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Ministry of Health and Population The Higher Committee of Scientific Council Egyptian Fellowship
[2015]
Egyptian Fellowship of Cardiology Curriculum of Adult
Echocardiography Subspecialty
Egyptian Fellowship
2
Preface
References
Acknowledgement
Egyptian Echocardiography Fellowship Committee
Goal
Aims
Entry requirements for the Egyptian Fellowship of Echocardiography
Training rules and regulations
Curriculum and Themes
3
PREFACE
The Egyptian Fellowship Board and the Egyptian Fellowship of Cardiovascular
medicine (EFOC) scientific council worked collaboratively and closely to make this
curriculum available for trainees’ guidance and support.
Worldwide, postgraduate medical education is now governed by sets of academic
standards that describe the qualities and abilities of graduates. In addition, there are
standards for the training processes, trainers’ selection and methods of assessment to
ensure transparency and clarify expectations.
The Egyptian fellowship board has already defined and published its standards for the
general and professional competencies’ expected from our graduates in different
specialties upon successful completion of training. These expectations are clearly
reflected in the Cardiovascular medicine curriculum and thus echocardiography.
The curriculum describes what trainees should know and be able to do upon
completion of training. The curriculum also describes in details, expectations from
trainees during their rotations.
Methods of assessment and examination regulations are also available in the last
section of the curriculum.
We hope that all our trainees, trainers and educational supervisors will follow the
guidelines provided in the curriculum and cooperate with The Egyptian Fellowship
Board and EFOC Scientific Council to implement the curriculum in the best ways.
This curriculum will be revised and updated every 3 years.
The aim of the one-year Echocardiology Fellowship is to provide an opportunity for
fellows to develop proficiency in performing and interpreting echocardiographic
studies they apply to cardiovascular diseases. The training program can be customized
to meet individual career goals
Secretary General
Higher Committee of Medical Specialties
4
REFERENCES
The Committees consulted international curricula in cardiovascular
medicine. The external references for the development of this
curriculum are:
Nanda NC ed. Comprehensive Textbook of Echocardiography. 2013 .
Feigenbaum H Echocardiography. 7th edition, Lea and Febiger, Philadelphia,2009
Weyman AE. Principles and Practice of Echocardiography. Lea and Febiger,
Philadelphia, 1994.
Otto CM, Pearlman AS. Textbook of Clinical Echocardiography 5th
edition, 2013 .
Otto CM. The Practice of Clinical Echocardiography. 3rd
edition 2002.
Agreed upon items between American and European Guidelinesand curricula in the
last three years and National Guidelines.
5
Acknowledgement
This curriculum has been created through collaboration between the head of EFOC
Scientific Council, the EFOC accreditation team and the Egyptian Fellowship
Curriculum Committee. The following members of the Cardiology experts have made
substantial contribution to the curriculum development as subject matter experts
Professor Khairy Abdel Dayem, Professor of Cardiovascular
Medicine, Ain Shams University and head of the Cardiovascular
Medicine scientific fellowship council
Professor Ahmad Magdy, Consultant of Cardiovasuclar Medicine,
National Heart Institute.
Professor Gamela Nasr, Professor of Cardiovascular Medicine,
Suez Canal University and Coordinator of Egyptian fellowship for
Echocardiograrphy
With Cooperation of Dr Eman Ellabany managerial specialty coordinator of The
Egyptian Fellowship Curriculum Committee has made significant contribution to the
curriculum
6
This has been revised and approved by:
Egyptian Echocardiography Fellowship Committee
Professor Khairy Abdel Dayem AinShams University
Professor Ahmed Magdy National Heart Institute
Professor Aziz Madkour Azhar University
Professor Wafaa ElArousy Cairo University
Professor Gamela Nasr Suez Canal University Coordinator
Professor Mona AbouelSoud AinShams University
Professor Azza Elfiky Ain Shams University
Professor Amal Hamdy Azhar University
Professor Mohamed Osama National Heart Institute
7
Goal The goal of EFOC curriculum is to graduate a safe competent trained specialist in
cardiovascular echocardiography who will be able to work within the National Health
Service and will have the knowledge, skills and attitudes required to do this and to
develop further subspecialty expertise if appropriate.
Aims The educational process in the fellowship of Cardiovascular Medicine aims to equip
trainees with the necessary knowledge, skills and attitude so that they will acquire
competencies; at a level consistent with practice in the specialty of echocardiography
and at the level of professionalism, that will include the following:
Patient care that is appropriate, effective and compassionate dealing with cases in
the field of echocardiography .
