Despite good progress being made in national echocardiography training programmes the UK shortage of echocardiographers is well documented, with services increasingly turning to international recruitment to fill staff vacancies.
This guidance document from the British Society of Echocardiography (BSE) is aimed at those recruiting via international routes and will be of particular interest to organisations that have not previously commissioned/provided echocardiography services in the UK; for example, Integrated Care Board’s commissioning organisations to deliver Community Diagnostic Centre transthoracic echocardiography (TTE) services. The following guidance highlights the key professional differences between BSE accredited echocardiographers and those graduating from international accreditation programmes and addresses the question of whether these processes are equivalent.
Echocardiography in the UK
In the UK TTE is generally performed AND reported autonomously by BSE accredited Band 7 cardiac physiologists/clinical scientists. This senior level of independent practice is supported by the clinical guidelines published by the BSE, and by the BSE Level 2 TTE accreditation process that confirms clinical competence. As such, the UK practice of echocardiography is almost unique from the rest of the world.
The UK training for BSE accreditation is delivered at postgraduate level and can follow in-house training programmes or formal academic processes. Typically, in-house training pathways are available for cardiac physiologists who have graduated from the Practitioner Training Programme (BSc Hons Healthcare Science), while formal academic postgraduate programmes are offered by the National School of Healthcare Science (NSHCS) – the Scientist Training Programme (STP) and the Echocardiography Training programme (ETP).
Upon graduation BSE accredited echocardiographers employed in the UK are responsible for scanning and reporting autonomously, with a very clear role in guiding patient care and ensuring optimal outcomes.
In almost all other countries, the role of the accredited echocardiographer is to perform the TTE image acquisition, and in some instances, draft a report, however the responsibility for the report is held by a medical colleague, usually a cardiologist. Due to the fundamental difference in reporting responsibility, the BSE accreditation process must incorporate a thorough and robust assessment of reporting competence, something not always required in other international accreditation programmes. Therefore, there are significant but necessary differences between the international TTE accreditation processes with different requirements for achieving TTE accreditation in countries outside of the UK. Consequently, no international TTE accreditation process can be considered “equivalent” to that of the BSE.
To ensure that clinical standards and patient safety are maintained, it is imperative that employers are cognisant of differences between the accreditation processes when recruiting staff with international qualifications.
British Society of Echocardiography level 2 transthoracic echo (TTE) accreditation
The BSE accreditation process is comprised of two exams. Part 1 (the theory exam) is delivered twice per year via the global Pearson Vue examination centre network, with sites worldwide. The second part of the accreditation process, Part 2, consists of a logbook of 250 cases performed and reported by the candidate, a practical scanning assessment, and a digital case viva station; Part 2 must be completed within two years of successfully passing Part 1. This is delivered five times per year at various locations in the UK.
Additionally, two to three years of hands-on experience is required to develop the fine motor skills, communication, and hand/eye coordination skills necessary to acquire diagnostic image quality. International candidates who have already developed these scanning and patient interaction skills may already have acquired and demonstrated these competencies but they will still require ongoing support and supervision from BSE accredited echocardiographers in a suitable environment in order to safely progress to autonomous reporting.
BSE guidance for recognition of international accreditations
The BSE recognises that those with international accreditations have already demonstrated their skills and expertise to a certain degree. Therefore, the BSE have developed an accelerated pathway to BSE accreditation for internationally qualified echocardiographers. The pathway varies depending on which international accreditation is held and is detailed in Appendix 1: BSE recognition of knowledge and experience within echocardiography: International transthoracic accreditations.
Registration/regulation
Professional regulation of echocardiographers is not yet mandatory for practice within the UK and the majority of cardiac physiologists are not under statutory regulation. To maintain patient safety employers must ensure that all echocardiographers practicing independently within their service hold relevant, up-to-date qualifications.
View Appendix 1: BSE recognition of knowledge and experience within echocardiography: International transthoracic accreditations
BSE Council and Trustees, July 2025