Year 1
All first-year fellows spend 2-3 months in the echocardiography laboratory and are expected to perform transthoracic echocardiograms on call with the assistance and backup of a senior fellow and cardiology attending.
Almost without exception, fellows rotate through 2 of the 3 laboratories so that they are familiar with different attending physicians and with different approaches to echocardiographic interpretation.
The objective of the first year is to become adept at the utilization of echocardiography in clinical practice as a diagnostic tool. During the initial rotations, training objectives include:
- introduction to the fundamentals of diagnostic ultrasound, with emphasis on indications and limitation of echocardiography
- correlation of clinical and echocardiographic data
- knowledge of physical properties of ultrasound
- fluid dynamics
- recognition of cardiac pathologic findings likely to be encountered in an emergency situation, such as tamponade
- recognition of wall motion abnormalities and their relationship to coronary artery distribution
Didactic instructions are provided during regular morning and subspecialty conferences as well as during supervised interpretation sessions that occur at least once per day with the laboratory director. There is an echocardiography “case-of-the-week” conference at which the most interesting cases are presented and discussed. As part of the MMC program, a multiple choice exam is given at the beginning and the end of the formal rotation to confirm that knowledge has been gained, the results of which are reviewed with the laboratory director.
In addition, technical skill acquisition is encouraged and it is assumed that by the end of the first year of training, fellows will have performed and interpreted approximately 100 complete studies independently and a far larger number of studies will have been reviewed with the echocardiography attending physicians. A complete study should involve image acquisition including M-mode and 2-dimensional imaging as well as pulsed wave, continuous-wave and color flow Doppler studies. The first-year trainee is also expected to develop some skill in performing TEE, but in general the fellow is encouraged to master transthoracic echocardiographic techniques before performing transesophageal studies.
Research participation is encouraged.
Years 2 and 3
During the second and third year, most fellows spend an additional 3-4 months of dedicated time in one of the non-invasive laboratories, and a few fellows devote a substantial portion of their unstructured research time to the pursuit of clinical research involving echocardiography. Additional practical and theoretical instructions are available in echocardiography. These include participation in all transesophageal echocardiographic studies, as well as exercise and pharmacologic stress echocardiographic procedures.
Second-year fellows continue with regularly scheduled didactic sessions reviewing the basic principles of echocardiography and advancing manual skills in the independent performance of transthoracic echocardiograms. Fellows are asked to regularly interpret complete transthoracic echocardiograms with a focus on providing a clinical diagnosis and a thorough interrogation of associated cardiac abnormalities.
The objective of the second year is to become adept at the independent performance and interpretation of complete transthoracic echocardiographic studies. Stress echocardiography (SE) and transesophageal echo (TEE) are introduced.
Third-year fellows are further trained in the performance and interpretaion of transesophageal and stress echocardiography (exercise treadmill and dobutamine stress). Fellows continue active involvement in the didactic sessions and clinical performance and interpretation of transthoracic echocardiograms.
Fellows who choose the noninvasive path spend an additional 3-6 months in echocardiography.
The objective of the 3rd-year noninvasive echocardiography program is to add procedural skills.