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Cardiac Anesthesiology: Training Outside the Box, Page 1) Volume 5, Issue 4 2010 HIGHLIGHTS Anesthesiologists at the Heart Institute have become national leaders in [transesophageal echocardiography] education, particularly in the emerging field of three-dimensional echocardiography. (from Cardiac Anesthesiology: Training Outside the Box, page 1) “Intensive care can be a very intimidating nursing placement, but with the Heart Institute course, I felt prepared and eager to start my new nursing role.” — Julie Lukus, Nursing Trainee, UOHI (from Education for 24/7 Patient Care, page 2) The Heart Institute’s Biomedical Engi- neering program is widely regarded. Its innovative work in battery management As a teaching hospital, the University of Ottawa Heart Institute trains doctors, nurses, researchers, technologists, physiotherapists and more in has garnered a good deal of attention on the science and treatment of heart disease. With a passion for education and all aspects of cardiovascular medicine integrated at a single site, the Institute is widely recognized for its unparalleled training. both sides of the border and won Timothy Zakutney the Outstanding Canadian Biomedical Engineer of the Year award. (from Spreading the Word about Cardiac Anesthesiology: Clinical Engineering, page 3) Training Outside the Box “Education is really emphasized, and The University of Ottawa Heart Institute cardiac surgery to provide real-time education, particularly in the emerging field people here want to teach—they volunteer is a leading centre for training in cardiac feedback on the progress of an operation. of three-dimensional echocardiography. to do it, they’re happy to do it and they’re anesthesiology, from rotations for “That’s really where echocardiography good at doing it. That culture of being very medical residents to full- and multiyear Because of their experience in the op- is moving, and we’re trying to be on the passionate about teaching and doing it well specialty training for currently qualified erating room handling patient sedation forefront of that,” said Dr. Hudson. sets this place apart.” anesthesiologists. But the teaching in- and intraoperative procedures, “anes- terests of the Cardiac Anesthesiology thesiologists, particularly cardiac All cardiac anesthesiology fellows at anesthesiologists, have become experts in the Heart Institute receive training — Dr. Michael Froeschl, Cardiologist, UOHI clinicians range beyond the standard doing intraoperative echocardiograms,” in TEE and are required to write the (from In Conversation, page 4) medical curriculum, and several have developed innovative educational oppor- explained Dr. Christopher Hudson, a staff national PTEeXAM to become certified tunities to broaden the experience anesthesiologist at the Heart Institute. advanced practitioners in perioperative of trainees who pass through the “We’ve learned to use intraoperative echocardiography. Staff also provide Institute’s wards. TEE to help make decisions regarding training, on request, to practicing anes- management of blood circulation, and thesiologists from other institutions in IN THIS ISSUE Teaching Real-Time also to give the surgeon information Canada and abroad. Cardiac Imaging following a repair about whether or not P. 1 Cardiac Anesthesiology: that repair has worked.” Cardiac Anesthesiology staff conduct Training Outside the Box Echocardiography, the use of non- peer-to-peer TEE training through invasive ultrasound to picture the heart’s TEE is primarily used in valve surgery, professional conferences and classes. In P. 2 Education for structure and function, is a mainstay particularly mitral valve surgery, said June, Dr. Hudson, Dr. Stéphane Lambert 24/7 Patient Care of cardiac diagnosis and monitoring. Dr. Hudson. The aim in mitral valve and Dr. Benjamin Sohmer presented on Traditionally, echocardiography has been surgery today is to repair rather than three-dimensional TEE at the Canadian P. 3 Spreading the Word about performed transthoracically, meaning replace a valve. TEE allows surgeons to Anesthesiologists’ Society meeting, and Clinical Engineering that external probes image the heart via noninvasively determine whether a valve Dr. Hudson and Dr. Lambert are scheduled P. 3 Training Excellent ultrasound waves transmitted through can be repaired. “Once the repair is done to teach a related class at the annual Cardiologists the chest wall. and the patient comes off bypass, you can international echocardiography training immediately assess whether the repair course administered by the Society of P. 4 In Conversation: However, a newer method called was successful. The last thing you want Cardiovascular Anesthesiologists. Dr. Michael Froeschl: transesophageal echocardiography (TEE) is for a patient to leave the OR with an A Passion for Education takes advantage of the fact that the heart unsuccessful repair,” he explained. “We’re introducing the idea and the lies close to the esophagus, the pathway benefits of 3-D and its potential new The Beat is published by the University of Ottawa that carries food from the mouth to the Surgery teams at the Heart Institute