Module information

Module details

Title
Introduction to Clinical Echocardiography
Module code
A-CS-S1
Requirement
Compulsory

Aim of this module

This module provides Echocardiography trainees with the knowledge and skills to perform and report high-quality transthoracic echocardiography.

Work-based content

Competencies

# Learning outcome Competency Action
# 1 Learning outcome 1, 2, 3, 4, 6 Competency

Discuss the values and principles as laid out in the NHS Constitution, describe how will you demonstrate these in your daily practice

Action View
# 2 Learning outcome 2, 4, 6 Competency

Control risks in accordance with departmental protocols for echocardiography procedures

Action View
# 3 Learning outcome 2, 4, 6 Competency

Demonstrate competency in appropriate level of resuscitation as per local policy

Action View
# 4 Learning outcome 3, 4, 5, 6, 7 Competency

Review the literature and evidence base for best practice regarding assessment of a pathology; compare best practice to local practice and make recommendations for service improvement

Action View
# 5 Learning outcome 4, 5 Competency

Identify common indications for transthoracic (Level 1 and 2) bubble contrast, LV opacification, stress and transoesophageal echocardiography

Action View
# 6 Learning outcome 5, 6, 7 Competency

Discuss a case where complementary technologies may be useful to further assess cardiovascular disease where echocardiography cannot differentiate fully between pathologies and/or artefact

Action View
# 7 Learning outcome 6 Competency

Explain an echocardiography procedure to another healthcare professional, address any questions they may have related to the procedure

Action View
# 8 Learning outcome 2, 4, 6 Competency

Gain informed consent for an echocardiography procedure, under direct supervision

Action View
# 9 Learning outcome 2, 3, 4, 5, 6 Competency

Present a clinical history together with the images obtained for a procedure to another healthcare professional; discuss progression of disease/symptoms and agree outcomes and next steps

Action View
# 10 Learning outcome 2, 3, 4, 6 Competency

Take appropriate action to respond to the specific needs of the patient to ensure equitable access to echocardiography procedures

Action View
# 11 Learning outcome 3, 4, 6 Competency

Explain the procedure for obtaining results to the patient, alleviating any concerns the patient may have

Action View
# 12 Learning outcome 1, 4 Competency

Produce high-quality cardiac ultrasound images, demonstrating use of a full range of machine controls and ultrasound probes including standalone probe

Action View
# 13 Learning outcome 2, 4 Competency

Set up appropriate equipment in preparation for an advanced echocardiography procedure, including resuscitation equipment where appropriate, and ensure daily checks have been carried out

Action View
# 14 Learning outcome 1, 3, 4, 6 Competency

Identify correct anatomical structures demonstrated on 2D image planes including cardiac and extracardiac anatomy

Action View
# 15 Learning outcome 1, 4 Competency

Acquire standard views in accordance with local and national protocol for Level 2 transthoracic Echocardiogram

Action View
# 16 Learning outcome 1, 4 Competency

Obtain standard measurements using 2D or M-mode in accordance with the local and national protocol

Action View
# 17 Learning outcome 1, 4 Competency

Recognise imaging artefact and normal variants, including Eustachian valve, Chiari network, LV tendon

Action View
# 18 Learning outcome 1, 4 Competency

Utilise colour flow mapping in at least two planes for all valves, optimising gain and box size

Action View
# 19 Learning outcome 1, 4 Competency

Acquire & optimise pulsed and continuous wave Doppler traces and make measurements in accordance with the local and national protocol including use of a standalone CW probe

Action View
# 20 Learning outcome 1, 4, 6 Competency

Produce a clear and accurate written report of a transthoracic echocardiography procedure in accordance with local and national protocols

Action View
# 21 Learning outcome 6, 7 Competency

Critically assess a new technology being introduced into practice; consider benefits and barriers to introduction

Action View
# 22 Learning outcome 1, 4, 6 Competency

Interpret results for a myocardial deformation/speckle tracking analysis study in line with local and national protocols

Action View

Assessments

You must complete:

