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 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 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 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 , 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. All sessions are observed by a Links in the electronic edition at far,” said Dr. Macdonald. “Trainees find www.ottawaheart.ca/the_beat.htm issues, such as withdrawing life support moderator, who can step in to assist the it very practical and tell us it’s actually or giving poor prognoses—either with trainees as appropriate and give real- • Read more about Cardiac giving them tools they can use instead of the patient, or the family, because the time feedback. Anesthesiology at UOHI us just talking at them and theorizing.”

Students enrolled in the Bachelor of Ontario, the Heart Institute’s CCUs have Education for 24/7 Nursing program at the University of had challenges in recent years recruiting Ottawa and Algonquin College can choose enough qualified cardiac nurses. In a clinical placements on the Heart Institute proactive move, Clinical Services decided Patient Care wards during the third and fourth years to grow its own expertise. of their degrees. Placements range from two weeks of practical experience in the “In 2006, we initiated an in-house day-to-day challenges of cardiovascular education program for nurses on both the nursing, to six-week consolidation place­ Cardiac Care Unit and Cardiac Surgery ments for senior students. Consolidation , to take people with placements are usually chosen in the no critical care experience and train them areas nursing students hope to enter after up to our standards,” explained Sellick. In graduation. 2007, two additional intensive care units within The Ottawa Hospital system joined Senior nurses provide mentorship to the program, expanding both the faculty all students participating in clinical and the facilities available to the students. placements in the Institute’s wards, Learning tools available to trainees helping them integrate their academic include a life-sized patient simulator that knowledge with the skills and technical can produce abnormal cardiac rhythms expertise that will be required in their and deteriorating vital signs and mimic ongoing practices. Registered nurses respiratory emergencies. (RNs) enrolled in the Masters of Nursing Participants in the Cardiac Nursing Series receive specialized training in caring for patients and programs at the The program comprises 20 weeks of full- with heart disease. Here Lee Pollington, Peggy Banning and Apryil Bay (left to right) learn University of Ottawa are also mentored time instruction. The first 12 weeks are a about ventricular assist devices. by advanced practice nurses and clinical mix of classroom and clinical experience, educators at the Institute. with a week of class followed by a week Nurses form the backbone of patient care of innovative homegrown programs that of hands-on practice of the newly learned at the University of Ottawa Heart Institute, have been emulated elsewhere. Some newly qualified nurses who have skills. In the last eight weeks, the nurses seeing patients through the continuum of rotated through the Institute’s wards work one on one with a mentor in the cardiovascular treatment from admission “We’re trying to make our nurses the best choose to return for employment after critical care setting, with one hour of class a to treatment, recovery and the transition at what they do, and we want to keep them graduation. These new graduates ben­ day to reinforce newly acquired knowledge. back to health. Many of these patients are up to date on the care they provide,” said efit from the ongoing New Graduate acutely ill with complex conditions. On Judith Sellick, Clinical in Initiative, a program sponsored by the “I had been a nurse for three and a half the frontline of care, it is often the nurse the Cardiac Surgery Intensive Care Unit. Ontario Ministry of Health and Long years before I applied to work in the who identifies new or developing clinical “Nurses are the ones who are there for the Term Care that provides an additional Cardiac Surgery Intensive Care Unit and issues in patients. Critical thinking and the patients 24/7, so they have to be trained 12 to 30 weeks of mentorship by an was offered participation in the nursing ability to function in highly technological to a standard where they can recognize experienced RN. critical care program,” said Julie Lukus, environments are essential skills. emergent problems and know what to a recent graduate. “In an ICU setting, do—or where to go and who to contact— Homegrown Expertise you need to be constantly on your toes, Recognizing the integral role nurses play to solve those problems.” anticipate all the possible outcomes for Even though new nurses have received and the specialized training they require, the a patient and intervene before anything a thorough formal education, they do Heart Institute’s Clinical Services division Early Exposure to happens. We re-enacted crisis scenarios not graduate with the extensive skill set is strongly committed to nursing education Cardiovascular Challenges in the lab, which helped ease us into the and knowledge required to work in an and training at all career stages. This real ICU. Intensive care can be a very The Heart Institute’s role in mentoring intensive cardiac care environment. Like commitment has sparked the development nurses begins at the undergraduate stage. most other critical care units (CCUs) in (continued on page 3) 3

