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The American Society of Echocardiography (ASE) developed the initial formal exam in echocardiography over the years of 1993 to 1995. Following the pilot exam in 1995, the first exam was administered in 1996 and has been administered yearly since by ASEeXAM, Inc, an independent corporation designed to reduce any potential conflicts of interest between the professional society and the certifying entity. The ASEeXAM exam was designed to test all aspects of echocardiography and was intended primarily for cardiologists with additional training in echocardiography. Many in anesthesiology felt that this exam might result in their exclusion from using transesophageal echocardiography (TEE) perioperatively. Thus, in 1996 the Society of Cardiovascular Anesthesiologists (SCA) convened a task force for certification in perioperative transesophageal echocardiography.1 This committee was responsible for defining the appropriate fund of knowledge, for outlining the exam content based on this fund of knowledge, and for the development of fair multiple-choice questions.

The initial step in exam development was to define the content outline. The task force, with input from cardiology colleagues, set forth 23 initial knowledge categories that emphasized basic echocardiography and ultrasound principles, assessment and interpretation of echocardiographic images, Doppler calculations, and intraoperative applications. The next step for the committee was to write the questions with each member being given a category from the content outline on which to base their questions. All questions were then reviewed by both the committee and a medical editor for the National Board of Medical Examiners (NBME) for content, accuracy, clinical significance, and relevance.2 The pilot examination was given to 95 representative participants in 1997; this exam contained two parts. Part 1 was allotted 60 minutes and consisted of 15 videotaped echocardiography cases with two to four questions per case for a total of 43 questions. Part 2 consisted of both A-type (single best answer) and K-type (complex multiple choice) multiple-choice questions from one of two exam booklets.2 The initial responses to a survey about the initial exam were positive. Following question analysis and recommendations of the NBME, the K-type questions were removed for future exams. The first formal perioperative transesophageal exam (PTEeXAM) was administered by the SCA the following year. In 1998 the SCA and ASCeXAM, Inc, formed the National Board of Echocardiography (NBE). Within its charter, three of the 10 NBE members are anesthesiologists, and eight members are required to change any bylaws. Thus, anesthesiologists are appropriately represented within the NBE. Yearly since 1998, the NBE has developed and administered both the ASCeXAM and the PTEeXAM.

The PTEeXAM is now administered as a computer-based exam. The exam is currently administered once per calendar year at Prometric Testing Centers within the United States, U.S. territories, and Canada, but may increase in administration frequency in the future. The test is given in a standardized fashion; all personal belongings are to be left in a locker outside the testing room. A laminated note board, dry erase markers, and an eraser are provided by ...

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