33
Ministry of Health and Population The Higher Committee of Scientific Council Egyptian Fellowship [2015] Egyptian Fellowship of Cardiology Curriculum of Adult Echocardiography Subspecialty Egyptian Fellowship

Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

  • Upload
    ngophuc

  • View
    227

  • Download
    1

Embed Size (px)

Citation preview

Page 1: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

Ministry of Health and Population The Higher Committee of Scientific Council Egyptian Fellowship

[2015]

Egyptian Fellowship of Cardiology Curriculum of Adult

Echocardiography Subspecialty

Egyptian Fellowship

Page 2: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

2

Preface

References

Acknowledgement

Egyptian Echocardiography Fellowship Committee

Goal

Aims

Entry requirements for the Egyptian Fellowship of Echocardiography

Training rules and regulations

Curriculum and Themes

Page 3: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

3

PREFACE

The Egyptian Fellowship Board and the Egyptian Fellowship of Cardiovascular

medicine (EFOC) scientific council worked collaboratively and closely to make this

curriculum available for trainees’ guidance and support.

Worldwide, postgraduate medical education is now governed by sets of academic

standards that describe the qualities and abilities of graduates. In addition, there are

standards for the training processes, trainers’ selection and methods of assessment to

ensure transparency and clarify expectations.

The Egyptian fellowship board has already defined and published its standards for the

general and professional competencies’ expected from our graduates in different

specialties upon successful completion of training. These expectations are clearly

reflected in the Cardiovascular medicine curriculum and thus echocardiography.

The curriculum describes what trainees should know and be able to do upon

completion of training. The curriculum also describes in details, expectations from

trainees during their rotations.

Methods of assessment and examination regulations are also available in the last

section of the curriculum.

We hope that all our trainees, trainers and educational supervisors will follow the

guidelines provided in the curriculum and cooperate with The Egyptian Fellowship

Board and EFOC Scientific Council to implement the curriculum in the best ways.

This curriculum will be revised and updated every 3 years.

The aim of the one-year Echocardiology Fellowship is to provide an opportunity for

fellows to develop proficiency in performing and interpreting echocardiographic

studies they apply to cardiovascular diseases. The training program can be customized

to meet individual career goals

Secretary General

Higher Committee of Medical Specialties

Page 4: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

4

REFERENCES

The Committees consulted international curricula in cardiovascular

medicine. The external references for the development of this

curriculum are:

Nanda NC ed. Comprehensive Textbook of Echocardiography. 2013 .

Feigenbaum H Echocardiography. 7th edition, Lea and Febiger, Philadelphia,2009

Weyman AE. Principles and Practice of Echocardiography. Lea and Febiger,

Philadelphia, 1994.

Otto CM, Pearlman AS. Textbook of Clinical Echocardiography 5th

edition, 2013 .

Otto CM. The Practice of Clinical Echocardiography. 3rd

edition 2002.

Agreed upon items between American and European Guidelinesand curricula in the

last three years and National Guidelines.

Page 5: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

5

Acknowledgement

This curriculum has been created through collaboration between the head of EFOC

Scientific Council, the EFOC accreditation team and the Egyptian Fellowship

Curriculum Committee. The following members of the Cardiology experts have made

substantial contribution to the curriculum development as subject matter experts

Professor Khairy Abdel Dayem, Professor of Cardiovascular

Medicine, Ain Shams University and head of the Cardiovascular

Medicine scientific fellowship council

Professor Ahmad Magdy, Consultant of Cardiovasuclar Medicine,

National Heart Institute.

Professor Gamela Nasr, Professor of Cardiovascular Medicine,

Suez Canal University and Coordinator of Egyptian fellowship for

Echocardiograrphy

With Cooperation of Dr Eman Ellabany managerial specialty coordinator of The

Egyptian Fellowship Curriculum Committee has made significant contribution to the

curriculum

Page 6: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

6

This has been revised and approved by:

Egyptian Echocardiography Fellowship Committee

Professor Khairy Abdel Dayem AinShams University

Professor Ahmed Magdy National Heart Institute

Professor Aziz Madkour Azhar University

Professor Wafaa ElArousy Cairo University

Professor Gamela Nasr Suez Canal University Coordinator

Professor Mona AbouelSoud AinShams University

Professor Azza Elfiky Ain Shams University

Professor Amal Hamdy Azhar University

Professor Mohamed Osama National Heart Institute

Page 7: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

7

Goal The goal of EFOC curriculum is to graduate a safe competent trained specialist in

cardiovascular echocardiography who will be able to work within the National Health

Service and will have the knowledge, skills and attitudes required to do this and to

develop further subspecialty expertise if appropriate.

