This month may include Level 1, Year 2, Month 3 for fellows depending on career path.
Educational Purpose
Between the 2 second-year months there is further emphasis in refining the knowledge base and interpretive echo skills. Fellows are expected to recognize subtleties in stress echo and manipulate and interpret TEE at a superior level.
At a minimum, fellows must reach level II training in transthoracic echo and complete at least 50 supervised transesophageal studies and 100 supervised stress echocardiographic studies to be certified to independently perform these procedures.
Further learning in transthoracic echocardiography (TTE), stress echo (SE) and performing and interpreting transesophageal echocardiography (TEE). The goal is to obtain level 2 training (6 months, total of 150 examinations performed and total of 300 interpreted. Level 2 training is the minimum recommended training for a physician to perform and interpret echocardiograms independently. These requirements are specifically for transthoracic 2-dimensional and Doppler echocardiography. Level 2 is defined as a minimum of an additional 3 months of training in echocardiography (6 months cumulative) and the addition of 150 transthoracic two-dimensional and Doppler examinations interpreted (300 cumulative exams interpreted).
Additional training in special procedures, such as TEE and stress echocardiography, is detailed above. Although some experience in special procedures may be attained as a part of Level 2 training, in most instances, full competence in these areas will require additional training beyond Level 2.
Topics Covered: Sentinel Medical Knowledge and Patient Care Skills
- Proximal Isovolumic Surface Area (PISA)
- Pressure half-time method for MS
- Pressure half-time method for AI
- Cardiac output
- Regurgitant fraction (AI)
- Continuity equation for AS
- Dimensionless index (AS, prosthetic aortic valves)
Clinical Encounter Experiences
- patients with hypertrophic cardiomyopathy and aortic stenosis
- patients with mitral stenosis and regurgitation (assess Wikins score)
- patients with effusive-constrictive and restrictive cardiomyopathy
- patients with ischemic heart disease
- patients with CHF
Teaching Methods
- didactic teaching
- daily teaching sessions
- bedside training in TEE
- teaching conferences
See teaching methods, year 2, month 1 for more information.
Procedure Types Performed
Fellows perform a complete 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