(Education for 24/7 Patient Care, continued) intimidating nursing placement, but with Heart Institute nurses are encouraged the Heart Institute course, I felt prepared to pursue additional professional edu­ Training Excellent and eager to start my new nursing role.” cation and certification, such as the Canadian Nursing Association’s national In the years since the Heart Institute certification program, which allows RNs Cardiologists program started, according to Sellick, “This to earn credentials in specialized areas, is the route most Canadian institutions such as cardiovascular or critical care. Every year, up to 60 internal medicine residents apply for four available positions in the have gone, either collaborating with a local In addition to providing an eight-part cardiology residency program at the Heart Institute, making the program one of the college or doing it on their own.” evening review class for nurses preparing most competitive in Canada. The rigorous three-year program begins after a full three to write the exam, Clinical Services has years of training in internal medicine, including up to six months of previous clinical Career-Long Learning developed a set of online test preparation cardiology experience. Nursing education at the Heart Institute materials to allow nurses to study and The Heart Institute offers a training experience unique in Canada in that its physicians does not stop when trainees step into review on their own time. perform “pretty much all procedures in cardiology and all at the same centre,” said their first full-time positions. The rapid innovation in modern The nursing education provided by the technology and delivery makes continuing Heart Institute no longer stops at its education a priority for the nurse ed­ front doors; a regional educator is now ucators. In-house training sessions on available on staff to assist partner hospitals new equipment, “lunch and learns,” all- throughout the region and around the day seminars and web-based educational province. “We recognized that if we are materials all keep Heart Institute nurses working in concert with all of the smaller current on changes in best practices, new hospitals in the area, and even some of the technology and updates to how care is larger ones, we need to make sure that provided to patients at the Institute. all are rolling out best practice in cardiac care,” explained Sellick. “I think that’s one The nurse educators also present a continuing of the most unique things that the Heart education program called the Cardiac Institute does—involving our partners Nursing Series, which is taught once a directly in our patient care programs.” month from September to March every year. The five daylong courses cover specialized For example, the Institute is currently topics in cardiovascular medicine: rolling out a new care protocol for and training its nurses on the new • Cardiac assessment and diagnostics standards of treatment. “But we won’t just roll it out here. It will be implemented • Basic interpretation across the region, so all the hospitals have A group of residents at the University of Ottawa Heart Institute participate in rounds with the opportunity to care for their patients cardiologist Dr. Benjamin Chow (right). Competition is fierce for the four cardiology residency • Acute coronary syndrome and 12-lead using programs based on best practice slots available each year. ECG interpretation guidelines,” she said. j • Electrophysiology, pacemakers and Dr. Christopher Glover, Director of the defibrillators Cardiology Residency Program. “We’re a comprehensive cardiology centre. Any “We develop strong • Heart failure, cardiac assist devices More Information Online patient requiring more than just basic care mentorships with and cardiac surgery in cardiology comes to our site, and the residents get exposed to all of that.” the staff, which The series has run for more than 10 years, Links in the electronic edition at and up to 40 per cent of participants come www.ottawaheart.ca/the_beat.htm In their three years at the Heart Institute, translates into better from outside institutions all across Ontario. • See the 2010-2011 Cardiac Nursing the residents rotate through acute guidance and research The sessions have also been simultaneously Series schedule cardiac care, clinical and outpatient broadcast to partner hospitals, such as • Read about Clinical Services cardiology, and pediatric cardiology, opportunities for us.” Thunder Bay in northwestern Ontario. including a rotation at the Children’s Hospital of Eastern Ontario (CHEO). – Dr. Nina Ghosh, Chief Resident The trainees receive instruction in a wide in Cardiology, UOHI range of techniques, including cardiac Spreading the Word about catheterization, echocardiography, elec­ trophysiology and pacemaker implantation, stress testing, and nuclear medicine.