Aims The educational process in the fellowship of Cardiovascular Medicine aims to equip

trainees with the necessary knowledge, skills and attitude so that they will acquire

competencies; at a level consistent with practice in the specialty of echocardiography

and at the level of professionalism, that will include the following:

Patient care that is appropriate, effective and compassionate dealing with cases in

the field of echocardiography .

Medical knowledge in the basic and clinical sciences, and medical ethics and

application of such knowledge in the diagnosis and management of patients with

cardiovascular disorders through echocardiography.

Acting as safe independent specialists whilst recognizing the limitation of their

own practice and the obligation to seek assistance from colleagues where

appropriate.

Interpersonal and communication skills that ensure effective information

exchange with individual patients and their families and teamwork with other

health professionals.

Appraisal and utilization of new scientific knowledge to update and continuously

improve clinical practice.

The ability to function as a trainer and teacher in relation to colleagues and

medical students.

Maintenance of standards appropriate in their professional field and able to

respond constructively to assessments and appraisals of professional competence

and performance.

Page 8: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

8

Entry requirements for the Egyptian Fellowship

of Echocardiography

Any of the following is considered a satisfactory entry requirement for the Egyptian

Fellowship of echocardiography

1. M.D.in Cardiovascular Medicine

2. Fellowship of Egyptian Board of Cardiovascular medicine

3. MSc in Cardiovascular Medicine

TRAINING RULES & REGULTIONS

STRUCTURE OF THE TRAINING PROGRAM The structure of the training program of EFOC Board requires one year supervised

training that must be conducted in an accredited hospital before sitting for the final

examination.

A list of accredited hospitals will be announced yearly by the Board.

During the entire training program the candidate must be dedicated full time and must be

fully responsible for patient care. He will be evaluated through (guided by his Log

Book) two times by PBA exams as follows :After 6 months for ( pass or not) and

finally at end by MCQ and OSPE .

Holidays and on call duties are according to Ministry of health regulation.

GENERAL RULES for Evaluation oF TRAINEE PERFORMANCE

Workplace Based Assessment (WPBA) Performance of the trainee shall be evaluated on regular and continuous basis. The

evaluation process should involve all aspects of the training including clinical and

procedural skills, review of the logbook as well as review of attendance . This is

performed on-monthly bases for the trainees.

Workplace based assessment will be performed as well as procedure based assessment

(PBA) will be both considered .

THE LOGBOOK It is the responsibility of the trainee to record echocardiographic cases into the

logbook at least on weekly basis.

These entries should be signed by the trainer directly supervising the trainee

during the procedure and countersigned by his assigned trainer.

Page 9: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

9

Educational activities should also be recorded and signed by person in charge of

the activity and countersigned by the assigned trainer.

Logbooks should be ready for inspection by the education supervisor at all times.

It is the responsibility of each trainee to fill the logbook statistics in the trainee

assessment form (attached). This form should be counter signed by his assigned

trainer.

Logbooks and trainee assessment forms will form part of the evidence submitted

for the annual assessment meeting by review committee.

Procedure Based Assessments (PBAs) The PBA is a formative method (without marks allocated in the exit exam) for

assessing a range of competencies involved in performing certain procedures during

routine training. It enables trainees to build on assessor feedback and follow their

own progress. Although PBA is formative, the summary evidence will contribute to

the decision made as to how well the trainee is progressing and his illegibility to sit

for exam. The tool has two principal components:

1- A series of competencies within four core domains (consent, preprocedure,

procedural and post-procedural that are scored as follows:

N = Not observed U = Unsatisfactory S = Satisfactory

2- An overall global assessment divided into four levels rated as follows:

Level 0: Insufficient evidence observed to support a judgment

Level 1: Unable to perform the procedure under supervision

Level 2: Able to perform the procedure under supervision

Level 3: Able to perform the procedure with minimal supervision

(occasional help)

Level 4: Competent to perform procedure unsupervised (and deal with

complications)

HOW SHOULD IT WORK? The trainee’s learning agreement should indicate which PBAs are selected. It is the

trainee’s responsibility to ensure the required number of PBAs is performed to a

satisfactory standard by the specified timescale. The trainee generally chooses the

timing and makes the arrangement with the assessor. Trainees should carry out the

procedure, explaining what they intend to do throughout. The assessor should

observe the trainee undertaking the agreed sections of the PBA in the normal course

of workplace activity. Given the priority of patient care, the assessor should choose

the appropriate level of supervision depending on the trainee’s stage of training. If

the trainee is in danger of harming the patient at any point, he must be warned or

stopped by the assessor immediately. Trainees and assessors will find the assessment

criteria in the next 2 pages of the validation worksheet. This will help them define

each phase in the procedure and the required satisfactory level.

Page 10: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

01

WHAT DOES A COMPLETED PBA MEAN? A completed set of PBAs provides evidence that a trainee has learned to perform

competently a number of procedures in supervised settings.