Medical knowledge in the basic and clinical sciences, and medical ethics and
application of such knowledge in the diagnosis and management of patients with
cardiovascular disorders through echocardiography.
Acting as safe independent specialists whilst recognizing the limitation of their
own practice and the obligation to seek assistance from colleagues where
appropriate.
Interpersonal and communication skills that ensure effective information
exchange with individual patients and their families and teamwork with other
health professionals.
Appraisal and utilization of new scientific knowledge to update and continuously
improve clinical practice.
The ability to function as a trainer and teacher in relation to colleagues and
medical students.
Maintenance of standards appropriate in their professional field and able to
respond constructively to assessments and appraisals of professional competence
and performance.
8
Entry requirements for the Egyptian Fellowship
of Echocardiography
Any of the following is considered a satisfactory entry requirement for the Egyptian
Fellowship of echocardiography
1. M.D.in Cardiovascular Medicine
2. Fellowship of Egyptian Board of Cardiovascular medicine
3. MSc in Cardiovascular Medicine
TRAINING RULES & REGULTIONS
STRUCTURE OF THE TRAINING PROGRAM The structure of the training program of EFOC Board requires one year supervised
training that must be conducted in an accredited hospital before sitting for the final
examination.
A list of accredited hospitals will be announced yearly by the Board.
During the entire training program the candidate must be dedicated full time and must be
fully responsible for patient care. He will be evaluated through (guided by his Log
Book) two times by PBA exams as follows :After 6 months for ( pass or not) and
finally at end by MCQ and OSPE .
Holidays and on call duties are according to Ministry of health regulation.
GENERAL RULES for Evaluation oF TRAINEE PERFORMANCE
Workplace Based Assessment (WPBA) Performance of the trainee shall be evaluated on regular and continuous basis. The
evaluation process should involve all aspects of the training including clinical and
procedural skills, review of the logbook as well as review of attendance . This is
performed on-monthly bases for the trainees.
Workplace based assessment will be performed as well as procedure based assessment
(PBA) will be both considered .
THE LOGBOOK It is the responsibility of the trainee to record echocardiographic cases into the
logbook at least on weekly basis.
These entries should be signed by the trainer directly supervising the trainee
during the procedure and countersigned by his assigned trainer.
9
Educational activities should also be recorded and signed by person in charge of
the activity and countersigned by the assigned trainer.
Logbooks should be ready for inspection by the education supervisor at all times.
It is the responsibility of each trainee to fill the logbook statistics in the trainee
assessment form (attached). This form should be counter signed by his assigned
trainer.
Logbooks and trainee assessment forms will form part of the evidence submitted
for the annual assessment meeting by review committee.
Procedure Based Assessments (PBAs) The PBA is a formative method (without marks allocated in the exit exam) for
assessing a range of competencies involved in performing certain procedures during
routine training. It enables trainees to build on assessor feedback and follow their
own progress. Although PBA is formative, the summary evidence will contribute to
the decision made as to how well the trainee is progressing and his illegibility to sit
for exam. The tool has two principal components:
1- A series of competencies within four core domains (consent, preprocedure,
procedural and post-procedural that are scored as follows:
N = Not observed U = Unsatisfactory S = Satisfactory
2- An overall global assessment divided into four levels rated as follows:
Level 0: Insufficient evidence observed to support a judgment
Level 1: Unable to perform the procedure under supervision
Level 2: Able to perform the procedure under supervision
Level 3: Able to perform the procedure with minimal supervision
(occasional help)
Level 4: Competent to perform procedure unsupervised (and deal with
complications)
HOW SHOULD IT WORK? The trainee’s learning agreement should indicate which PBAs are selected. It is the
trainee’s responsibility to ensure the required number of PBAs is performed to a
satisfactory standard by the specified timescale. The trainee generally chooses the
timing and makes the arrangement with the assessor. Trainees should carry out the
procedure, explaining what they intend to do throughout. The assessor should
observe the trainee undertaking the agreed sections of the PBA in the normal course
of workplace activity. Given the priority of patient care, the assessor should choose
the appropriate level of supervision depending on the trainee’s stage of training. If
the trainee is in danger of harming the patient at any point, he must be warned or
stopped by the assessor immediately. Trainees and assessors will find the assessment
criteria in the next 2 pages of the validation worksheet. This will help them define
each phase in the procedure and the required satisfactory level.
