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FELLOWSHIP COURSE IN BASIC ECHOCARDIOGRAPHY

1. Proper name of the certificate course: Fellowship Course in Basic Echocardiography

2. Duration of the course: 12 months

3. Commencement of Course: 17th January 2016

4. Intake capacity: 50 - 75 candidates per year

5. Complete curriculum of the course Appendix I

6. Teaching scheme: Total Time & periods Through 15 modules throughout the year followed by an internal assessment combined 100 marks for internal assessment

7. Eligibility criteria for admission:

Post one year training in:-

o DM/FNB/PDCC/FIACTA/FTEE

o Critical care – DM/FNB/FICCM

o DM/FNB: Pediatrics/neonatology

o DM/FNB: Pulmonary medicine

o DM/FNB: Cardiac Surgery

Post 2 year MD Anaesthesia with atleast one year experience in a cardiac setup is also eligible.

8. FACULTY REQUIRED WITH THEIR QUALIFICATIONS AND EXPERIENCE:

Faculty should have DM/DNB Cardiology degree or similar degree in cardiac anaesthesia

At least 15 years of teaching experience as faculty.

9. SCHEME OF EXAMINATION IN DETAILS:

(Number of question papers, Number of marks to each question paper, Duration of question paper,

practical examination etc.)

Theory paper: See Point No 16 below

Practical examination: See Point No 16 below

10. Infrastructure required for conducting the course.

INTENSIVE CARE UNITS:

Medical Neuro Intensive Care Unit

Intensive Coronary Care Unit

Dialysis Unit

Surgical ICU

Emergency Medicine ICU

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CLASSROOMS FOR DIDACTIC TEACHING:

Radiology, Pathology and Biochemistry – routine and emergency:

LIBRARY: General library with relevant books and journals:

Department library with relevant books and journals:

CASES: The medical ICU admits approximately 1000 patients per year provides a wide

range of patients for learning critical care.

ICU EQUIPMENT:

Class 1 Ventilators

Multiparameter monitors

Continuous renal replacement therapy

Bedside ultrasonography and echocardiography machine

Temporary pacemaker

Defibrillator

Fiberoptic bronchoscope

Infusion pumps

11. Faculty required with their qualification and experience (add visiting faculty)

INTENSIVIST: MD General Medicine with minimum 10 years’ experience, post MD in the

field of Critical Care Medicine, Cardiology, Cardiac Anaesthesia, Pulmonary

Medicine, Pediatric.

+ TEACHING EXPERIENCE:

MBBS students

MD students

DNB Students

VISITING FACULTY: Will include two or three experts from the field of Critical Care Medicine who

have excellent knowledge as well as teaching experience both nationally and

internationally.

12. ADVERTISEMENT:

Association website and the intranet

On the notice boards of the colleges and medical institutes

BASIC QUALIFICATION: As determined for each certificate/fellowship course- each individual

department to write

13. INTERVIEW

By a panel of experts of three - including the Presidents of the Association and

at least one external expert and an internal expert

14. SELECTION

A total of 50 candidates per year will be selected for the course. Selection will be based on

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performance at interview (30%), University level academic merits (30%) publications if any (20%),

and recommendations from PG teacher (20%)

15. PATTERN OF EXAM

Each year an examination coordination committee (ECC) consisting of six teachers running

Fellowship/certificate courses will be nominated by the President. Both theory and practical

Examinations will be concluded within 15 days of the end of the course.

Examination will be conducted in 2 centers in India. Each examination will have two Internal and

two external examiners (approved by the ECC).

Theory

MCQ’S & Short objective questions - ONLINE

PRACTICALS IN MEDANTA/AIIMS NEW DELHI

Each candidate will be examined by SIX examiners simultaneously for between 60 and 90 mins. This

will cover a:-

Viva Voce and practical

Videos

Logbook & CD

“Hands on” on the Simulator both Transthoracic Echocardiography and Transeasophageal

Echocardiography

Passing marks 50%.

Candidates have to pass individually in both theory and practical.

