologies that have been shown to improve patient outcomes.

The University of Nebraska Medical Center Department of Anesthesiology Perioperative and Critical Care Echocardiography EMF program consists of 5-day, on-site sessions that are customized post-graduate training programs tailored to physicians who want to further their education and career without compromising their existing practice. Specifically, the EMF program offers an alternative to traditional methods for learning perioperative echocardiography. In general, the EMF program covers the following topics.

1. Ultrasound core concepts and principles.
2. Technical skills related to transesophageal echocardiography and transthoracic echocardiography.
3. Perceptual detection skills to identify features in medical imaging, also called visual sensitivity or visual recognition.
4. Image recognition skills to simultaneously perform the necessary technical procedures and identify normal and abnormal structures.
5. Knowledge and skills necessary to accurately and effectively report the medical imaging findings.

A new EMF course format is being introduced starting in May. The new format requires attendance at the first two, 5-day onsite sessions (Weeks 1 and 2), with Week 3 and Week 4 being optional sessions. The two required, 5-day onsite sessions (Weeks 1 and 2) cover the perioperative and critical care echocardiography core curriculum and must be attended at least 30 days apart and both weeks must be completed within one year.

Week 3 and Week 4 sessions are optional, but cannot be attended without first attending both Weeks 1 and 2. You may attend either Week 3 or Week 4, or both; it is not required that you attend both Week 3 and Week 4. The three EMF program options and program requirements are outlined in Table 1 and the curriculum for each program is outlined in Table 2.

Schedule of Available weeks

^aAll on-site sessions will be held on-site M-F at the University of Nebraska Medical Center, Omaha, NE.
^bAll additional in-practice echo cases must be specific to the program taken.

Table 2. Program curriculum for EMF programs.

The University of Nebraska Medical Center Department of Anesthesiology Perioperative and Critical Care Echocardiography Core Competencies program is designed to meet or exceed the basic clinical competence requirements developed by the American College of Cardiology (ACC) and the American Heart Association (AHA) for perioperative echocardiography (2003).

The program involves attendance at two, 5-day, on-site sessions at the University of Nebraska Medical Center for a total of 10 days on-site over the course of the 1 year or less. Between these 5-day, on-site sessions, students review or perform a minimum of 150 perioperative echocardiography studies. Of these 150 studies, at least 50 are personally performed on their own patients and 100 are performed as simulated diagnostic exercises.

Echo studies are submitted to the University of Nebraska Medical Center's EMF faculty using an internet-based, remote supervision software system. After completion of each diagnostic exercise, immediate feedback via the remote supervision system is provided to the student. For studies performed on the student’s own patients, the EMF faculty reviews and quality assesses each study, and then makes it available online for the student to review.

At the completion of the Core Competencies EMF program, physicians should be able to use TEE for indications that lie within the customary practice of anesthesiology. Under appropriate supervision, students will learn to place the TEE probe, operate the ultrasound machine, perform a TEE examination, and convey and document the results of the examination effectively.

The University of Nebraska Medical Center Department of Anesthesiology Surgical Applications EMF program is designed to cover all aspects of echocardiography for making diagnoses and decisions in surgical settings.

To attend the surgical applications program, students must have already completed the Core Competencies EMF program outlined above.

The Surgical Applications program involves attendance at one, 5-day, on-site session at the University of Nebraska Medical Center. In addition to the 150 cases required for the Core Competencies Program, completion of an additional 50 cases is required; 25 echo cases on their own patients and 25 simulated diagnostic exercises.

Cases are submitted to the University of Nebraska Medical Center's EMF faculty using an internet-based, remote supervision software system. After completion of each diagnostic exercise, immediate feedback via the remote supervision system is provided to the student. For studies performed on the student’s own patients, the EMF faculty reviews and quality assesses each study, and then makes it available online for the student to review.

The University of Nebraska Medical Center Department of Anesthesiology Perioperative Stress Testing Program is designed to cover all aspects of echocardiography-based stress testing.

To attend the perioperative stress testing program, students must have already completed the Core Competencies EMF program outlined above.

The Perioperative Stress Testing Program involves attendance at one, 5-day, on-site session at the University of Nebraska Medical Center. In addition to the 150 cases required for the Core Competencies Program, completion of an additional 50 cases is required; 25 echo cases on the students’ own patients and 25 simulated diagnostic exercises.

Cases are submitted to the University of Nebraska Medical Center's EMF faculty using an internet-based, remote supervision software system. After completion of each diagnostic exercise, immediate feedback via the remote supervision system is provided to the student. For studies performed on the student’s own patients, the EMF faculty reviews and quality assesses each study, and then makes it available online for the student to review.

Educational Methods

• Students acquire the basic concepts and principles of echocardiography, on their own time, using internet-based electronic modules.
• Students participate in hands-on training sessions where he/she can learn and practice the technical components of transesophageal and transthoracic echocardiography on live models. Students also attend small, on-site group review sessions with experts in the field. The purpose of these sessions is to provide a venue for students to review and discuss a large number of images in a positive and supportive environment.
• Students perform procedures at their own facility utilizing an internet-based remote supervision program. An expert is centrally located at the University of Nebraska Medical Center and supervises the work of the students in their own practice. The student’s assessment of each case is evaluated by an expert and feedback is provided.

Advantages of the University of Nebraska Medical Center, Department of Anesthesiology Perioperative and Critical Care Echocardiography EMF

The advantages of the Executive Fellowship programs are numerous. In particular, they allow physicians to:

• Acquire skills necessary to improve patient outcomes and standard of care;
• Develop medical imaging skills that can be passed to peers;
• Keep up with the latest technical medical advances without compromising an existing medical practice;
• Interact with peers and experts in a flexible learning environment that provides open and supportive supervision;
• Develop skills necessary to accurately diagnose and identify perioperative cardiac pathologies using medical imaging techniques; and
• Provide an avenue for professional development and greater career opportunities.

Physicians receive 35 AMA PRA Category 1 Credit(s)™ for Week 1. The program and syllabus for Weeks 2-4 are in the process of being developed.  

Application Process

The Department of Anesthesiology is approved by the American Board of Anesthesiology (ABA) and the Accreditation Council on Continuing Medical Education (ACCME) of the American Medical Association (AMA) for the executive fellowship programs.

Physicians who wish to be considered for an Executive Fellowship position must submit the following information. All applications received are screened by an applications committee, and selected applicants may be invited for a personal interview.

NOTE: Please send all information in one package.
• Must be board certified or a board eligible physician.
• Completed Application Form
• Letter of Intent that describes, in one page or less:
  1. Why you want to be trained in perioperative echocardiography
  2. Your goals of training, and
  3. How you foresee perioperative echocardiography impacting your practice
• Curriculum Vitae with two (2) references including relation, position, organization, phone and address
• Two recent, passport sized photographs
• Copy of valid medical license
• Completed letter of good standing for clinical privileges (The letter must be completed by the chairman or head of department)

In addition to the above items, if accepted into the program, students will be required to bring five (5) completed echo cases on their own patients to the EMF faculty upon arrival at their first on-site session.

Practicing physicians who complete the certification requirements below for the specific program enrolled receive a certificate of completion of the Perioperative and Critical Care Echocardiography Executive Medical Fellowship issued by the University of Nebraska Medical Center, Department of Anesthesiology.

Tuition

Tuition for the EMF programs is outlined in the table below.