Do we all need to have TEE capability?

Given these considerations, and in the absence of data to the contrary, the answer to the question of whether we all need to be proficient in TEE must, in my opinion, at the present time, be no. It will have a role to play in centres where cardiac surgery or treatment of major trauma are performed. Apart from these areas, the onus is on TEE investigators, using appropriately rigorous investigative methods, to demonstrate why the rest of us should develop TEE skills. This is not to deny that the role for TEE may not expand but, before more widespread application of the technology (and its cost) can be justified, further study is required.