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Training in critical care echocardiography: Both sides of the atlantic
Overview
Echocardiography provides intensivists with a means of rapidly assessing the anatomy and function of the heart in intensive care unit (ICU) patients with hemodynamic failure, thus guiding management. Since echocardiography is a key skill for frontline intensivists, developing effective training programs is essential to ensure that clinicians have competence in the field. This chapter discusses some issues related to training in critical care echocardiography (CCE) while considering the challenges from both the European and North American perspectives. Information in this chapter is relevant for two groups: for intensivists who seek to develop competence in CCE, it provides a guide for the process of training, and for intensivists who have the responsibility to train others to become proficient in CCE, it provides guidance for process development.
The North American Challenge
Roughly 6000 intensivists (at the attending level) in the United States need training in CCE. These frontline clinicians work on a full-time basis in the ICU and have the potential to use CCE as a primary bedside imaging modality. Some of these intensivists are faculty at fellowship programs and have the responsibility of training fellows in CCE. In the United States in 2011, 170 fellowship training programs under the specialty of internal medicine offered training in critical care medicine. These programs graduated 545 fellows with an additional 89 from anesthesiology-based critical care programs. CCE is an essential part of their training. For the individual fellow or attending intensivist, the question is how to become competent in CCE. At the system level, the challenge is how to provide training in CCE to many thousands of intensivists at both the fellow and attending levels.
The European Challenge
Europe has 49 self-governing countries, 27 of which are member states of the European Union. The health care systems in each of these countries are different, as is the status of critical care itself, thus providing considerable challenges when considering the development of unified training programs. Accreditation in echocardiography at a European level is run by the European Association of Cardiovascular Imaging (formerly known as the European Association of Echocardiography) under the auspices of the European Society of Cardiology. Certification in intensive care medicine is provided at a national level. The European Society of Intensive Care Medicine , which aims to promote and coordinate activities, foster research and education, and provide recommendations for optimizing facilities in intensive care medicine, runs a diploma service in intensive care medicine but is not responsible for certification or accreditation. As in North America, for the individual intensivist in training the challenge is how to become competent in CCE. With the different systems that exist in Europe, the challenge of providing training has devolved to the individual nations. The role of regulatory bodies and relevant international societies is rather to provide guidance regarding the key skills and level of competence required in CCE for nations to be able to devise the most appropriate training program given the way that intensive care is structured in their own country.
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