uses—we’re trying to disseminate that Heart Institute (UOHI). Comments or questions about The Beat should be directed to Jacques stomach. TEE uses a small probe on the also use intraoperative TEE during information and encourage people to Guérette, Vice President, Communications, end of a flexible line that can be threaded aortic valve replacement to look for learn 3-D TEE,” said Dr. Hudson. “We’re at 613-761-4850 or [email protected]. down the patient’s esophagus, imaging leaks in newly attached mechanical or using it now for mitral and aortic valve For more information about UOHI, please visit the heart from its back side. bioprosthetic valves and in coronary surgery, so we’ve seen the benefits in www.ottawaheart.ca. bypass surgery to assess blood flow after terms of providing insight into how a © 2010 University of Ottawa Heart Institute Without the chest wall, ribs and lungs in blood-vessel grafting. structure in the heart is working.” The Beat is a trademark of the University of the way, TEE provides a better picture Ottawa Heart Institute. of the heart (see image on p. 2), and Anesthesiologists at the Heart Institute the procedure can be carried out during have become national leaders in TEE (continued on page 2) 2 (Cardiac Anesthesiology: Training Outside the Box, continued) Teaching the ABCs of Difficult patient is intubated and sedated. Lack of Conversations communication training is a huge issue,” he explained. Intensive care units (ICUs) are filled with a hospital’s sickest patients, requiring To remedy what they saw as a gap in the around-the-clock specialized care. Not training of residents rotating through surprisingly, ICUs also have the highest the ICU, Dr. Macdonald and a colleague, mortality rates of any unit in a hospital. Dr. Mike Hartwick of The Ottawa Hospital, designed a course, taught over Consequently, doctors who staff ICUs two half days to teach trainees how often must have sensitive discussions with to rapidly establish and, importantly, patients or, in cases in which patients maintain rapport with patients and their are too sick to communicate, with the families during these difficult discussions. patients’ families. The course begins with classroom training “You deal with death a lot in the ICU, and that explains the steps of successful many people find it difficult to do well,” communication using a model that mimics said Dr. John Macdonald, an intensive care the mnemonics medical students use to medicine specialist and anesthesiologist remember resuscitation protocols. They who joined the Heart Institute this year. call these the ABCs of communication— Three-dimensional transesophageal echocardiography is an emerging technique that gives He previously worked at hospitals in ask, build and check. surgical teams real-time feedback on the success of procedures such as valve repair. The Ottawa and Peterborough and remains a Heart Institute is home to several of the country’s leaders in 3-D TEE. regular serving Lieutenant Commander Important within that sequence is making in the Canadian military, serving three sure not to ignore when a patient or “We are very fortunate to have John Drs. Macdonald and Hartwick have been tours in Afghanistan in the past four years. family has become uncomfortable with Macdonald on staff,” said Dr. James asked to teach the course to residents or disconnected from the conversation. Robblee, Chief of Cardiac Anesthesiology in other programs, including internal Ideally, explained Dr. Macdonald, difficult “We’re teaching people that if you lose at the Heart Institute. “With this new medicine, palliative care, and oncology, conversations would be led by the patient’s rapport, you have to cycle back and program, we have added a new strategic and they hope to continue expanding the primary doctor or another physician who had your focus has to be re-establishing that focus for the division. Dr. Macdonald course to reach other interested trainees. worked extensively with a patient and family rapport before you can continue on with intends to refine and scientifically members and had established a rapport. But in conveying additional information,” said validate the program with the help of People think it’s sort of a natural ability to reality, things often don’t work out that way. Dr. Macdonald. other members of the staff, and there is be a good communicator, but it’s really a skill—you can be taught, and you need to “A lot of high-acuity situations requiring After the brief theory-based classroom potential to apply the training beyond practice,” concluded Dr. Macdonald. j these conversations happen at night session, trainees move on to experienced- intensive care communications to other when it’s the trainees in hospital. And based learning sessions where they have a areas of medicine.” MORE INFormation ONLINE our trainees are finding these discussions chance to act out difficult case scenarios The course is currently in its second year. one of the most stressful parts of their with professional actors playing the roles “Feedback has been extremely positive so rotations—having to discuss end-of-life of patients.
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