WHAT TYPES OF ACCREDITATION ARE AVAILABLE TO YOU?

 
BSE Badge *

Transthoracic Echocardiography

BSE accreditation is a formal process to certify competence in basic echocardiography. Accreditation involves a written and practical (video) exam, a collection of full studies & a logbook of cases.  Accreditation is recognised throughout the UK & Europe.

 
ACTACC *

Transoesophageal Echocardiography

Please click on "read more" for the current Accreditation Pack.

please see accreditation pack below.

Click here for the latest Transoesophageal Accreditation pack which applies to candidtaes that will sit the November 2016 exam onwards.

Click here for the Transoesophageal Accreditation pack which applies to candidates that sat their exam pre 2016.

 
 
Echo Image 3 *

Community Echocardiography

Please click on read more to download the current Community Accreditation pack

Please download the pack which applies to candidates who sat the exam in April 2013 and before by clicking this link and see the FAQ's in the downloads listed below.

Please click here download the pack which applies to candidates sitting the exam in October 2016 and onwards.

 
 
ICS Logo *

Critical Care Echocardiography

Following a successfull collaboration between The British Society of Echocardiography (BSE) and The Intensive Care Society (ICS) over the last 2 years, we announce a newly structured training process for Transthoracic Critical Care Echocardiography.

 
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Stress Echo Accreditation

Please click on read more to view the Stress Echo accreditation pack

 
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FEEL

Focused Echocardiography in Emergency Life Support

FOCUSED ECHOCARDIOGRAPHY INEMERGENCY LIFE SUPPORT(FEEL-UK)

This text has been reprinted from a 2010 article in ECHO; issue 70

BACKGROUND

The two key components of successful resuscitation are high quality CPR, and identification and treatment of any underlyingreversible cause(s). Although ancillary devices are routinely used by the resuscitation team (ECG, pulse oximetry, capnography, NIBP/arterial line), and diagnostic tests performed (ECG, CXR, ABGs) the routine use of echocardiography is not yet widespread. This is despite persistent/worsening haemodynamic instability being a Class I indication for its use.

The reasons for the apparent reluctance to incorporate focused echocardiography into peri-resuscitation care are numerous. These relate to lack of availability and portability of equipment, and the fact that echocardiography has remained largely the province of cardiologists and cardiac physiologists, who are not routinely part of the cardiac arrest team. In recent years the development of simpler, cheaper, more portable machines with rapid boot-up times has led to the widespread use of ultrasound(US) in emergency & critical care medicine. Indeed, most acute clinicians are now familiar with the routine use of US for vascular access and pleural imaging, and FAST scanning (focused US) is now considered a standard part of Advanced Trauma Life Support (ATLS). These developments have led to a demand for training in focused US and echocardiography for the critically ill patient.

FEEL-UK

There is a growing body of evidence supporting the performance of focused echocardiography by novice/minimally trained practitioners in the context of significant haemodynamic instability including cardiac arrest. Despite this, there has been an apparent reluctance of the accrediting echocardiography bodies to formally endorse this practice, primarily due to concerns regarding standards of training and practice. FEEL UK is a programme intended to train practitioners in the use of transthoracic echocardiography (TTE) in a standardised manner during the peri-resuscitation period. The course has been developed using experience from various international courses of focused echocardiography in the critically ill.

FEEL UK was piloted in the UK in 2009 with invited delegates from all relevant specialities, the Royal Colleges and other Societies involved in managing the critically ill, together with the Resuscitation Council and the British Society of Echocardiography (BSE).  The FEEL-UK programme comprises a didactic one-day course containing a 50:50 mixture of lectures and small group (maximum 3 students) hands-on training sessions, computer based teaching and simulated resuscitation scenarios. FEEL-UK is run along the lines of the ALS/ATLS, being highly standardised and regulated thus ensuring minimal standards are achieved. The course objectives are outlined in Table 1. The delegates are then required to continue their training locally by performing focused studies on critically ill patients under the supervision of a local mentor.