  • 4 Case-Based Discussions (CBDs)
  • 4 of the following Direct Observation of Practical Skills (DOPS) and/or Observed Clinical Event (OCE)
Type Title
DOPS Carry out a procedure for an infectious patient
DOPS Demonstrate appropriate care of the equipment pre, during and post procedure
DOPS Identify cardiac structures in all image planes
DOPS Generate high quality ultrasound images of all standard image planes
DOPS Perform standard 2D/M mode measurements of the left ventricle
DOPS Acquire and optimise colour Doppler of the mitral, aortic, pulmonary and tricuspid valves
DOPS Acquire, optimise and perform standard measurements of pulsed and continuous wave Doppler of the left ventricular outflow tract, aortic valve and mitral valve
DOPS Review the indication for the test and any appropriate records prior to a procedure
OCE Introduce yourself to a patient, confirm patient identity and explain the procedure
OCE Present finding of critical appraisal of ultrasound related topic at departmental meeting
OCE Obtain informed consent prior to a procedure
OCE Obtain a suitable clinical history during an appointment
OCE Explain and discuss the procedure for obtaining results with a patient
OCE Demonstrate to another healthcare professional how to manage infection risks for an echocardiography procedure including managing operator and equipment risks

Learning outcomes

# Learning outcome
1

Perform and report high quality transthoracic echocardiography.

2

Employ strategies to manage risk in the practice of echocardiography.

3

Apply the principles of patient-centred care to provide a high-quality echocardiography service.

4

Practice echocardiography in accordance with local and national guidelines.

5

Appraise the role of echocardiography and complementary technologies in the patient pathway.

6

Demonstrate effective communication in the practice of echocardiography.

7

Identify and appraise new developments in echocardiography practice.

Clinical experiences

Important information

Clinical experiences help you to develop insight into your practice and greater understanding of your specialty. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. While Clinical Experiences are not assessed, reflections and observations from your experiences can be used to support evidence for competencies to demonstrate your awareness and appreciation of your specialty and it’s impact on patient care. You may find it helpful to capture thoughts from your experiences in your reflective log.

Activities

To develop a broader understanding of their specialty practice and support the completion of assessments and competencies, it is recommended a trainee should:

  1. Observe the use of stress echocardiography in the diagnosis & assessment of coronary artery disease.
  2. Observe the use of stress echocardiography in the assessment of structural heart disease.
  3. Observe the use of trans-oesophageal echocardiography in the diagnosis & assessment of structural heart disease to appreciate what additional information may be acquired when compared to TTE.
  4. Observe the use of transoesophageal echocardiography for the investigation of Infective Endocarditis to appreciate its role in the diagnostic process including advantages compared to transthoracic echo.
  5. Observe the use of transoesophageal echocardiography in cardiac interventional procedures such as PFO/ASD/VSD closures, LAAO, TAVI, MV clip, MV balloon valvotomy and paravalvular leak closures.
  6. Observe left ventricular opacification studies to appreciate the application of pharmacological contrast agents in echocardiography and compare with bubble studies.
  7. Observe the use of 3D echocardiography and reflect on its applications, advantages and disadvantages in the assessment of common pathologies for both transthoracic and trans- oesophageal echocardiography.
  8. Observe complimentary cardiac imaging such as CMR, cardiac CT, angiography and MPI.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Evaluate and critique the role of echocardiography with respect to clinical presentation, diagnosis and management.
  2. Explain and apply the fundamental physical imaging principles relating to clinical echocardiography.
  3. Explain and apply anatomical and physiological correlates to the traditional imaging planes used in transthoracic echocardiography.
  4. Plan, execute and evaluate detailed echocardiographic data within the context of normal findings using nationally recognised clinical guidelines and reporting techniques.

Indicative content

  • Indications for and effectiveness of echocardiography with respect to patient presentation, diagnostic and treatment pathways.
  • Ultrasound physics and equipment function / manipulation.
  • Normal cardiovascular anatomy and physiology.
  • Echocardiographic imaging planes with respect to cross sectional anatomy.
  • Normal parameters and advantages versus disadvantages relating to the measurement of normal parameters.
  • Introduction to the current national standards for performing and analysing data obtained during transthoracic echocardiography.
  • Alternative clinical imaging techniques used in cardiology practice.