Clinical Engineering “Compared to other cardiology residency programs, we manage sicker patients in the critical care unit, and we get to see a wide variety of cases,” commented Dr. Nina While Timothy Zakutney has been busy “A huge portion of our responsibility Ghosh, currently the Chief Resident in Cardiology. “And since all the care is delivered with educational initiatives as Manager of relates to patient and staff safety,” in one place, we develop strong mentorships with the staff, which translates into better Biomedical Engineering, he makes clear Zakutney said. “There’s a vast amount guidance and research opportunities for us." that it is the next generation of clinical of technology that goes into an operating engineers that the University of Ottawa room. We have to make sure each piece is The residents are provided with laboratory rotations throughout all three years of the Heart Institute is training. fully integrated and ensure that people program, and they perform at least one of their own basic or clinical research projects know how to use it. It’s more than just under the mentorship of Heart Institute scientists. In the third year of the program, What is the difference between a clinical filling out a purchase order and buying residents run a cardiology clinic for the entire year, attending one day each week, with engineer and a biomedical engineer? equipment.” oversight from a faculty cardiologist. According to Zakutney, biomedical engi­ neers develop technologies and devices for The Heart Institute’s Biomedical En­ Unlike the recent changes in undergraduate medical education (see “In Conversation,” use in a medical context. Clinical engineers gineering program is widely regarded. Its p. 4), the format of residency training has remained relatively stable over the years. “But put those technologies and devices to innovative work in battery management one thing that’s happened over the last 10 to 20 years,” explained Dr. Glover, “is that work. Their focus is the application of has garnered a good deal of attention there has been a recognition in all of medicine that being a medical expert is important, those products, from the point at which a on both sides of the border and won but there are also so many other aspects of being a physician that are important—like need is expressed, right through a piece of Zakutney the Outstanding Canadian being a good communicator and a good manager—and the Royal College [of Physicians equipment’s life cycle until it is disposed Biomedical Engineer of the Year award. and Surgeons of Canada] wants us to emphasize those aspects more. So they have of or becomes obsolete. quantified what they expect a little better, and we’ve adapted that into our program.” An increasing portion of Zakutney’s Clinical engineers plan for technology. responsibility revolves around education. The Heart Institute recently received its re-accreditation from the Royal College for They procure the equipment, design the For many years, Biomedical Engineering a full six years. (Institutions not meeting all of the College’s qualifications may only space in which it will be used—such as has attracted students to the field by receive two- or four-year conditional accreditation.) “They usually identify where a an operating room or electrophysiology hosting them at the Heart Institute, residency program needs to improve, and this time there was nothing, no weakness, lab, arrange and provide training for including students from high school, identified in the program,” said Dr. Glover. staff, monitor its use and rectify problems university engineering programs and as they occur. This behind-the-scenes college technology programs. This year, “That being said, I think we always need to be vigilant because there are so many expertise is a critical aspect of the for the first time, the group is hosting demands on the residents—they have to study a lot, they have to do their research, they technology-dependent environment of an intern courtesy of a new endowment have to work a lot—they have a lot of competing elements to their training. My role is cardiovascular medicine. from the Leacross Foundation. to make sure all three are kept in their proper perspective,” he continued. “We want them to be well-rounded, but ultimately, we want to make sure that they’re excellent cardiologists so that wherever they go, they’re going to deliver excellent care to patients. (continued on page 4) That’s really the main goal of our program.” j 4

(Spreading the Word about Clinical Engineering, continued)

The Leacross endowment originated For students, internships are absolute­ from a compelling tour of Heart Institute ly essential. “We’re problem solvers,” facilities that Zakutney conducted for Zakutney explained. “The only way you Roslyn Bern, President of the Leacross can get a sense of the problem is to be in Foundation. The Foundation has a par­ the middle of it.” ticular interest in supporting women in engineering and technology, and But while there’s nothing like real-world Bern was impressed by what she saw. experience, Zakutney is also venturing As a result, the Heart Institute received into the classroom, teaching a fourth- a $300,000 endowment to hire a female year course in clinical engineering student in engineering or technology for the Department of Systems and studies each summer. Computer Engineering at Carleton University. It has been a rewarding “Roslyn recognized the vital role we play experience exposing students to an area and valued it,” said Zakutney. As a result of engineering they’ve not previously of her philanthropy, Rachel Zhang, a encountered and talking to them about master’s student in clinical engineering issues such as patient safety. His efforts from Zakutney’s alma mater, the Uni­ are already having an impact, with one Technologists Mark Cleland and Jolene Robbins examine a malfunctioning intra-aortic versity of Toronto, spent her summer student going on to the University of balloon pump, a cardiac assist device. Biomedical Engineering plans for, implements and learning about application of her field in Toronto master’s program. “If you can maintains the vast array of clinical technology at the Heart Institute and is working to attract a hospital context. connect with one student and convert more women to the field of clinical engineering. them, it’s a great thing,” he said. A nice thing about the endowment, said of Ottawa. Right now, there are only a Zakutney, is that it doesn’t require that Zakutney feels the rewards of teaching More Information Online handful of such programs in Canada,” interns come from a specific school. outweigh the daunting demands of lecture said Zakutney. Teaching a course has So, while this year he approached the preparation and plans to be back for Links in the electronic edition at gotten his foot in the door, and he intends www.ottawaheart.ca/the_beat.htm University of Toronto, in future years, more in January. “It is my desire to help to make the most of his foothold. j he’ll go to other universities and colleges, establish a graduate program in clinical • Read about the Biomedical to “spread the wealth,” as he put it. engineering at Carleton or the University Engineering program

