ROTATION:  CA-3 Cardiovascular Anesthesia at Shands Hospital  (CV); VA Medical Center Cardiothoracic Anesthesia  (VACT) ; Cardiovascular Anesthesia - Shands Jacksonville (UMCCV); Cardiovascular Anesthesia at St. Vincents - Jacksonville (CVSTV), and Cardiovascular Anesthesia at Texas Heart Institute (THI)
TYPE: Required or elective 
DURATION: 1 month - 6 months
Faculty member:  Greg Janelle, MD (Shands), Felipe Urdaneta, MD (VA Medical Center); Robert Redfern, MD (Shands-Jacksonville); Kevin Donovan, MD (St. Vincent's - Jacksonville); Douglas Hirsch, MD (Texas Heart Institute
PREREQUISITES: CA-3 resident in good standing

CA-3 Advanced Clinical Track Cardiovascular Rotations

Advanced Clinical Track Rotations in CV Anesthesiology may be performed at:  Shands Hospital at UF, VA Medical Center, Shands at Jacksonville, and Texas Heart Institute.  The Goals / Competencies are the same for all three rotations.  Rotation Directors are listed below.

Goals: In addition to those outlined for the basic rotation in Cardiothoracic Anesthesia:

• Expand the knowledge base with regards to cardiovascular and pulmonary physiology and pharmacology and pathophysiology developed during CA-1 and CA-2 years. 
• Develop clinical judgment to provide anesthetic care for more complex cardiovascular and thoracic procedures. 
• Develop technical skills necessary to conduct more complex cardiothoracic cases

Patient Care Skills and Medical Knowledge: In addition to those outlined for the basic rotation in Cardiothoracic Anesthesiology:

• Be able to complete a thorough preoperative evaluation for all cardiothoracic patients, 
  recognizing impact of their disease states on perioperative management. For routine cardiothoracic procedures, accomplish preoperative preparation and anesthetic planning independently.  For complex procedures, preoperative preparation and planning will occur with assistance from the attending anesthesiologist as needed and as appropriate.
• Plan and carry out anesthetics for routine cardiothoracic procedures with minimal assistance from the attending physician. 
• Perform anesthetics for complex cardiothoracic procedures with as needed assistance from the attending anesthesiologist. 
• Perform all invasive monitoring techniques and interpret information obtained reliably with minimal assistance from the attending anesthesiologist. 
• Develop beyond a basic understanding of transesophageal echocardiography, be able to insert the probe.  Be able to obtain and interpret 4-chamber and short-axis views, recognize most common pathology including valvular lesions and wall motion abnormalities.  Be aware of and able to discuss documented advantages and disadvantages of the use of TEE monitoring during cardiothoracic procedures. 

Evaluation:  As described in the primary cardiothoracic rotation.  However, in addition, your ability to practice cardiothoracic anesthesia as an independent consultant anesthesiologist will be assessed.
Resources: As described in basic Cardiothoracic Rotation

Responsible Faculty:

• Shands at UF:  Dr. Janelle
• VA Medical Center:  Dr. Urdaneta
• Shands at Jacksonville:  Dr. Redfern
• St. Vincent's - Jacksonville:  Dr. Donovan
• Texas Heart Institute:  Dr. Douglas Hirsch