01
WHAT DOES A COMPLETED PBA MEAN? A completed set of PBAs provides evidence that a trainee has learned to perform
competently a number of procedures in supervised settings.
FEEDBACK When a PBA is completed, the assessor should provide immediate feedback to the
trainee in a debriefing session. The assessor should identify areas of achievement and
opportunities for improvement. This should be done sensitively and in a suitable
environment.
AFTER THE ASSESSMENT AND FEEDBACK The corresponding PBA table should be filled and signed by both the assessor
(assigned trainer or other consultant) and trainee.
TIPS FOR USING PROCEDURE-BASED ASSESSMENTS (PBAS) Perform an assessment as many as possible an index procedure is carried
out; this helps to make assessment and feedback ‘routine’ and aids
learning.
Focus on one particular domain of a procedure this can reduce stress.
Review of the PBA checklist before the start of the procedure can help
with briefing.
The trainee can write up the procedure note whilst the assessor completes
the assessment table (not forgetting to assess the procedure note as well).
A suitable place is chosen for the assessor and trainee to review the
completed PBA table, and for the assessor to provide constructive
feedback.
Completion of the assessment without providing feedback is much less
useful for the trainee.
Items rated as “0, 1, 2” should be expected the first time that a trainee
performs a procedure. This simply means that they need more practice
and more assessments.
Half ANNUAL REVIEW PROCESS (HARP) The chairman of the scientific council sets the date for the HARP, selects the
members of the review board and sends the invitations.
Minimum 4 out of the following review board members (Chairman of scientific
council + program director + council member + educational supervisor + specialty
coordinator + representative of trainers) should attend this meeting.
Trainees will be notified one month ahead of the meeting date.
Learning agreements, logbooks (PBAs), trainer monthly reports, educational
supervisor reports, trainee assessment forms and training post assessment forms
should be submitted by the specialty coordinator at least 3 weeks before the date
of the meeting (all these forms are attached)
00
The specialty coordinator will forward the above documents to the review board
members at least 2 weeks before meeting date.
The following items will be assessed in the meeting:
Verification of signatures
Attendance of activities
Trainees' performance during previous placement
The level of competence achieved by the trainee
Based on the above evidence and following discussion with trainees one of the
following outcomes will be decided:
ARP 1: Satisfactory to progress to the following stage
ARP 2: Can proceed but with targeted training (closer than usual
monitoring and supervision, to address particular needs & provide
feedback). The recommended improvements will be reassessed in the
following ARP meeting.
ARP 3: An official warning of discontinuation of the training program
will be issued if the previous recommendations have not been rectified,
subject to review in a follow up meeting.
ARP 4: Unsatisfactory and should be dismissed from the training
program.
ARP 5: Satisfactory completion for training program, legible to sit for a
final exam.
LEARNING AGREEMENT Soon after start of each post the trainee and trainer should arrange a formal
meeting to discuss trainee needs and career plans.
An agreed plan should be documented in the learning agreement form detailing
objectives, procedures and other activities to be achieved during the placement.
This form should be filled no later than one month after the start of the post and
the form should be forward to the EFOC offices to be retained in the candidates
file.
Dates of future meetings to review the progress of the trainee and the training
process should be agreed on during the initial meeting and documented on the
form.
In each of the above meetings the trainee and the trainer should discuss the
achieved objectives and plan further actions.
At the end of the post the completed learning agreement should be forward to the
Egyptian board offices together with trainee and training post assessment forms to
document the progress of such objectives in respective post. These forms together
with other evidence will form the basis of the Annual Review Process (ARP)
meeting.
Educational activities 1- Presents echocardiography cases in rounds
2- Participates in grand rounds and journal clubs concerning echocardiography
02
3- Attends local echocardiography meeting and possible international meetings for
echocardiography
4- Learns to prepare audiovisual materials for presentations
Central Scientific Day
All Trainees are expected to have protected teaching time at a specific day every 2
weeks. The teaching program of these days is drafted centrally at the Egyptian
Fellowship Boards.
The Specialty Coordinator should notify training centers by the agenda of these days.