Table 1

Table 1 The objectives of the one-day training course in ALS-compliant peri-resuscitation echocardiography, FEEL-UK. TTE; transthoracic echocardiography, ALS; advanced life support

 

In mentoring trainees, several key differences exist when compared with supervision and training for standard echocardiography. First, focused peri-resuscitation echocardiography does not require the practitioner to perform all standard views, but simply obtain a view that may rule in/rule out some of the important causes of cardiac arrest.  Second, potentially treatable findings in the peri-resuscitation period are expected to be gross and easily recognisable by eyeballing an echo study. Examples would include severe systolic left ventricular dysfunction, profound hypovolaemia or massive pericardial collection. Thus, there are no requirements for any echocardiographic measurements or Doppler echocardiography. Third, reporting comprises a simple binary diagnostic approach, applicable in the context of cardiac arrest, and easily communicable to the resuscitation team. For FEEL UK a tick-box report sheet is available (Figure 1).  In practice, each delegate is required to identify a local mentor (BSE accredited TTE practitioner or equivalent). This will generally be their local cardiologist, cardiac physiologist or an appropriately qualified cardiology registrar.

Image 1

Figure 1 Standard reporting sheet used for focused echocardiography studies provided for FEEL-UK. DOB; date of birth, CPR; cardiopulmonary resuscitation, PLAX; parasternal long axis, PSAX; parasternal short axis, ECG; electrocardiogram, PEA; pulseless electrical activity, VF; ventricular fibrillation, LV; left ventricle, RV; right ventricle

 

Following the course, the student is required to demonstrate competence to their local mentor in performance and interpretation of focused echocardiography in critically ill patients.

The main points relevant to the mentor are:

  • The onus is on the student to identify, approach and liaise withtheir mentor(s)
  • The TTE examinations must be performed on supine Level III (intensive care) patients in addition to during resuscitation
  • 2D imaging only is required, and the report should simplyreflect the questions relevant to the peri-resuscitation scenario(see Figure 1, report sheet)
  • The mentor need not be present for all scans, however the first ten or so should be directly observed as this provides anopportunity to ensure correct technique and feedback on image optimisation
  • Subsequently, trainees should perform, record and reportsystematic scans, attempting to achieve all 4 views if possible,and arrange to meet with their mentor at a mutually convenient time to review the images and their interpretation
  • An examination may be repeated on the same patient ondifferent occasions if their condition has changed and a repeatecho would be clinically appropriate. An example is after successful diagnosis and drainage of a pericardial collection arepeat scan in the presence of ongoing shock may demonstrate severe hypovolaemia or underlying severe LVdysfunction.
  • Each study takes only a few minutes. The aim is to perform afocused echo scan, and not undertake a full echocardiographicstudy
  • Each student may have more than one mentor, as there will often be more than one within an institution or (if the traineeis a junior doctor) they move between institutions
  • Completion of a minimum of 50 scans is required to obtain FEEL-UK certification

The student will keep a logbook of scans performed and the mentor should sign this once satisfied the student is performing and interpreting a FEEL examination adequately. The student will then send the front sheet back to their course director, who will notify the BSE that the student has adequately completed the entire programme. The BSE will then issue them with acertificate of competency in peri-resuscitation focused echocardiography. Re-certification requires evidence of ongoing practice and will be performed at three yearly intervals using web-based assessment tools.

Although increasing pressures on echocardiography departments may make this additional demand seem prohibitive, in practice, the amount of time required for supervision is minimal. There are ample opportunities to fit training into current practice. For example, the student may accompany their mentor for the performance of urgent inpatient ward based echo studies. Where based on an ICU, students should prepare the patient and machine in anticipation of the arrival of their mentor and perform an initial focused scan prior to (or after) the full study being undertaken by the echocardiographer.

Further information, along with a brief guide for mentors is obtainable via the FEEL-UK website: www.FEEL-UK.com

Conclusion

Focused echocardiography is increasingly widespread, and it isessential that standards are clearly defined and maintained by the appropriate bodies. The BSE has taken an important step in recognising this, and its role in supporting the development of a peri-resuscitation echocardiography certification for the UK is fundamental. Continued support of this process from echocardiography practitioners is equally central to its successful implementation, ensuring that focused echocardiography is practised to an adequate standard within existing clinical governance frameworks.

Susanna Price, Royal Brompton Hospital, FEEL-uk

Shahana Uddin, Barts and the London Hospital, FEEL-uk

 
 
EACVI *

Paediatric Accreditation

BSE no longer runs a Paediatric Accreditation Process. Members who wish to attain accreditation in Paediatric Echocardiography can do so by undertaking the EACVI Paediatric CHD Certification process.

To be redirected to the EACVI page, please click here

 

Copyright © 2011 British Society of Echocardiography