II. Accreditation in transoesophageal echocardiography in the UK: the initial experience

Abstract

UK accreditation in transoesophageal echocardiography (TOE) commenced as a joint venture between the Association of Cardiothoracic Anaesthetists (ACTA) and the British Society of Echocardiography (BSE) to advance safe practice and set standards. 1 The 10th examination is hosted later this year and we describe in this editorial how accreditation has become established among TOE practitioners. Miller 2 promoted the idea that assessing a clinical skill requires more than the mere test of knowledge and this is particularly relevant with a complex skill like TOE. He argued that acquisition of (in this case echocardiographic) information, the analyses and interpretation of (echocardiographic and clinical) data, and translating the information into a diagnosis (writing a report) are integral to skill assessment. Formulating a management plan remains the domain of clinicians, and not necessarily the echocardiographer, hence this is not assessed. Competency in TOE is inferred by the practitioner demonstrating sufficient knowledge, skill, and judgement to acquire accreditation. Accredited practitioners should be able to competently perform and report a comprehensive TOE in different clinical settings, as opposed to a basic or focused examination. Accreditation requires passing both the written examination and a practical competency assessment and there is no concept of partial accreditation. To date, 339 out of 468 (78.9%) candidates have passed the examination. The base speciality of candidates was anaesthesia (42%), cardiology (40%), echocardiography (8%), and other/unknown (10%). More than 200 logbooks have been submitted and 150 candidates are accredited in TOE. Approximately 15% of ACTA members are UK TOE accredited, but some members have pursued accreditation through European or other bodies instead and not all ACTA members perform TOE in their practice. In a recent survey of ACTA members, just under 30% of cardiac anaesthetists indicated that they were TOE accredited (personal communication, June 2012). The growth in the number of

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“…The importance of becoming proficient in the use of TEE is well recognized in anesthesia, and accreditation has been developed to support this. 8 The traditional approach for TEE training has been self-directed learning via literature and a lecture-based approach. The intraoperative ''handson'' approach, which may be regarded as the gold standard, can be difficult to achieve for trainees because of reduced working hours, shift patterns, service provision priorities, and the unpredictability of operating lists and intraoperative situations.…”

Simulation‐based teaching versus point‐of‐care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study

“…The recent publication of guidelines recommending the use of TOE in both cardiac and non‐cardiac surgery reflects this broader interest . There is therefore an increasing need for effective training in TOE, and an accreditation system has been established in the UK to support this . Training in TOE has traditionally been based on didactic lectures, self‐directed learning using literature and course material, and also hands‐on teaching in the operating theatre.…”

A review of echocardiography in anaesthetic and peri‐operative practice. Part 2: training and accreditation

“…The Association of Cardiothoracic Anaesthetists (ACTA) and the British Society of Echocardiography (BSE) followed suit by launching UK accreditation in 2002. This accreditation was modelled on the existing TTE accreditation for cardiologists and sonographers, and consisted of a curriculum, a formal examination and a logbook . A local supervisor was responsible for overseeing this process and verifying the competence of the individual.…”

“…The migration and translation of echocardiography for broader application in new areas of clinical practice is a progressive theme in the new millennium. Echocardiography training and accreditation is embedded in cardiology training and practice, and is now well established in cardiac anaesthesia . Similarly, the evolution and integration of echocardiography within critical care is in progress .…”