INTERRUPTION OF TRAINING It is not permissible to interrupt such a structural training program except in major
unavoidable circumstances. Such circumstances should be convincing and approved by
the Secretary General of The higher committee of Medical Specialties. The interruption
once approved should not be for more than one month . Interruption of the training
program for more than one month shall result in dismissal from the program and
cancellation of the preceding training period
JOB DESCRIPTION OF THE TRAINER DURING THE TRAINING
PROGRAM 1. Provides training and teaching for the trainees according to the provided curriculum
and intended learning outcomes and sign a learning agreement with each trainee.
2. Supervises the various activities of the trainees and their logbooks.
3. Ensures and help trainees for fulfillment of the logbook activities during the year of
training and the required level of competence and signing them.
4. Ensuring patient safety in relation to trainee performance by the early recognition and
management of those trainees in distress or difficulty.
5. Evaluates the trainees through WPBA and routine training activities with feedback to
the trainee, to the educational centrally in the trainer monthly report.
6. Participate as attendant in the annual review process and in exit examination as
nominated or requested by the scientific board
JOB DESCRIPTION OF THE EDUCATIONAL SUPERVISOR
DURING THE TRAINING PROGRAM
1- Checks and evaluates the progress of the training program
2- Evaluates the trainers periodical reports and propose remedial actions for any
deficiencies
3- Ensures that all training activities are running according the curriculum
4- Checks the availability of the requirements for training.
5- Checks that each trainee is involved in an audit process
03
6- Assesses the logbook activities of each trainee & provide needed remarks for both
trainer & trainees.
7- Reports to the EFOC accreditation committee and scientific board and discuss with
them the performance of trainees and their legibility to sit for the exam
8- Discuss with hospital authorities the administrative affairs of the trainees and propose
solutions.
9- Participate in the annual review process and in exit exams as nominated or required by
the cardiology scientific board.
JOB DESCRIPTION OF THE TRAINING PROGRAM
COORDINATOR DURING THE TRAINING PROGRAM 1. Advise trainees on all aspects of Echocardiography Curriculum
2. Follow implementation of the curriculum and the planned program of education
3. Supervise the organization of the training sequence
4. Ensure that each post delivers the education and training expected for that period and
to feed back to the trainers involved any unsatisfactory reports from trainees
5. In conjunction with the scientific council and the Egyptian board, may withdraw a
placement which is considered unsuitable to the needs of the trainee
6. Ensure that the cycle of academic lectures is in place
7. Monitor logbook entries by regular inspection with the specialty coordinatorthrough
the ARP
8. Arrange the ARP meeting with the head of scientific council.
9. Arrange for completion of the training post-assessment form by each trainee after the
end of each rotation. The training post assessment form is confidential and should
only be retained by the specialty coordinator with access rights to the head of the
scientific council and Program Director. The Program coordinator is to give
anonymous feedback to training units and ensure any problems highlighted are
investigated
10. Advise the scientific council on: the facilities needed for training; and the minimum
learning requirements necessary to complete training
JOB DESCRIPTION OF SPECIALTY COORDINATOR
1- Training management across hospitals and hospital networks
2- Keep records of trainees' progression in trainees’ files
3- Collection and follow up of all forms related to the training process. These forms
should be organized and summarized in a suitable spreadsheet reflecting each
activities corresponding to trainees, trainers, supervisors and training post.
4- Organization of the training sequence to meet the needs of the trainee
5- Recruitment of trainers under scientific board supervision
6- Recruitment of trainees in collaboration the Egyptian Board administration and
according to the approved scientific board requirements.
7- Follow up and facilitation of trainers and supervisors activities
8- Liaise with training hospitals’ management teams to successfully manage the training
program in each training center
04
9- Coordination of annual review meetings
10- Preparation for and participation in visits for accreditation of training hospitals
11- Follow up on regular Audit of training centers performance which is based on:
a. Reports from trainers
b. Reports from educational supervisors
c. Trainee post assessment forms
d. Feedback from program director
e. Reports from the monitoring and evaluation office of the Egyptian Boards.
The specialty coordinator should identify any issues arising from previously mentioned
monitoring approaches or as a direct complain from trainees and liaise appropriately with
relevant personal to resolve it.