In Conversation

Dr. Michael Froeschl: A Passion for Education Dr. Michael Froeschl joined the University of Ottawa Heart Institute in 2006 recruited to assume management of the cardiology component of the University as a cardiologist with practice interests in both general and critical care as well of Ottawa Medical School curriculum. Heart Institute physicians are generally as interventional cardiology. In addition to his clinical duties, Dr. Froeschl was cross-appointed as University faculty.

The Beat: What aspects of the undergraduate medical Once you’ve designed the test, you look at what you the Netherlands. The degree itself is fairly new—it’s curriculum are you responsible for? need to teach to make sure they pass those tests. an acknowledgment that medicine has been basically like an apprenticeship in that you were taught by Dr. Froeschl: I’m responsible for the cardiology Now when we create a teaching session, a lecture, people who could do, but who had not necessarily been component of the first-year undergraduate medical for example, we generate objectives—clearly stated trained to teach. We’re learning how the mind works, curriculum. It’s all about learning the basics. But the and ideally observable—that students are given ahead how adult students learn—which is quite different division between learning the basics and learning the of time so they know exactly what they’re expected from how children learn—how to organize curricula, practice is much more graduated than it used to be. to take away from that one-hour session. And they those types of things. We’ve also delved into clinical There’s now clinical exposure in the first two years, know that only those objectives can be tested. It’s a reasoning, which is a hot topic these days—how and there’s a back-to-basics portion of the fourth year. practical recognition that even though they love the to teach people to think rationally about a patient. There’s also a three-week transition period between subject matter and are passionate about learning to be Basically, I want to use what I learn in order to teach the predominantly classroom and predominantly great doctors, there’s a limitless amount of material cardiology better. clinical periods, and I have a role in the cardiology that could be taught and a relatively limited amount training there as well. of time in which to teach it. I think this system really The Beat: What is your impression of the overall helps both the students and the teachers focus. teaching culture here at the Heart Institute? I’d really like to create a unified four-year cardiology curriculum for the undergraduate students, to have The Beat: The education aspects of your appointment Dr. Froeschl: The Institute was originally built topics revisited throughout their training, but at a take up a large percentage of your time. Had you to serve the clinical needs of the patients of the more advanced stage and at more depth—an organized always wanted to be a teacher? Champlain region, but at the same time, the people curriculum that builds on what came before. The only who founded this place—Dr. Keon on the surgical way to do that is to have one person responsible for all Dr. Froeschl: In high school, I wanted to be a teacher—I side and Dr. Beanlands on the cardiology side—always of the components. had great high school teachers—but then I went to placed a strong emphasis on education. Though the university and became enamoured with the sciences, Institute has grown, that culture remains today. The Beat: Has the undergraduate curriculum changed and at that point decided, well, I’ll give up my dream Education is really emphasized, and people here want since you assumed oversight? of becoming a teacher since I really want to be a doctor. to teach—they volunteer to do it, they’re happy to do Then during medical school I realized that the people it and they’re good at doing it. I think that culture of Dr. Froeschl: When I came into my position, the lecturing us weren’t teachers but were physicians who being very passionate about teaching and doing it well medical school was in the process of completely were also teaching. That’s when I realized that you sets this place apart.” j changing the content, so I was able to come in at the could do both. ground level and help shape the new curriculum. More Information Online The emphasis is now very much on outcomes: You The Beat: And now you’re pursuing additional ed ­ begin with the attributes that you think make a good ucation for yourself in the area of medical teaching? Links in the electronic edition at physician, and then you design tests that you believe www.ottawaheart.ca/the_beat.htm Dr. Froeschl: I am—I’m just completing a master’s in will ensure that those outcomes have been achieved. • Read more about Cardiology at UOHI medical education, through Maastricht University in