Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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EDITORIAL Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 75-76
Teaching cardiac anaesthesia

Professor & Consultant - Anaesthesia & Intensive Care & Director (Academic) Narayana Hrudayalaya Institute of Medical Sciences, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore - 560 099, India

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How to cite this article:
Muralidhar K. Teaching cardiac anaesthesia. Ann Card Anaesth 2008;11:75-6

How to cite this URL:
Muralidhar K. Teaching cardiac anaesthesia. Ann Card Anaesth [serial online] 2008 [cited 2022 Nov 29];11:75-6. Available from:

With an estimated population of 1.13 billion in 2008 (of which approximately 400 million will be under the age of 18 years), India is the world's second most populous country after China. [1] Heart disease is one of the most common illnesses in India - approximately 2.4 million people need heart surgery in this country every year; although due to lack of affordable treatment, only 75,000 cardiac surgical operations are performed annually. [2]

There is a growing demand for cardiac care in India, and many new cardiac centres are being commissioned to cater to the increasing demand. Needless to say, with the statistics as alluded to, there is a compelling need to train anaesthesiologists in the field of cardiovascular disease (CVD). The complexity of many of the CVDs requires that there should be a cadre of super-specialists, specially trained and educated in the field of cardiac anaesthesia. There is an incessant demand for trained human resources in the field of cardiac anaesthesia. Recent advances in cardiac technology, need for evidence-based management strategies, and changing complexities of surgical and non-invasive procedures have made the structured training programmes imperative. [3] Due to the fact that increasing number of patients with CVDs undergo non-cardiac operations, it is suggested that even those anaesthesiologists who practice non-cardiac anaesthesia must have a mandatory training in cardiac anaesthesia for 12 months in their career to be able to manage cardiac patients presenting for non-cardiac surgery. Experience has confirmed that the postdoctoral training in cardiac anaesthesia has helped young anaesthesiologists in building up confidence in managing patients with cardiovascular disease undergoing non-cardiac procedures, in addition to giving them a flavour of the demanding speciality.
"Cardiac anaesthesia" (CA) can be defined as a sub-speciality of anaesthesia, which is devoted to the preoperative, intraoperative, and postoperative care of adult and paediatric patients undergoing cardiac surgery and related invasive procedures. The first formal training programme in cardiac anaesthesia in India was started in 1982 at Thiruvananthapuram. Sub-speciality training in CA should be for a minimum duration of 12 months beginning after satisfactory completion of 3 years' speciality training in anaesthesia (e.g., MD, DNB, Anaesthesia). The training, although stated to be 12 months, varies not only in its nomenclature but also in duration in different institutions across India. For example, the postdoctoral certificate programme in cardiac anaesthesia offered by Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMS), Thiruvananthapuram, has a duration of 12 months, which also includes training in neuro-anaesthesia; the same institute offers Doctor of Medicine (DM) in cardiac anaesthesia, which is of 3 years' duration. The fellowship programme offered by National Board of Examinations (NBE), New Delhi; and Indian Association of Cardiovascular Thoracic Anaesthesiologists (IACTA) is of 24 months' duration, while that offered by Rajiv Gandhi University of Health Sciences, Karnataka, is of 18 months' duration. Education and training programmes in India have, more often than not, been conceived and implemented in an ad-hoc and haphazard fashion. This has predictably resulted in programmes falling short of lofty objectives, with which they were formulated. The IACTA should take this opportunity to standardise the training programmes provided by various institutions/boards in India, aiming to produce a product, which has uniform capability of a high standard. This would become a model for all health care training programmes.

The sub-speciality training programme in CA is structured to ensure optimal patient care while providing the fellows an opportunity to develop skills in clinical care, teaching, and research. An accredited programme in CA must provide education, training, and experience in an atmosphere of mutual respect between the mentor and the fellows so that the candidate will be stimulated and prepared to apply required knowledge independently. In addition to imparting clinical skills, the training programme must stress the need to develop inter-personal skills, effective communication, professionalism, and managerial attributes. By the time the training is complete, the fellows must be capable of assuming responsibility, act with integrity, and demonstrate a commitment to excellence and ethics. Clinically, they must become adept in managing adult and paediatric patients, especially those that are not highly complex.

The three basic fundamental requirements of CA education will involve cognitive (knowledge base), psychomotor, and affective material. Cognitive or knowledge base of CA is the scientific knowledge relating to basic medical sciences as applicable to CA. [4] The psychomotor skills refer to capability of performing techniques such as pulmonary artery catheterisation, cardiac output measurement, transoesophageal echocardiography (TOE), etc. The author strongly feels that training in transoesophageal echocardiography must form an integral part of the cardiac anaesthesiology training programme as TOE has become a gold-standard intraoperative monitoring and diagnostic tool in cardiac surgery; and anaesthesiologists are most suited to perform and interpret TOE. [5] Affective learning deals with feelings or emotions. In real life situations, the behaviour and interaction of the mentor with a surgical colleague or hospital manager will provides a lesson in affective domain for the CA fellows.

The process of teaching and learning may adopt one of the several methods available, namely, didactic lectures, interactive teaching sessions, problem-based learning, case discussions, journal clubs, bedside teaching, and video conferencing. In the author's institute, telemedicine facility is used extensively for video-conferencing teaching sessions. Use of internet and web resources provide access to up-to-date information and learning materials in a very practical manner. In addition to the three types of skills that should form an integral part of the training programme, a project or research study must be mandatory for each of the fellows taking up CA sub-speciality training programme.

In addition to acquiring knowledge (cognitive) and skill (psychomotor), the author believes postdoctoral programmes must include sessions on (i) teaching methodology, (ii) management principles, and (iii) thesis/research methodology. This is aimed to prepare the fellows to become efficient teachers and managers, in addition to developing into able clinicians in the field of cardiac anaesthesia (CA).

Education is a change in behaviour based upon experience, and the learning does not end after successful completion of the fellowship programme. Learning is a lifelong process, and participating in continuing medical education programmes, conferences, and workshops must form an integral part of any professional in CA till he/she retires or calls it a day.

   References Top

1.Wikipedia, the free encyclopedia wide website (  Back to cited text no. 1    
2.Khanna T, Kasturi Rangan V, Merlina M, Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor, Harvard Business School; 2005. p. N9-505-078.  Back to cited text no. 2    
3.Mohandas K, Education and training in cardiothoracic anaesthesia. Ann Cardiac Anaesth 2000;3:1-2.  Back to cited text no. 3    
4.Schwartz AJ. Training, qualification, teaching and learning in cardiac anesthesia. In: Kaplan editor. Kaplan's Cardiac Anesthesia, 5 th ed. Philadelphia: Saunders Elsevier; 2006. p. 1235-51.  Back to cited text no. 4    
5.Swanevelder J, Chin D. Accreditation in transoesophageal echocardiography: Statement from Association of cardiothoracic anaesthetists and the British Society of Echocardiography joint TOE accreditation committee. Br J Anaesth 2003;91:469-72.  Back to cited text no. 5    

Correspondence Address:
Kanchi Muralidhar
Professor & Consultant - Anaesthesia & Intensive Care & Director (Academic) Narayana Hrudayalaya Institute of Medical Sciences, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore - 560 099
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-9784.41573

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