Overview of Rotation/Content of the Training
Program Echocardiography is currently the most widely used non invasive imaging technique to
evaluate the patient with known or suspected heart disease. It involves a wide variety of
diagnostic ultrasound techniques: M mode, 2-dimensional, harmonic, strain and strain-
rate, pulsed, continuous wave, and color Doppler imaging. In a given patient, any or all of
these modalities may be used to assess the nature and severity of a suspected cardiac
disorder. Fellowship training in Echo should include education in physical principles and
instrumentation of ultrasound, 3-dimensional cardiac anatomy, physiology, and
pathophysiology and acquisition and interpretation of transthoracic echo images. Also to
have ability to interpret transesphageal examination . Fellowship trainees will be required
to perform echo/Doppler examinations themselves and to integrate echo findings with 1)
patient history and physical examination 2)the medical and surgical management of
patients, and 3)the results of other imaging modalities (e.g. CXR, Catheterization,
Nuclear, CT, MRI).
Training Level 1:
All cardiology fellows will be required to complete a three-month core experience in
Echo
Trainees should participate in the interpretation of a minimum of 150 complete echo
examinations (M-mode, 2-dimensional, and Doppler) and personally perform 75 of these
studies. Having completed this level, trainees should be able to recognize common
cardiovascular pathologic conditions
Level 2:
Level 2 training should comprise an additional three months of full time experience
during which an additional 150 studies (300 total) will be interpreted, of which 75 (150
total) should be personally performed. A trainee having completed Level 2 should be able
to independently and accurately perform and interpret a complete adult echo examination.
05
Level 3: Level 3 training consists of an additional six months and 450 additional
examinations interpreted (750 total), 150 of which should be personally performed (300
total). Trainees at this level should be increasingly independent in interpretation. This
level of training includes exposure to the administrative aspects of running an echo lab
and participation in echo related research, understanding new and evolving ultrasound
technologies and applications of echocardiography.
.
Core Competencies 1.Patient Care
2. Medical knowledge
3. Practice-Based Learning and Improvement
4. Interpersonal and Communication Skills
5.Professionalism: through clinical mentoring and self-appraisal, fellows will develop
and demonstrate a professional approach to their work responsibilities, academic pursuits,
and interactions with others.
6. System-Based Practice
7. Administrative Expectations
06
Contents Theme Topic Page
THEME I General Principles Transducers ,Safety and
Physics of Cardiac Ultrasound
THEME 2 The Echocardiographic Examination and
Views and Hemodynamics Derived from Echo
Doppler
THEME 3 Cardiac function : Systolic and Diastolic
Function
THEME 4 Coronary Artery Disease
THEME 5 Valvular Heart Disease
THEME 6 Diseases of the Myocardium (nonischemic)
THEME 7 Systemic and Pulmonary Hypertensive Heart
Disease
THEME 8 Pericardial Disease
THEME 9 Congenital Heart Disease
THEME 10 Cardiac Masses
THEME 11 Diseases of the Aorta
THEME 12 Writing an Echocardiography Report
THEME 13 Medical Ethics and Consent
07
THEME I.
1.1. General Principles ,Transducers ,Safety and
Physics of Cardiac Ultrasound
OBJECTIVE
All trainees must be able to appreciate the general principles of ultrasound
as well as different transducers .Safety and Physics of Cardiac Ultrasound
as well as to be applied .
KNOWLEDGE (K.1.1)
All trainees should be able to:
k.1.1.1 Describe Basic Principles of Ultrasound
K.1.1.2 Identify Transducers
K.1.1.3 Identify Imaging Principles of Ultrasound
K.1.1.4 Identify Biologic Effects of Ultrasound and Safety
K.1.1.5 Identify and manage Quality Assurance of Ultrasound
Instruments.
K.1.1.6 Describe Physical Basic Principles of Doppler
Intellectual & Clinical Skills (ICS.1.1)
All trainees should be able to:
08
ICS.1.1.1 Select patients appropriately for echocardiographic
examination
ICS.1.1.2 Select patients appropriately for transducers .
ICS.1.1.3 Explain the procedure, possible biologic effects and safety .
ICS.1.1.4 Assess the Quality Assurance of Ultrasound Instruments.
Attidute & Behaviour (AB.1.1)
All trainees should be able to:
AB.1.1.1 Educate patients and explain the procedure & follow-up
AB.1.1.2 Get an informed consent
AB.1.1.3 Develop self confidence and recognition of limitations.
AB.1.1.4 Develop a team approach including a close relationship with
nursing.
AB.1.1.5 Work closely with other health care professionals as
necessary.
AB.1.1.6 Explain the anxiety that the patients suffer with
echocardiographic examination
09
THEME II.
