Two months are dedicated to echo training in the first year. The initial experience will be spent primarily learning the technical aspects of image acquisition under the tutelage of a board-certified sonographer.
The primary role of the fellow is to learn. Learning should incorporate all of the primary competencies including medical knowledge, patient care, practice-based learning, interpersonal skills, professionalism and system-based practice.
Secondary roles of the fellows are to assist in the delivery of high quality medical care. Cooperation is expected when ancillary echo staff is unavailable, to assist with administration of IV contrast, performance of STAT echoes, insertion of IV lines.
A monthly orientation will be given to each fellow to go over roles, expectations and learning objectives for that month.
Educational Purpose
Perform and interpret transthoracic echocardiograms, including:
- ultrasound physics and techniques and principles of instrumentation
- anatomy, physiology, and pathology of the heart and great vessels
Topics Covered: Sentinel Medical Knowledge and Patient Care Skills
- Understand the physics of sound and ultrasound
- Operate the echo machine
- Learn the potential bioeffects of ultrasound
- Assess cardiac morphology
- Assess LV/RV regional and global systolic function
- Assess valvular function and specifically the standard evaluation of valve stenosis/regurgitation
- Estimate pulmonary pressures
- Assess pericardial disease, specifically pericardial effusion/tamponade
Clinical Encounter Experiences
- Patients with normal cardiac exam
- Patients with valvular stenosis and regurgitation
- Patients with CHF (systolic heart failure)
- Patients with a pericardial effusion for diagnosis of pericardial effusion and cardiac tamponade
Teaching Methods
Didactic teaching: in introductory didactic series is initiated during the first month of fellowship training and will continue throughout fellowship training. This includes lectures in echocardiography.
Daily teaching sessions: during the first echo rotation, a clear outline of the echo curriculum as well as goals and expectations of time spent in echo are given to the fellows. There is a daily teaching session, which includes both anatomical and Doppler topics.
Bedside image acquisition: at the bedside, fellows are taught how to acquire ultrasound images. Both echo technologists (ultrasound technologists) and the echo attendings spend time at the bedside to teach the fellows the fundamentals of image acquisition. Learning is divided into two important skill sets:
- transducer manipulation
One should not underestimate the mastery required in transducer manipulation, which is critical to obtaining optimal image quality in standard imaging planes, as well as obtaining optimal Doppler flow velocity signals.
- ultrasound system adjustments
The second set of technical skills includes appropriate knowledge of ultrasound instrument settings such as transducer frequency, use of harmonics, mechanical index, depth, gain, time-gain-compensation, dynamic range, filtering, velocity scale manipulations, and display of received signals.
Teaching conferences: echocardiography conducts weekly, one hour organized teaching meetings that includes the ultrasonographers, echocardiography fellows and echocardiography attendings. Fellows will also be expected to present relevant echocardiographic studies at this and other conferences such as the catheterization conference.
Procedure Types Performed
- Perform a complete transthoracic echocardiography exam
- Identify the standard imaging planes for 2D echocardiography
- Perform accurate measurements for chamber dimensions
- Learn basic Doppler.
Service Types Performed
- on-call echocardiography (stat echos)
- emergent echocardiography under supervision of attendings during daytime hours (includes to catheterization or EP labs to rule out tamponade)
- administration of agitated saline (bubble studies) for detection of intracardiac shunts
- exercise electrocardiography under supervision of attending
Reading List
Feigenbaum. Echocardiography (Sixth Edition). Lippincott, Williams & Wilkins. 2005.
Weyman. Principles and Practice of Echocardiography (Second Edition). Lea & Febiger. 1994.
Oh. The Echo Manuel. Lippincott, Williams & Wilkins. 1994.
Otto. The Practice of Clinical Echocardiography (Second Edition). 997 pages.
Textbook of Clinical Echocardiography (Third Edition). 443 pages. Saunders. 2000.
Reference textbook Principles & Practice of Echocardiography, second edition (Editor: Weyman) is available in the echo lab for advanced reading.