Assessment of Resident Performance During the Cardiac Anesthesia Rotation: Application of the House Officer Clinical Assessment in Cardiac Anesthesiology.

OBJECTIVE: The assessment of clinical skills was created that evaluates House Officer performance within 13 clinical domains during the Cardiac Anesthesiology rotation to provide an assessment and evaluation process for residents while performing a cardiac anesthetic. DESIGN: A retrospective evaluation of performance assessments over a 33-month period. SETTING: University hospital-based Accreditation Council for Graduate Medical Education accredited Residency Training program. PARTICIPANTS: Anesthesiology house officers within the Department Residency Program. INTERVENTIONS: This House Officer Clinical Assessment was created and implemented as residents rotated through the cardiac anesthesia service. Scores in 13 domain-specific components from this assessment were collected after the attending-resident debrief. MEASUREMENTS AND MAIN RESULTS: Most scores were found to be sufficient to suggest competency, and the evaluation allowed for a more detailed approach to assessment and feedback. The most common aspects of the case in which the residents showed reduced performance and proficiency were the transition off cardiopulmonary bypass and the performance of the transesophageal echocardiogram. Overall, the resident survey showed a positive response to the assessment and the feedback provided during the post-examination debrief. CONCLUSION: The House Officer Clinical Assessment in Cardiac Anesthesiology allows for a more objective assessment of performance for specific portions of the case and allows for improved feedback on performance. Aspects of the evaluation tool and where residents correlate with the Anesthesiology Milestones for residency are discussed, as well as the ability to determine sufficient proficiency with knowledge and skills over the use of subjective rank to determine competency.

Right Atrial Inversion Mimicking Right Atrial Mass in the Setting of Cardiac Tamponade.

A 44-year-old woman was transferred to the authors' institution in cardiogenic shock secondary to a presumed viral myocarditis and subsequently was placed on venoarterial extracorporeal membrane oxygenation. Transthoracic echocardiography revealed a large right atrial mass of unknown etiology and moderate pericardial effusion. The patient was taken to the operating room for surgical removal of the right atrial mass. Intraoperative transesophageal echocardiography demonstrated cardiac tamponade with complete invagination of the right atrium. Surgical evacuation of the pericardial effusion reverted the right atrium, with no further evidence of the right atrial mass, and no mass was discovered after right atriotomy, indicating that the right atrial "mass" was likely the result of complete inversion of the right atrium in the setting of cardiac tamponade.

Financial Considerations of an Anesthesia Consult Service.

Surgical patients with complex cardiac disease often require noncardiac surgery. There have been recent articles written concerning the role of the cardiothoracic anesthesiologist as a consultant in the operating room as well as outside the operating theatre.1,2 With the evolution of the cardiothoracic anesthesia consult service (CACS), there are many issues regarding medical billing, financial reimbursement, and Medicare rules that anesthesiologists may not be familiar with. This paper will discuss the financial implications of starting a CACS.