Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)

Abstract

<p>Abstract</p> <p>Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described.</p> <p>Obtaining competence in ICU echocardiography may be achieved in different ways – either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level – obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs.</p

Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

“…Curriculum and didactics are being implemented in emergency medicine, medical schools, and critical care programs throughout the United States and internationally with a high degree of accuracy and retention [1,9,10,[20][21][22]. Many programs are also being offered for postgraduate studies and for clinicians in the field.…”

Ultrasound beyond regional anesthesia: formal training?

“…La Society of Cardiac Anesthesiologists et l'American Society of Echocardiography ont défini un cadre de compétences exhaustif pour le niveau d'un cardiologue détenteur d'un certificat de spécialiste. 6 La formation et la certification des anesthésiologistes cardiaques est similaire au Royaume-Uni et se déroule dans un centre cardiothoracique pendant l'année de stage (le fellowship), dont trois à six mois sont consacrés à l'échographie transoesophagienne. Les compétences sont enseignées par des anesthésiologistes cardiaques, souvent sous la supervision de collègues cardiologues, auxquelles s'ajoutent cours et ateliers.…”

“…Des directives ont récemment été établies par le groupe WINFOCUS (World Interactive Network Focused on Critical UltraSound) ECHO-ICU afin de soutenir les formations structurées et la certification en soins intensifs des personnes intéressées à acquérir les compétences d'imagerie nécessaires aux intensivistes. 6 La structure de la formation ressemble à celle en médecine d'urgence et se fonde sur une approche opportuniste continue sous un formateur certifié.…”

“…Guidelines have been established recently by the WINFOCUS (World Interactive Network Focused on Critical UltraSound) ECHO-ICU Group to aid structured training and credentialing in intensive care to those interested in developing the imaging skills required of intensivists. 6 The structure of training is similar to that in emergency medicine and uses a continual opportunistic approach under an accredited trainer.…”

“…The Society of Cardiac Anesthesiologists and the American Society of Echocardiography have defined comprehensive competencies for the level of a board certified cardiologist. 6 Training and credentialing for cardiac anesthesiologists is similar in the United Kingdom, taking place in a cardiothoracic centre during the fellowship year, with three to six months dedicated for transesophageal echocardiography. Skills are taught by cardiac anesthesiologists, often under the supervision of cardiologist colleagues, and are supplemented by courses and workshops.…”