Back Module: E-CS-S1

Foundations of Echocardiography Practice

Module information

Module details

Title
Foundations of Echocardiography Practice
Module code
E-CS-S1
Credits
30
Phase
1
Requirement
Compulsory

Aim of this module

This module will introduce the trainee to the practices and principles of quality, analysis, and basic cardiac science fundamental to practice as an Echocardiographer. The module aims to promote trainees’ understanding of basic cardiac diagnostic tests, engrain the importance of the wider clinical picture and to provide a sound basis to their understanding of Echocardiography. This module will provide trainees with context and foundations for their practice in healthcare. Central to this module is the provision of safe, effective, high quality patient centred care.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 7 Competency

Set objectives for your personal wellbeing and a targeted training plan for completion of the course.

 Type DTA Action View
# 2 Learning outcome 1, 6, 7 Competency

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

 Type DTA Action View
# 3 Learning outcome 6 Competency

Demonstrate competency in appropriate level of resuscitation as per local policy.

 Type DTA Action View
# 4 Learning outcome 1, 2, 4 Competency

Perform appropriate manual blood pressure measurements.

 Type ETA Action View
# 5 Learning outcome 1, 2, 3 Competency

Perform a 12 lead ECG and discuss the findings.

 Type DTA Action View
# 6 Learning outcome 1, 3 Competency

Review and identify major rhythms and discuss further investigations and/or clinical management based on the following ECG findings:

 

  • Sinus rhythm
  • Atrial arrhythmia
  • Ectopic beats
 Type DTA Action View
# 7 Learning outcome 1, 3 Competency

Review and identify major rhythms and discuss further investigations and/or clinical management based on the following ECG findings:

 

  • Atrioventricular heart blocks
  • bundle branch blocks
 Type DTA Action View
# 8 Learning outcome 1, 3 Competency

Review and identify major rhythms and discuss further investigations and/or clinical management based on the following ECG findings:

 

  • Ventricular fibrillation
  • Ventricular tachycardia
  • Ventricular paced rhythm
 Type DTA Action View
# 9 Learning outcome 5 Competency

Review pharmacological treatments for patients presenting with the following and discuss with another healthcare professional:

 

  • Chest pain/coronary disease
  • Heart failure
  • Hypertension
  • Atrial fibrillation
 Type DTA Action View
# 10 Learning outcome 5 Competency

Identify and discuss the common indications and contraindications for transthoracic echocardiography at level 1 and 2 with consideration of guidelines/consensus recommendations.

 Type ETA Action View
# 11 Learning outcome 5 Competency

Identify common indications for bubble contrast, LV opacification, stress and transoesophageal echocardiography.

 Type ETA Action View
# 12 Learning outcome 2 Competency

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

 Type DTA Action View
# 13 Learning outcome 2, 6 Competency

Gain informed consent for an echocardiography procedure.

 Type ETA Action View
# 14 Learning outcome 1, 4 Competency

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

 Type ETA Action View
# 15 Learning outcome 4 Competency

Identify correct anatomical structures demonstrated on 2D image planes including intracardiac normal variants such as Eustachian valve, Chiari network, LV tendon and extracardiac anatomy.

 Type ETA Action View
# 16 Learning outcome 4 Competency

Recognise imaging artefact on 2D, Doppler and M-mode imaging.

 Type ETA Action View
# 17 Learning outcome 2, 4 Competency

Acquire standard views in accordance with local and British Society of Echocardiography (BSE) protocol for Level 2 transthoracic Echocardiogram.

 Type ETA Action View
# 18 Learning outcome 4 Competency

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

 Type ETA Action View
# 19 Learning outcome 2, 4 Competency

Utilize colour flow mapping in at least two planes for all valves, optimizing gain and box size.

 Type ETA Action View
# 20 Learning outcome 2, 4 Competency

Acquire and optimize pulsed and continuous wave Doppler traces and make measurements in accordance with the local and BSE protocol including use of a standalone CW probe.

 Type ETA Action View
# 21 Learning outcome 1, 2, 4 Competency

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

 Type ETA Action View
# 22 Learning outcome 1, 2, 6 Competency

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

 Type ETA Action View
# 23 Learning outcome 4,7 Competency

Review a set of images you’ve captured, discuss with healthcare professional how these could be optimised.

 Type DTA Action View
# 24 Learning outcome 1, 2 Competency

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

 Type ETA Action View
# 25 Learning outcome 1, 6 Competency

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

 Type DTA Action View
# 26 Learning outcome 1, 5, 6 Competency

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

 Type DTA Action View
# 27 Learning outcome 2, 6 Competency

Present to colleagues the importance of ergonomics and safety when conducting diagnostic tests.

 Type DTA Action View
# 28 Learning outcome 1, 5 Competency

Observe a patient undergoing a catheter laboratory procedure who also has an echo. Reflect on the role of the different procedures in the patient pathway.

