Level 2, Month 2 (Comprehensive Echocardiography/Doppler/TEE/Intraoperative Echo/3D Echo/Stress)
Educational Purpose
There are 3-6 months or more dedicated to echo training in the third year with the goal of achieving level 3 training in echocardiography.
Fellows integrate their echo training with all other cardiovascular disciplines, such as cardiac catheterization, heart failure and cardiac transplantation, clinical cardiology and nuclear cardiology. The emphasis of training is shifted to from basic echo interpretation to advanced level transthoracic echo interpretative skills and proficiency in stress echo and TEE including experience of intraoperative echocardiography.
Fellows spend the majority of their time with the senior attending in the echocardiography laboratory and some time in the operative room. Fellows are expected to supervise and interpret all types of echocardiograms including stress, contrast, emergent and complex congenital heart studies. Fellows also perform many more transesophageal studies on a regular basis. At a minimum, a fellow must reach Level 3 training in transthoracic echo and complete at least 100 supervised transesophageal studies and 250 supervised stress echocardiographic studies to be certified to independently perform these procedures and be able to direct a laboratory.
Fellows pursue advanced level training in the interpretation of transthoracic echocardiography (TTE), stress echo (SE) and proficiency to perform and interpret transesophageal echocardiography (TEE). The goal is to obtain level 3 training (12 months, 300 transthoracic 2-dimensional and Doppler echocardiograms performed [150 additional] and 750 interpreted [450 additional]).
Level 3 represents a high level of expertise that would enable an individual to serve as a director of an echocardiography laboratory and be directly responsible for quality control and for the training of sonographers and physicians in echocardiography. Although these guidelines reflect the minimum number of TTE and Doppler studies, most physicians who are level 3 trained will also have additional training in TEE and stress echocardiography. It should be emphasized that these numbers reflect the minimum examinations considered for clinical competence; many training programs will offer a greater experience in interpretation of transthoracic echocardiograms over the time periods previously outlined.
Special procedures such as TEE would require 100 procedures and stress echocardiography (250 interpretations). Although some experience in special procedures was attained as a part of level 2 training, in most instances, full competence in these areas would likely require the equivalent of level 3 training.
Topics Covered: Sentinel Medical Knowledge and Patient Care Skills
- calculating atrial and LV volumes
- evaluate all types of prosthetic valves
- all anatomical and Doppler studies in a variety of clinical conditions and settings
- TEE diagnosis of infective endocarditis complications such as abscess
- all aspects of stress echocardiography including viability
- intraoperative (TEE) echo
- foundation in real-time 3D echocardiography (RT3DE)
Clinical Encounter Experiences
- intubated patients (ICU/SICU/CSICU)
- patients with acute MI (CCU)
- patients with cardiomyopathies (outpatients/inpatients)
- patients with complex congenital heart disease (cath lab)
Teaching Methods
The third-year fellow is involved in developing modules and providing didactic teaching to the junior fellows such as the interpretation of a normal echocardiogram. Lectures are given in multi-valvular heart disease, hypertrophic cardiomyopathy with aortic stenosis, hepatic vein Doppler, PISA in MS, and advanced training in all aspects of TEE and stress echocardiography such as viability testing.
Daily teaching sessions include both anatomical and Doppler topics. At the bedside fellows are taught how to:
- optimize ultrasound images
- perform shunt calculations
- obtain contrast images
- perform basic congenital heart echo studies
- administer Dobutamine during stress echocardiography
Fellows pursue advanced-level bedside training in TEE as described in year 3, month 1.
Fellows participate in teaching conferences as described in year 2, month 3.
Procedure Types Performed
Fellows perform an advanced transthoracic echocardiography exam, stress echos, and transesophageal echo as detailed in procedure types, year 2, month 3.
Service Types Performed
- on-call echocardiography (stat echos)
- stress echocardiography
- transthoracic echo in special settings (cath lab during balloon mitral valvuloplasty (PBMV))
- transesophageal echo
- intraoperative echo