Education and evaluation of knowledge and skills in echocardiography: how should we organize?

Excerpt

Echocardiography is a valuable tool for the assessment of critically ill patients [1‐3]. When combined with Doppler analysis, two-dimensional (2-D) echocardiography allows comprehensive assessment of cardiac structure and function. The combined use of 2-D imaging and Doppler, when linked to other physiological signals, reveals information from flow variations; most notably when coupled with respiratory variation for the determination of preload sensitivity. In the early years of application, learning echocardiography and Doppler was straightforward; as there were a limited number of views and techniques to master. In the past decade, additional imaging planes have been defined [4, 5] and intriguing techniques, such as myocardial tissue Doppler imaging [6‐8], are now available. Complete mastery of critical care applications for transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) has become a challenging task both for intensivists in training and for attending-level clinicians. The most basic application of echocardiography in the critical care unit is the goal-directed examination. By definition, this type of study is performed without Doppler analysis and encompasses a limited number of 2-D imaging planes. More sophisticated applications of echo Doppler include multiple 2-D images to identify subtle functional abnormalities of valvular or segmental wall abnormality, as well as full hemodynamic monitoring with Doppler [1, 6‐10]. Advanced critical care echocardiography requires extensive training, and this has limited its widespread use as a tool by non-cardiologists in ICU practice or intra-operative settings. There is clear need for dedicated education and training in echocardiography and Doppler for intensivists [11]. …