16. ANNOUNCEMENT OF RESULTS

Results will be announced on the Website and Notice board within one week of the conclusion of the

examination. The result will be only “Fellowship granted/Denied and marks will not be displayed. Repeats

next year only with Additional fees of Rs. 10,000/-

17. AWARD OF FELLOWSHIP

Certificates will be awarded by the President at the GBM of Annual Conference of The Simulation

Society (TSS) in January every year. The certificate accredited by:

Internal Society of Cardiovascular Ultrasound (ISCU)

Indian Academy of Echocardiography (IAE)

Australian Institute of Ultrasound

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The decision of the Examination Co-ordination Committee will be binding on all. On all matters pertaining

to the examinations

Clinical rotation:

Intensive Cardiac Care Unit (ICCU) 6 months.

CCU and Cath Lab :- 6 months

MAINTENANCE OF LOG BOOKS:

Every fellow shall maintain a record of skills he has acquired during the training period certified by

the Head of Department in which he/she has undergone training.

The candidates should also be required to participate in the teaching and training programme of

undergraduate and post graduate (MD) students.

In addition, the Head of the Department shall involve their Post-Graduate CCM candidates in

Seminars, Journal Clubs, Group Discussions and participation in clinical, clinicopathological

conferences.

Candidates are required to attend at least 2 Regional/National/ International Conferences and make

at least one presentation at any of these conferences during the course on relevant subjects. These

should be entered in the Log Book.

At the end of the course, the candidate should summarise the contents and get the Log Book Certified

by the Head of the Department.

The Log book should be submitted at the time of practical Examination for the scrutiny of the Board

of Examiners.

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SIGNATURE OF CANDIDATE

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LOG OF CASES DONE MONTHLY IN ICU

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LOG OF CASES DONE MONTHLY IN ICU

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LOG OF CASES DONE MONTHLY IN CCU

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LOG OF CASES DONE MONTHLY IN CCU

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LOG OF CASES DONE MONTHLY IN OPERATING ROOM

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LOG OF CASES DONE MONTHLY IN OPERATING ROOM

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NUMBER OF CASES & PROCEDURES DONE MONTHLY

CASES JAN FEB MAR APR MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL

ROUTINE /

EMERGENCY

OPEN /

CLOSED

CABG

VALVE

CHD

OTHERS

CENTRAL

VENOUS LINES

TEE

MRI

CT ANGIO

GRAPHY

CATH LAB

PROCEDURES

- AICD

- RFA

- PTCA

- OTHERS like

- CCU CARE

-

RESUSCITATION

TOTAL NO OF

CASES

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POSTINGS IN OR

S.NO OPERATION THEATRE DURATION

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POSTINGS IN OR

INCHARGE SIGNATURE REMARKS

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POSTINGS IN ICU

INCHARGE SIGNATURE REMARKS

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POSTINGS IN ICU

INCHARGE SIGNATURE REMARKS

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POSTINGS IN CATH LAB

INCHARGE SIGNATURE REMARKS

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POSTINGS IN CATH LAB

INCHARGE SIGNATURE REMARKS

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POSTINGS IN CCU

INCHARGE SIGNATURE REMARKS

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POSTINGS IN CCU

INCHARGE SIGNATURE REMARKS

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RESEARCH WORK UNDERTAKER

S.NO TOPIC GUIDE /CO-

GUIDES

DATE OF

SUBMISSION

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CLINICAL PRESENTATIONS

S.NO TITLE PRESENTED AT

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PUBLICATIONS CURRENT YEAR (2017)

S.NO TITLE PUBLISHED IN

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SYLLABUS

APPENDIX I

Complete curriculum of the course

COURSE OBJECTIVES

At the end of the course, the candidate should be able to:

Understand the theoretical basis of organ dysfunction and critical illness in

Echocardiography

Apply these principles in Echocardiographic techniques, both Transeasophageal

Echocardiography (TEE) and Transthoracic Echocardiography (TTE)

Critically evaluate published literature

Apply the highest ethical standards in the practice of medicine

Transeasophageal Echocardiography (TEE) and Transthoracic Echocardiography (TTE)

views as per the American Society Guidelines

TEE Probe manipulation

Knobology of the latest ECHO machine

Left ventricle

Acquisition and display techniques - Volumes - Mass - Shape - 4D strain - Regional

and global function (ischemic heart disease, cardiomyopathy)

Right ventricle

Acquisition and display techniques - Regional and global function

Atria

Acquisition and display - Echo anatomy: left atrial appendage, pulmonary veins -

Global geometry and phasic function

Mitral valve

Acquisition and display techniques - Quantification - Mitral valve diseases - Mitral

annulus quantification in normal and diseases

Aortic valve

Acquisition and display techniques - Aortic valve diseases

Tricuspid valve

Acquisition and display techniques - Tricuspid valve diseases

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How to implement 4D echo in the routine of the echo lab?

