- Module code – A-CS-S1
- Module title – Introduction to Clinical Echocardiography
- Programme – PG Certificate – Echocardiography (PGCert)
- Perform and report high quality transthoracic echocardiography.
- Employ strategies to manage risk in the practice of echocardiography.
- Apply the principles of patient-centred care to provide a high-quality echocardiography service.
- Practice echocardiography in accordance with local and national guidelines.
- Appraise the role of echocardiography and complementary technologies in the patient pathway.
- Demonstrate effective communication in the practice of echocardiography.
- Identify and appraise new developments in echocardiography practice.
The work-based competencies listed below include considerations for completing the competency.
|Competency number||Learning outcomes||Title||Considerations for completing the competency (concepts to think about)|
|1||1, 2, 3, 4, 6||Discuss the values and principles as laid out in the NHS Constitution, describe how will you demonstrate these in your daily practice||
|2||2, 4, 6||Control risks in accordance with departmental protocols for echocardiography procedures||
|3||2, 4, 6||Demonstrate competency in appropriate level of resuscitation as per local policy||
|4||3, 4, 5, 6, 7||Review the literature and evidence base for best practice regarding assessment of a pathology; compare best practice to local practice and make recommendations for service improvement||
|5||4, 5||Identify common indications for transthoracic (Level 1 and 2) bubble contrast, LV opacification, stress and transoesophageal echocardiography||
|6||5, 6, 7||Discuss a case where complementary technologies may be useful to further assess cardiovascular disease where echocardiography cannot differentiate fully between pathologies and/or artefact||
|7||6||Explain an echocardiography procedure to another healthcare professional, address any questions they may have related to the procedure||
|8||2, 4, 6||Gain informed consent for an echocardiography procedure, under direct supervision||
|9||2, 3, 4, 5, 6||Present a clinical history together with the images obtained for a procedure to another healthcare professional; discuss progression of disease/symptoms and agree outcomes and next steps||
|10||2, 3, 4, 6||Take appropriate action to respond to the specific needs of the patient to ensure equitable access to echocardiography procedures||
|11||3, 4, 6||Explain the procedure for obtaining results to the patient, alleviating any concerns the patient may have||
|12||1, 4||Produce high-quality cardiac ultrasound images, demonstrating use of a full range of machine controls and ultrasound probes including standalone probe||
|13||2, 4||Set up appropriate equipment in preparation for an advanced echocardiography procedure, including resuscitation equipment where appropriate, and ensure daily checks have been carried out||
|14||1, 3, 4, 6||Identify correct anatomical structures demonstrated on 2D image planes including cardiac and extracardiac anatomy||
|15||1, 4||Acquire standard views in accordance with local and national protocol for Level 2 transthoracic Echocardiogram||
|16||1, 4||Obtain standard measurements using 2D or M-mode in accordance with the local and national protocol||
|17||1, 4||Recognise imaging artefact and normal variants, including Eustachian valve, Chiari network, LV tendon||
|18||1, 4||Utilise colour flow mapping in at least two planes for all valves, optimising gain and box size||
|19||1, 4||Acquire & optimise pulsed and continuous wave Doppler traces and make measurements in accordance with the local and national protocol including use of a standalone CW probe||
|20||1, 4, 6||Produce a clear and accurate written report of a transthoracic echocardiography procedure in accordance with local and national protocols||
|21||6, 7||Critically assess a new technology being introduced into practice; consider benefits and barriers to introduction||
|22||1, 4, 6||Interpret results for a myocardial deformation/speckle tracking analysis study in line with local and national protocols||
- Complete 4 Case-Based Discussions (CBDs)
- Complete 4 of the following Direct Observation of Practical Skills (DOPS) and/or Observed Clinical Event (OCE)
|DOPS||Carry out a procedure for an infectious patient|
|DOPS||Demonstrate appropriate care of the equipment pre, during and post procedure|
|DOPS||Identify cardiac structures in all image planes|
|DOPS||Generate high quality ultrasound images of all standard image planes|
|DOPS||Perform standard 2D/M mode measurements of the left ventricle|
|DOPS||Acquire and optimise colour Doppler of the mitral, aortic, pulmonary and tricuspid valves|
|DOPS||Acquire, optimise and perform standard measurements of pulsed and continuous wave Doppler of the left ventricular outflow tract, aortic valve and mitral valve|
|DOPS||Review the indication for the test and any appropriate records prior to a procedure|
|OCE||Introduce yourself to a patient, confirm patient identity and explain the procedure|
|OCE||Present finding of critical appraisal of ultrasound related topic at departmental meeting|
|OCE||Obtain informed consent prior to a procedure|
|OCE||Obtain a suitable clinical history during an appointment|
|OCE||Explain and discuss the procedure for obtaining results with a patient|
|OCE||Demonstrate to another healthcare professional how to manage infection risks for an echocardiography procedure including managing operator and equipment risks|
Recommended clinical experience
To develop a broader understanding of their specialty practice and support the completion of assessments and competencies, it is recommended a trainee should:
- Observe the use of stress echocardiography in the diagnosis & assessment of coronary artery disease.
- Observe the use of stress echocardiography in the assessment of structural heart disease.
- Observe the use of trans-oesophageal echocardiography in the diagnosis & assessment of structural heart disease to appreciate what additional information may be acquired when compared to TTE.
- Observe the use of transoesophageal echocardiography for the investigation of Infective Endocarditis to appreciate its role in the diagnostic process including advantages compared to transthoracic echo.
- Observe the use of transoesophageal echocardiography in cardiac interventional procedures such as PFO/ASD/VSD closures, LAAO, TAVI, MV clip, MV balloon valvotomy and paravalvular leak closures.
- Observe left ventricular opacification studies to appreciate the application of pharmacological contrast agents in echocardiography and compare with bubble studies.
- Observe the use of 3D echocardiography and reflect on its applications, advantages and disadvantages in the assessment of common pathologies for both transthoracic and trans- oesophageal echocardiography.
- Observe complimentary cardiac imaging such as CMR, cardiac CT, angiography and MPI.
Learning outcomes: knowledge and understanding (PGCert)
On successful completion of this module the trainee will be able to:
- Evaluate and critique the role of echocardiography with respect to clinical presentation, diagnosis and management.
- Explain and apply the fundamental physical imaging principles relating to clinical echocardiography.
- Explain and apply anatomical and physiological correlates to the traditional imaging planes used in transthoracic echocardiography.
- Plan, execute and evaluate detailed echocardiographic data within the context of normal findings using nationally recognised clinical guidelines and reporting techniques.
- Indications for and effectiveness of echocardiography with respect to patient presentation, diagnostic and treatment pathways.
- Ultrasound physics and equipment function / manipulation.
- Normal cardiovascular anatomy and physiology.
- Echocardiographic imaging planes with respect to cross sectional anatomy.
- Normal parameters and advantages versus disadvantages relating to the measurement of normal parameters.
- Introduction to the current national standards for performing and analysing data obtained during transthoracic echocardiography.
- Alternative clinical imaging techniques used in cardiology practice.