The Echocardiographic Examination and Views and
Hemodynamics Derived from Echo Doppler.
2.1. Basic Science: 2.1.1 Anatomy & Histology OBJECTIVE All trainees must be able to describe the anatomy, developmental basis
and histology of cardiac and vascular structures with special emphasis
on applied anatomy relevant to echocardiography .
KNOWLEDGE (K.2.1.1)
All trainees should be able to identify and describe:
k.2.1.1.1 Identify Embryology of heart and its venous system
K.2.1.1.2 Identify Anatomy of heart
K.2.1.1.3 Identify Anatomical landmarks
K.2.1.1.4 Identify Anatomy of coronary vessels (arteries and veins)
K.2.1.1.5 Identify Anatomy of cardiac conduction system
Intellectual & Clinical Skills (ICS.2.1.1)
All trainees should be able to:
ICS.2.1.1.1 Distinguish anatomic landmarks clinically.
ICS.2.1.1.2 Differentiate different cardiac chambers and vascular
structures in non-invasive & invasive imaging.
21
2.1.2. Physiology
OBJECTIVE
All trainees must be able to discuss physiological basis of cardiac action and
mechanics and to apply this knowledge to understand the basic mechanism
of cardiac diseases .
KNOWLEDGE (K.2.1.2)
All trainees should be able to:
K.2.1.2.1 Recognize Physiologic properties of cardiac muscle and
Hemodynamics Derived from Echo Doppler
K2.1.2.2 Discuss cardiac cycle, pressure/volume loop and principles of
Volume and Flow Measurement.
K.2.1.2.3 Explain the autonomic regulation of heart rhythm.
K.2.1.2.4 Describe structural and molecular basis of the heart
K.2.1.2.5 Recognize biophysics of cardiac function
K.2.1.2.6 Describe and explain cardiac function
K.2.1.2.7 Describe and explain different mechanisms of different
cardiac diseases
Intellectual & Clinical Skills (ICS.2.1.2)
All trainees should be able to:
ICS.2.1.2.1 Interpret normal ECG and echocardiogram .
20
2.1.3. Pharmacotherapy:
OBJECTIVE
All trainees must be able to demonstrate deep understanding of the
classification, pharmacokinetics and pharmacodynamics of drugs used in
the field of cardiology and its impact upon myocardial contractility .
KNOWLEDGE (K.2.1.3) All trainees should be able to:
k.2.1.3.1 Describe classification of cardiac drugs.
K.2.1.3.2 Explain mode of action, indications, contraindications,
interactions and adverse reactions of cardiac drugs.
K.2.1.3.3 Recognize the effects of age, body size, organ dysfunction
and concurrent illness on drug distribution and metabolism.
K.2.1.3.4 Recognize effect of cardiac drugs in pregnancy.
K.2.1.3.5 Describe principals of drug trials.
Intellectual & Clinical Skills (ICS.2.1.3)
All trainees should be able to:
ICS.2.1.3.1 Take a relevant history of a patient’s medication regimen
and its side effects.
ICS.2.1.3.2 Adjust the dose of the prescribed drug for each disease in
adult groups.
ICS.2.1.3.3 Monitoring different drugs effects
ICS.2.1.3.4 Recognize and manage possible drug interactions and side
effects (including treatments of concomitant diseases or
22
during pregnancy).
2.2.ECHOCARDIOGRAPHIC Examination
OBJECTIVE
All trainees must be able to understand the principles underlying the
Tomographic imaging Nomenclature of standard views and Transducer
positions, views
KNOWLEDGE (K.2.2)
All trainees should be able to:
K.2.2.1 Define Basic imaging principles
1. Tomographic imaging
2. Nomenclature of standard views
3. Image orientation
4. Technical quality
5. Transducer positions, views.
K.2.2.2 Distinguish between the principle of M-Mode echo
1. Aortic valve and left atrium
2. Mitral valve
3. Left ventricle
23
4. Other M-mode recordings
D. Anatomic basis of 2D-echo
1. Orientation of images (terminology and display)
2. Left ventricular wall segments
3. Coronary artery distribution
E. Principles of echo measurements
1. M-mode
2. 2D-echo
K.2.2.3 Determine causes of Conduction Disturbances
A. Production of wall motion abnormalities
B. Effect on valve motion
C. Effect on Doppler flow velocity waveforms
K.2.2.4 Determine assessment of Intracardiac Pressures.