Congenital heart diseases

Atrial septal defects - Patent foramen ovale - Ventricular septal defects - Uni-/ Bi-

and Quadri-cuspid aortic valve - Mitral cleft - Parachute mitral valve - Cor

triatriatum - Univentricular heart - Ebstein disease - Pulmonary valve

Masses

Tumors - Thrombi

Pharmacological stress echo

3rd generation 3D transoesophageal echo

Introduction to Basic/Advanced Echocardiography

Anatomy/Imaging Planes

Muscular construct

Atria

Ventricles

Papillary Muscles

Electrical -Purkinje system

Great vessels (arteries & vein construct)

Hemodynamic Monitoring

Flow pattern of cardiovascular system

Normal blood flow

Chamber pressures normal range

Inflow and outflow

Frank Starling law

IMAGING TECHNIQUES

Knobology

Gain (B-Mode)

Time gain compensation (signal strength)

Focus zone

Transducer construct

Transducer function

Analog versus digital

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Artifacts

Hardcopy units

M-Mode

Value

Technique

Timing parameters

Chamber sizes

3/4 Dimensional

Value

Technique/windows

Physics & physical limitations

Complete echo examination

Limited echo, when is it used

Color Basics/Advanced

Limitations

Benefits

Nyquist limitations

Gain settings

Doppler Echocardiography

Continuous Wave Motion

Pulsed Wave Motion

Measurements

M-Mode

2D/3D

Doppler

PATHOPHYSIOLOGY OF DISEASES

Mitral/Tricuspid Disease on ECHO

o Review normal anatomy

o Stenosis (mild, moderate, severe)

o Hemodynamic changes

o Valve regurgitation

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o Chordae tendinae

Aortic/Pulmonic Valves on ECHO

o Review normal anatomy

o Stenosis (mild, moderate, severe)

o Hemodynamic changes

o Valve regurgitation

o Outflow abnormalities

Cardiomyopathy

o Hypertrophic CM (obstructive/non-obstructive)

o Dilated CM

o Restrictive CM

Coronary Artery Disease/Ischemia

o Anatomy

o Flow distribution

o Heart attack

o Chemistry changes

o EKG changes

o Arrythmia

o Acute, chronic

o Discussion of stress echocardiograms & value

Aortic Diseases

Pericardial Disease

THEORETICAL KNOWLEDGE

The Echocardiography specialist must understand the physiology, diagnosis, prevention

and management of the following disorders:

CARDIOVASCULAR DISEASES AND ECHO

Hemodynamic instability and shock

Acute myocardial infarction

Intra-aortic balloon pump and left ventricular assist devices

Severe heart failure

Cardiomyopathies

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Valvular heart disease

Myocarditis

Cardiac tamponade

Pulmonary embolism

Aortic dissection

Peripheral vascular diseases

Cardiovascular surgery post-operative care

INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Principles of echocardiography:

Physics, digital echocardiography, imaging artifacts and pitfalls, optimizing 2D echo

Intraoperative examination:

Surgical anatomy correlated with echocardiographic imaging planes,

Assessment of global ventricular function, right ventricular function,

Regional ventricular function,

Mitral valve,

Aortic valve ,

Tricuspid and pulmonic valves thoracic aorta and

Prosthetic valves.

Assessment of congenital heart disease in adults

Decision making in critical care:

TEE in critical care setting,

Assessment of perioperative hemodynamic

Surgical decision making in coronary artery disease:

Assessment of myocardial viability,

Assessment in higher risk myocardial revascularization,

Assessment of mitral valve in ischemic heart disease,

Assessment in off pump myocardial revascularization.

Surgical decision making in valvular heart disease:

Surgical consideration in mitral and tricuspid valve surgery,

Assessment in mitral valve surgery,

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Surgical consideration in aortic valve surgery,

Assessment in aortic valve surgery.

Surgical decision making in major vascular surgery:

Assessment of surgery of aorta.

Surgical decision making in congestive cardiac failure:

Pathophysiologic,

Assessment of cardiomyopathy,

Surgical considerations in nontransplant surgery for congestive cardiac failure,

Assessment in surgical procedures for CHF,

Assessment of cardiac transplantation

Surgical decision making in Interventional Cardiovascular Medicine and Non

cardiac surgery :

Assessment in cardiac intervention, assessment in noncardiac surgery.

