The examination of special competence in advanced perioperative transesophageal echocardiography. This examination was originally called the PTEeXAM and is intended for those who wish to demonstrate special competence in advanced perioperative transesophageal echocardiography. [Scope of Practice: The application of an advanced perioperative TEE examination is to utilize the full diagnostic potential of perioperative TEE including direction of the perioperative surgical decision making process.