Introduction
During CA-1 and CA-2 years, residents will rotate through a one-month Cardiothoracic-Vascular (CTV) rotation for a minimum of 2 months. Normally, no leave will be permitted during these rotations. The primary goal is for the resident trainee to have provided anesthesia to 20 Cardiopulmonary Bypass cases. Absence will be made up at a later date. Call will average 10 nights per month (1 in 3), including weekends.
By the end of the second rotation the resident will be able to:
• Evaluate patients scheduled for cardiac, thoracic, and vascular surgery
• Communicate the pre-operative evaluation to an attending anesthesiologist
• Communicate pertinent information to other members of the team (cardiology, surgery, nursing, perfusion and anesthesia technology).

Skill will be demonstrated in the following six competencies:
1. Patient Care:
The resident is expected to:
• Perform a history and physical examination to identify co-morbid conditions
• Review all available diagnostic tests
• Request appropriate diagnostic tests not yet scheduled
• Explain to the patient the anesthesia plan, which frequently involves advanced physiological monitoring or pain control methods before induction of anesthesia
• Prepare the operating room
• Prepare the patient for induction of anesthesia (use of appropriate pharmacological adjuncts:- agents, timing, dose and route)
• Have read the users’ manual for all machines which they will employ for patient care
• Report quality of care issues and complications to the director
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 and at least one anatomy dissection lab (cardiac anatomy). Educational modules and protected non-clinical time will be made available to CA-1 and CA-2 CT-V residents. Trans-esophageal echocardiography will be taught intraoperatively by attending anesthesiologists and supplemented by non-OR resources (eg, electronic texts)
When cardiopulmonary bypass is used, the resident is expected to sit at cardiopulmonary bypass machine console with a perfusionist, observing the conduct of cardiopulmonary bypass, and to learn the role of anesthesia in treating complications of cardiopulmonary bypass a minimum number of five times.
The resident is expected to:
• Review the surgical procedure(s)
• Review the ramifications of the procedure(s) on patient preparation, monitoring and selection of pharmaceutical agents
• Demonstrate an understanding of extracorporeal circulation
• Demonstrate an understanding of lung separation and one-lung ventilation
• Demonstrate an understanding of basic hemodynamics (central venous pressures, pulmonary capillary wedge pressure, ventricular preload, cardiac index, mixed venous saturation)
• Demonstrate an understanding of basic electrocardiography and be able to diagnose common dysrhythmias (nodal rhythm, atrial flutter, atrial fibrillation).
• Demonstrate the ability to recognize and treat life-threatening dysrhythmias (ventricular tachycardia, ventricular fibrillation and hemodynamically significant supraventricular tachycardias)
• Demonstrate an understanding of intra-aortic balloon pulsation (indications, contra-indications, risks and morbidity, and common problems)
• Demonstrate an understanding of cardiac pacing (methods, modes, indications and physiological effects)
• Demonstrate an understanding of all hospital formulary pharmacological agents used for circulatory support
• Demonstrate an understanding of the potential metabolic derangements with extracorporeal circulation
• Demonstrate an understanding of acceptable techniques for insertion of invasive monitoring lines
• Demonstrate an understanding of the use of transesophageal echocardiography in cardiac surgery
• Demonstrate an understanding of institution specific practice profiles
• Demonstrate an understanding of benefits and risks of carotid endarterectomy with regional anesthesia
• Demonstrate an understanding of lung-separation techniques (endobronchial tubes and blockers)
• Demonstrate and understanding of hemodynamic and metabolic consequences of aortic cross-clamping with or without extracorporeal circulation
3. Practice-based Learning Improvement
Residents must be able to evaluate published literature on techniques for anesthetic management of cardiac, thoracic and vascular procedures.
The resident is expected to:
• Read the recommended cardiac anesthesia textbook and to seek help from attending cardiothoracic anesthesiologist in understanding complex subjects
• Read the departmental manuals on cardiothoracic and vascular anesthesia and to have reviewed the clinical questions therein.
• Learn how to use available electronic searching tools
• Review ACC/AHA guidelines on perioperative management of patients undergoing non-cardiac surgery
• Review post-operative course of all inpatients
• Present a log of all CT-V cases done during each one-month rotation, describing educational value and documenting patient outcome to the Director of Cardiothoracic Anesthesia and the Program Director.
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.
The resident is expected to:
• Demonstrate an understanding of timely patient care without compromise to quality
• Demonstrate an understanding of essential resources versus optional resources
• Demonstrate an understanding of the costs associated with vascular access sepsis
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 and will involve input from team members outside of anesthesia.
3. A global evaluation will be submitted to all attending anesthesiologists who had the opportunity to evaluate the resident during each four-week 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 a PGY-1 year.