 Type OTA Action View
# 29 Learning outcome 1, 6, 7 Competency

Reflect on a time you were involved in or witnessed the care of an acutely unwell patient – discuss the consequences, overall outcome, and how this experience may influence your future practice.

 Type DTA Action View
# 30 Learning outcome 1, 6, 7 Competency

Reflect on a situation or case you were involved with where something went wrong or didn’t go to plan, discuss the consequences, overall outcome, and how this experience may influence your future practice.

 Type DTA Action View

Assessments

Complete 6 Case-Based Discussion

Complete 6 DOPS or OCE

Direct Observation of Practical Skills Titles

  • Prepare a patient for and perform a 12 lead ECG.
  • Prepare a patient for an echo including checking ID, blood pressure, height, and weight.
  • Perform parasternal views on a patient according to minimum BSE data set.
  • Perform apical views on a patient according to minimum BSE data set.

Observed Clinical Event Titles

  • Advise how to improve upon a 12-lead ECG recording with artefact or incorrect lead placement.
  • Explain the procedure to a patient and gain informed consent.
  • Explain and discuss the procedure for obtaining results with a patient.
  • Advise on how to improve upon a transthoracic echo recording with artefact or sub-optimal images.

Learning outcomes

# Learning outcome
1

Apply the principles of patient-centred care to provide a high-quality echocardiography service.
2

Demonstrate the ability to communicate effectively with patients, carers, and the wider multidisciplinary team.
3

Perform 12-lead ECG monitoring, identify major rhythms, and discuss further investigations and/or clinical management.
4

Perform a trans-thoracic echocardiogram (TTE) by acquiring and interpreting the standard images to prepare a report for a patient with a structurally normal heart according to BSE guidelines.
5

Appraise the role of echocardiography complementary technologies and medication in the patient pathway.
6

Employ strategies to manage risk in the practice of echocardiography.
7

Appraise and reflect on all elements of practice, identify areas for improvement and personal development.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  1. Observe a cardiac surgical procedure to gain insight into treatments available in the patient pathway.
  2. Attend a multidisciplinary ward round.
  3. Attend a cardiac rehabilitation session to appreciate the patient experience.
  4. Observe the use of stress echocardiography in the diagnosis & assessment of coronary artery disease.
  5. Observe the use of trans-oesophageal echocardiography including 3D in the diagnosis & assessment of structural heart disease to appreciate what additional information may be acquired when compared to TTE.
  6. Observe left ventricular opacification studies to appreciate the application of pharmacological contrast agents in echocardiography.
  7. Observe bubble studies to compare the indication and findings with left ventricular opacification studies.
  8. Observe a coronary angiography session and a pacemaker implant to appreciate the impact of catheter laboratory procedures in the patient pathway.

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. Differentiate common pathophysiology by applying an in depth understanding of normal cardiovascular system anatomy & physiology.
  2. Critically evaluate the principles and practices underpinning routine investigations and procedures used when undertaking testing, diagnosis and treatment in Cardiac Science.
  3. Explain and apply the fundamental physical imaging principles relating to clinical echocardiography.
  4. Evaluate and critique echocardiography performance with respect to operator wellbeing, patient clinical presentation, diagnosis and management.
  5. Explain and apply anatomical and physiological correlates to the traditional imaging planes used in transthoracic echocardiography.
  6. Plan, execute and evaluate detailed echocardiographic data within the context of normal findings using nationally recognised clinical guidelines and reporting techniques.

 

 

Indicative content

  • General:
    • Normal anatomy and physiology of the cardiovascular system
    • Typical presentation, diagnostic techniques used and treatment options for a range of cardiac diseases (to include heart failure, cardiomyopathies, inherited arrhythmogenic disorders, syncope, chest pain)
    • Major cardiac drug groups

 

  • 12-lead ECG recording procedure
  • A framework for basic interpretation of standard 12-lead ECGs including:
    • Rate ranges
    • Identify rhythm for:
      • Sinus rhythm
      • Atrial arrhythmia
      • Ventricular paced rhythm
      • Heart block /bundle branch block
      • Ectopic beats
      • Complete heart block
      • Ventricular fibrillation
      • Ventricular tachycardia
      • Ventricular paced rhythm
    • Overview of
      • Ambulatory electrocardiographic recording
      • Blood pressure recording techniques
      • Cardiac catheter lab procedures (haemodynamic and angiographic investigations)
      • Cardiac rhythm management services
    • Health and Safety
      • Health and safety issues in echocardiography incorporating reducing potential for work related musculoskeletal injuries

 

  • Cardiac ultrasound:
    • Role of ultrasound in the patient pathway
    • Physics/instrumentation and its application to cardiac ultrasound
    • Echo anatomy and physiology
    • Artefacts and optimisation
    • Image quality – acquisition and optimisation
    • Digital acquisition and storage
    • Cardiac function parameters and measurements (including Doppler haemodynamics)
    • Minimum dataset for a standard adult transthoracic echocardiogram
    • Limitations to cardiac ultrasound and alternative imaging modalities
    • Emerging techniques and innovations
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