Intellectual & Clinical Skills (ICS.2.2)
All trainees should be able to:
ICS2.2.1 History taking and appropriate examination in patients
ICS2.2.2 Obtaining an adequate resting echocardiogram
ICS2.2.3 Demonstrate a systematic approach to interpretation of resting echocardiogram
ICS2.2.4 Communicate effectively with patients
Attidute & Behaviour (AB.2.2)
24
All trainees should be able to:
A.2.2.1 Take a sensible, professional attitude towards patients
A.2.2.2 Consent patients sensitively with an objective assessment of risks.
A.2.2.3 To educate patients as to the treatment options open to
them, to empower them to take their own decisions as to
their preferred treatment strategy.
25
THEME III. Cardiac function : Systolic and Diastolic Function: 3.1. Systolic and Diastolic Function:
OBJECTIVE
All trainees must be able to competently apply the knowledge of Principles
of echocardiography in detection of cardiac dysfunction.
KNOWLEDGE (K.3.1)
All trainees should be able to:
k.3.1.1 Describe Determinants of LV Performance.
K.3.1.2 Explain Global LV Systolic Function and Regional systolic
function, Interdependence of LV and RV and Global RV
systolic function
K.3.1.3 Identify Cardiac Diastolic Function
Basic Principles. , Echo-Doppler Approach to LV Diastolic
Function, Right Ventricular Diastolic Function.
K.3.1.4 Describe new advances in assessment of cardiac function
Intellectual & Clinical Skills (ICS.3.1)
All trainees should be able to:
ICS.3.1.1 Perform a complete functional echocardiographic study.
Attitude & Behaviour (AB.3.1)
All trainees should be able to:
26
AB.3.1.1 Correctly attitude to the procedure approach-appreciating
usage.
THEME IV. Coronary Artery Disease
4.1. Coronary Artery Disease OBJECTIVE All trainees must be able to appreciate the role of echocardiography in the
management of patients with coronary artery disease and also to recognize
and deal with complications of coronary artery disease.
KNOWLEDGE (K.4.1)
All trainees should be able to identify:
K.4.1.1 Identify the role of Coronary Artery Anatomy and Function
K.4.1.2 Identify Coronary Artery Abnormalities.
K.4.1.3 Describe Basic principles , Relationship of wall motion and
wall thickening to coronary artery perfusion and Myocardial
Ischemia and detection of ischemic muscle
K.4.1.4 Detect and locate coronary artery disease
1. Regional wall motion abnormality
2. Relationship between transmurality and regional function
3. Non-CAD causes for chest pain.
K.4.1.5 Identify Quantitation of MI
27
(prognostic value: guide therapy)
C. Limitations and alternate approaches
D. Complications and associated findings.
K.4.1.6 Implantation of Follow-up transthoracic echo
Intellectual & Clinical Skills (ICS.4.1)
All trainees should be able to:
ICS.4.1.1 Select appropriate patients for echocardiographic
examination with coronary artery disease.
ICS.4.1.2 Consent a patient in a balanced and informed way about the
role of echocardiography in a safe and logical fashion.
ICS.4.1.3 Decide when an alternative technique or approach may be
required
Attitude & Behaviour (AB.4.1)
All trainees should be able to:
AB.4.1.1 Take a sensible, professional attitude to the procedure; learn
under supervision with appropriate requests for advice
AB.4.1.2 Be aware of importance of members of a multi-disciplinary
team in patient management and in maximizing benefit of
echocardiography .
AB.4.1.3 Appreciate the psychological impact of the patient's illness on the
patient and their family, and manage it selectively
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THEME V. Valvular Heart Disease
5. Valvular Heart Disease: OBJECTIVE All trainees must be able to select appropriate cases for Valvular Heart
Disease and understand the cardiac and thoracic anatomy and to apply this
knowledge to understand the and safely extract data using all available
technology.
KNOWLEDGE (K.4.2)
All trainees should be able to identify:
K.5.1.1 Basic Principles of Valve Stenosis : Aortic Stenosis , MitraL
Stenosis Tricuspid stenosis and pulmonary valvular stenosis
K.5.1.2 Basic Principles of Valve Regurgitation.
