Introduction
During CA-3 year, all residents will rotate through a one-month Cardiothoracic-Vascular (CTV) rotation for a minimum of one month. No extended leave will be permitted without extending the rotation- a minimum of twenty days availability for Operating Room experience is necessary to complete the rotation. Call will average ten days per month.
In addition to the separate Goals and Objectives for the CA-1 and CA-2 years the CA-3 will be able to:
• Provide safe anesthesia care to adult patients undergoing common cardiac surgical procedures with a minimum of assistance, with graduated responsibility
• Provide safe anesthesia care for non-cardiac surgery to pediatric patients with congenital heart disease
Skill will be demonstrated in the following six competencies:
1. Patient Care:
In addition to the separate Goals and Objectives for the CA-1 and CA-2 years the CA-3 resident is expected to:
• Perform induction of anesthesia
• Safely manage the transfer to extracorporeal circulation
• Recognize, evaluate, and manage deviations from the normal course
• Prepare for the weaning of extracorporeal circulation in cooperation with the surgeon and perfusionist
• Communicate patient physiological state to the surgeon and advise on the appropriate pharmacological intervention
• Independently resuscitate a patient if necessary
2. Medical Knowledge:
Residents in training must demonstrate knowledge about cardiac, thoracic and vascular surgical procedures and the anesthetic options. This will be gained through didactic lectures. Educational modules and protected non-clinical time will be made available to CA-3 CT-V residents. Trans-esophageal echocardiography will be taught intraoperatively by attending anesthesiologists.
In addition to the separate Goals and Objectives for the CA-1 and CA-2 years, the CA-3 resident is expected to:
• List the indications, contraindications and limitations of transesophageal echocardiography
• Insert a transesophageal echocardiography probe under supervision a minimum of five times (to be documented on activity log)
• Demonstrate basic echocardiographic views and cardiac structures and submit recording of three complete baseline evaluations to the director or his designate (to be documented on activity log)
• Demonstrate knowledge of methods of assessing valvular function or dysfunction including transmitral and pulmonary vein doppler flow patterns
• Demonstrate knowledge pertinent for insertion of femoral arterial and brachial arterial catheters
• Demonstrate knowledge of the indications for nitric oxide therapy
• Demonstrate knowledge of surgery for tracheal resection
• Demonstrate knowledge of endovascular aortic repair
• Demonstrate knowledge of congenital heart disease (to include anesthesia for ASD, VSD, transposition of great vessels, tetralogy of Fallot, coarctation of aorta and ligation of neonatal patent ductus arteriosus)
3. Practice-based Learning Improvement
Residents must be able to evaluate published literature on techniques for anesthetic management of cardiac, thoracic and vascular procedures.
In addition to the separate Goals and Objectives for the CA-1 and CA-2 years the CA-3 resident is expected to:
• Review ACC/AHA guidelines on CABG surgery (www.acc.org)
• Review ACC/AHA guidelines on echocardiography (www.acc.org)
• Review ASA Guidelines on the use of Pulmonary Artery Catheter
• Review SCA/ASE TEE guidelines (A&A Volume 89(4)October 1999 p 870)
4. Interpersonal and Communication Skills
Residents must be able to develop interpersonal and communication skills in order to interact effectively with patients, their families, and team members.
The resident is expected to:
• Develop consultant-level communication skills in discussing anesthesia-related issues to patients and team members (cardiologists, surgeons, nurses perfusionists and anesthesia assistants)
• Maintain a legible intraoperative anesthesia record
• Develop an understanding of the goals of other team members
5. Professionalism
Residents must be able to demonstrate ethical principles and sensitivity to a variety of culture.
The resident is expected to:
• Be respectful of the patient’s age, gender, culture and disabilities
• Maintain confidentiality
• Be appropriately attired with hospital ID displayed
• Be respectful of team members
6. Systems-based Practice
Residents must demonstrate an understanding of the health care system and resource management.
In addition to the separate Goals and Objectives for the CA-1 and CA-2 years the CA-3 resident is expected to:
• Demonstrate an understanding of how a new cardiac surgery service might be added to existing hospital
• Demonstrate an understanding of the absolute and relative costs of cardiac anesthesia interventions and pharmaceuticals
• Demonstrate an understanding of the cost of double-lumen tubes and adjuncts
• Demonstrate an understanding of the cost of acquisition and repair of fiberoptic bronchoscopes
• Demonstrate an understanding of the cost of transesophageal echocardiography probes
• Be able to describe setting up a TEE service to a hospital administrator

Resident Assessment
1. Resident-Attending discussions of individual cases will be used to assess patient care, medical knowledge and systems-based practice.
2. Interpersonal communication skills and professionalism will be assessed by observation.
3. A global evaluation will be submitted to all attending anesthesiologists who had the opportunity to evaluate the resident during each one-month rotation.
4. A review of the case log will be used to assess practice-based learning.
5. A multiple choice question examination will be administered before and after each rotation to document adequate medical knowledge.

Prerequisites:
Anesthesiology residents will be assigned to CTV rotations after successful completion of eight weeks of CTV anesthesia as CA-1 and CA-2 residents.