Elective: Echocardiography

Identify the structures appreciated in the parasternal (long & short axis), subcostal &

apical views

The assessment of LV systolic function using the modified Simpson rule method, &

it’s limitations

The assessment of RV systolic function

Identify pericardial effusion & the criteria for tamponade physiology

Identify normal chamber size for the right & left ventricles

Identify normal thickness for the RV free wall, IVS & LV free wall

The principles of Doppler in measuring the velocity of fluid, & therefore pressure

gradient (prograde & retrograde)

Identify findings consistent with moderate & severe MR

The assessment of aorta pulmonary shunt function

The determination of RV systolic pressure based on the TR jet

The estimation of RV systolic pressure based on the position of IVS during systole

The normal orientation & position of the IVS during diastole & systole

The abnormal orientation & position of IVS during diastole & systole

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SCHEME OF EVALUATION:-

Evaluation will be by Credit Based System

ALLOTMENT OF CREDITS:-

Total Credit Points 300

Minimum required for passing 240 (80%)

A) Didactic Credits :( 25 credit points)

Didactic on various topics as per syllabus spread over One Hour lecture. Total 10-

20 Lectures depending upon specified course material and depth of theory.

B) Presentation, Publications & Project Work (25 credit point)

Under faculty guidance, presentations for Local, Regional & national conferences.

C) Video Learning, Grand Rounds, Faculty Discussions (10 credit Points)

Review of Recorded Cases/ Procedures/Surgeries with Faculty Input.

Specific/specialized Surgery Grand Round/Clinical Case Conference.

Disease/Journal Club, Round Table Discussions.

D) Sessions in Imaging Clinics (15 credit points)

Learning of Ultrasound, CT scan, and MRI & Various Procedures required for the

particular course/module (e.g. Doppler etc.)

E) INTENSIVE CARDIAC CARE MANAGEMENT CREDITS. (TOTAL 175)

A Candidate is expected to maintain certified Log book indicating number of cases

assisted or individually managed and procedures performed under the guidance of

faculty for each Module.

F) Fellowship Examination 50 Credit Points (Terminal Exam by MCQs)

The examination for a particular course may be conducted according to the

requirement of a course.

TEXT BOOKS:

ASE’s Comprehensive Echocardiography

Cardiovascular Sonographer Registry Review Guide

Textbook of Clinical Echocardiography by Catherine M Otto, MD

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Echocardiography Review Guide: Companion to the Textbook of Clinical

Echocardiography BY Catherine M. Otto MD (Author), Rebecca Gibbons

Schwaegler BS RDCS (Author), Rosario V. Freeman MD MS (Author) Clinical

Sonography: A Practical Guide by Roger C Sanders

Diagnostic Ultrasound: Principles and Instruments by Frederick W Kremkau,

The Echo Manual by Jae K Oh, MD, James B Seward, A Jamil Tajik, MD

Echo Made Easy by Sam Kaddoura

Practice of Clinical Echocardiography by Catherine Otto

Echocardiography – a practical guide for reporting and interpretation by Priya

Margaret Joseph

Successful Accreditation in Echocardiography - A Self-Assessment Guide by Sanjay

Banypersad (Author)

INDIAN BOOKS:-

Problem Based Transesophageal Echocardiography by Deepak K.Tempe /

Balachundhar Subramaniam / Kathirvel Subramaniam / Harish Ramakrishna

(Author)

Review of Cardiac Anesthesia with 2100 MCQs by Poonam Malhotra Kapoor (1st

Edition)

Review of Cardiac Anesthesia with 2100 MCQs by Poonam Malhotra Kapoor (2nd

Edition)

Clinical Simulation in Medicine (For all Examinations in Cardiology, Critical Care,

Anesthesia and Pulmonary Medicine) by Poonam Malhotra Kapoor

Manual of Extracorporeal Membrane Oxygenation (ECMO) in the ICU: by Poonam

Malhotra Kapoor

Transesophageal Echocardiography of the Tricuspid and Pulmonary Valves by

Poonam Malhotra Kapoor

Journals

International Journal of Cardiovascular Research

Journal of the American College of Cardiology

American Journal of Cardiology

Journal of Molecular and Cellular Cardiology

European Journal of Preventive Cardiology

Cardiology

Cardiology Clinics