K.5.1.3 Mitral Valve Prolapse
K.5.1.4 Prosthetic Valve : Types of prosthetic valves, Echo-Doppler
clues to prosthetic valve dysfunction Routine” follow-up of
prosthetic valve function
K. 5.1.5 Endocarditis
A. Role of echo in diagnosis
K.5.1.6 Valvular Heart Disease Associated with Systemic Conditions
Intellectual & Clinical Skills (ICS.4.2)
All trainees should be able to:
ICS.5.1.1 Select appropriate echocardiographic approach patients for
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with Valvular Heart Disease
ICS.5.1.2 Consent a patient in a balanced and informed way about the
risk of Valvular Heart Disease in a safe and logical fashion.
ICS.5.1.3 Assess severity of Valvular Heart Disease using different
tools.
Attitude & Behaviour (AB.4.2)
All trainees should be able to:
AB.5.1.1 Foster a team approach to assessment of Valvular Heart
Disease including a close relationship with cardiac surgeons
AB.5.1.2 Educate patients about the treatment options available to
them and to explain treatment strategies including surgical
AB.5.1.3 Work closely with other health care providers
THEME VI. Valvular Heart Disease
6. Diseases of the Myocardium (nonischemic)
OBJECTIVE
All trainees must be able to select appropriate cases of non ischemic
myocardial diseases.
KNOWLEDGE (K.6.2)
All trainees should be able to identify:
K.6.1.1 Identify Cardiomyopathies
K.6.1.2 Identify Dilated cardiomyopathy
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1. Echo features
2. Associated findings.
K.6.1.3 Identify Hypertrophic cardiomyopathy
1. Epidemiology
a. Prevalence, incidence
b. Associated risk factors for sudden death
c. Presentation
d. Genetics
2. Anatomic features
a. Varied patterns of myocardial hypertrophy (pleomorphic)
Spectrum of dynamic obstruction
K 6.1.4 Identify Restrictive cardiomyopathy (RCM)
1. Etiologies
a. Primary
1) Idiopathic
2) Loeffler’s eosinophilic endomyocardial disease
3) Endomyocardial fibrosis
b. Secondary
1) Amyloid heart disease
2) Hemochromatosis
3) Heart muscle disease occasionally presenting
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with restrictive features
a) Post irradiation heart disease
b) Carcinoid heart disease
c) Doxorubicin/daunorubicin toxicity
d) Progressive systemic sclerosis
2. Typical 2D-echo findings
K.6.1.5 Endocarditis
A. Role of echo in diagnosis
K.6.1.6 Va Differentiating RCM vs constrictive pericarditis
Intellectual & Clinical Skills (ICS.6.2)
All trainees should be able to:
ICS.6.1.1 Consent a patient in a balanced and informed way in a safe
and logical fashion
Attitude & Behaviour (AB.6.2)
All trainees should be able to:
AB.6.2.1 Foster a team approach including a close relationship with
cardiac surgeons
AB.6.2.2 Educate patients about the treatment options available to
them and to explain treatment strategies including surgical
AB.4.2.3 Work closely with other health care providers as necessary:
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THEME V. MEDICAL ETHICS AND CONSENT
All trainees should know, understand and apply appropriately the
principles, guidance and laws regarding medical ethics and
confidentiality and be able to obtain valid consent from the patient and
respond to the patient's level of understanding and mental state.
KNOWLEDGE (K.5)
All trainees should be able to recognize
K.5.1 The principles of medical ethics
K.5.2 The factors influencing ethical decision making: religion,
moral beliefs, cultural practices.
K.5.3 Different types and structure of consents
K.5.4 Persons from whom consent should be taken
K.5.5 Situations where patient consent, while desirable, may not
required for disclosure e.g. communicable diseases
Intellectual and Clinical Skills (ICS.5)
All trainees should be able to:
ICS.5.1
Explain to the patient and family his or her disease, natural
history, prognosis, management plans, all care options and
possible complications.
ICS.5.2 Obtain a valid consent
ICS.5.3 Practice and promote accurate documentation within
clinical practice
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Attitude and Behavior (AB.5)
All trainees should:
AB.5.1 Respond to the patient's level of understanding and mental
state and how this may impair their capacity for informed
consent.
AB.5.2 Demonstrate balanced attitude to deliver the information in
the consent without ease or frightening to the patient and
his/her family.
AB.5.3 Respect patient’s requests for information not to be shared,
unless this puts the patient, or others, at risk of harm
AB.5.4 Demonstrate honesty and openness in any financial
arrangements with patients
AB.5.5 Conforms to codes of practice.
Recommended