FEEDBACK When a PBA is completed, the assessor should provide immediate feedback to the

trainee in a debriefing session. The assessor should identify areas of achievement and

opportunities for improvement. This should be done sensitively and in a suitable

environment.

AFTER THE ASSESSMENT AND FEEDBACK The corresponding PBA table should be filled and signed by both the assessor

(assigned trainer or other consultant) and trainee.

TIPS FOR USING PROCEDURE-BASED ASSESSMENTS (PBAS) Perform an assessment as many as possible an index procedure is carried

out; this helps to make assessment and feedback ‘routine’ and aids

learning.

Focus on one particular domain of a procedure this can reduce stress.

Review of the PBA checklist before the start of the procedure can help

with briefing.

The trainee can write up the procedure note whilst the assessor completes

the assessment table (not forgetting to assess the procedure note as well).

A suitable place is chosen for the assessor and trainee to review the

completed PBA table, and for the assessor to provide constructive

feedback.

Completion of the assessment without providing feedback is much less

useful for the trainee.

Items rated as “0, 1, 2” should be expected the first time that a trainee

performs a procedure. This simply means that they need more practice

and more assessments.

Half ANNUAL REVIEW PROCESS (HARP) The chairman of the scientific council sets the date for the HARP, selects the

members of the review board and sends the invitations.

Minimum 4 out of the following review board members (Chairman of scientific

council + program director + council member + educational supervisor + specialty

coordinator + representative of trainers) should attend this meeting.

Trainees will be notified one month ahead of the meeting date.

Learning agreements, logbooks (PBAs), trainer monthly reports, educational

supervisor reports, trainee assessment forms and training post assessment forms

should be submitted by the specialty coordinator at least 3 weeks before the date

of the meeting (all these forms are attached)

Page 11: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

00

The specialty coordinator will forward the above documents to the review board

members at least 2 weeks before meeting date.

The following items will be assessed in the meeting:

Verification of signatures

Attendance of activities

Trainees' performance during previous placement

The level of competence achieved by the trainee

Based on the above evidence and following discussion with trainees one of the

following outcomes will be decided:

ARP 1: Satisfactory to progress to the following stage

ARP 2: Can proceed but with targeted training (closer than usual

monitoring and supervision, to address particular needs & provide

feedback). The recommended improvements will be reassessed in the

following ARP meeting.

ARP 3: An official warning of discontinuation of the training program

will be issued if the previous recommendations have not been rectified,

subject to review in a follow up meeting.

ARP 4: Unsatisfactory and should be dismissed from the training

program.

ARP 5: Satisfactory completion for training program, legible to sit for a

final exam.

LEARNING AGREEMENT Soon after start of each post the trainee and trainer should arrange a formal

meeting to discuss trainee needs and career plans.

An agreed plan should be documented in the learning agreement form detailing

objectives, procedures and other activities to be achieved during the placement.

This form should be filled no later than one month after the start of the post and

the form should be forward to the EFOC offices to be retained in the candidates

file.

Dates of future meetings to review the progress of the trainee and the training

process should be agreed on during the initial meeting and documented on the

form.

In each of the above meetings the trainee and the trainer should discuss the

achieved objectives and plan further actions.

At the end of the post the completed learning agreement should be forward to the

Egyptian board offices together with trainee and training post assessment forms to

document the progress of such objectives in respective post. These forms together

with other evidence will form the basis of the Annual Review Process (ARP)

meeting.

Educational activities 1- Presents echocardiography cases in rounds

2- Participates in grand rounds and journal clubs concerning echocardiography

Page 12: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

02

3- Attends local echocardiography meeting and possible international meetings for

echocardiography

4- Learns to prepare audiovisual materials for presentations

Central Scientific Day

All Trainees are expected to have protected teaching time at a specific day every 2

weeks. The teaching program of these days is drafted centrally at the Egyptian

Fellowship Boards.

The Specialty Coordinator should notify training centers by the agenda of these days.

INTERRUPTION OF TRAINING It is not permissible to interrupt such a structural training program except in major

unavoidable circumstances. Such circumstances should be convincing and approved by

the Secretary General of The higher committee of Medical Specialties. The interruption

once approved should not be for more than one month . Interruption of the training

program for more than one month shall result in dismissal from the program and

cancellation of the preceding training period

JOB DESCRIPTION OF THE TRAINER DURING THE TRAINING

PROGRAM 1. Provides training and teaching for the trainees according to the provided curriculum

and intended learning outcomes and sign a learning agreement with each trainee.

2. Supervises the various activities of the trainees and their logbooks.

3. Ensures and help trainees for fulfillment of the logbook activities during the year of

training and the required level of competence and signing them.

4. Ensuring patient safety in relation to trainee performance by the early recognition and

management of those trainees in distress or difficulty.

5. Evaluates the trainees through WPBA and routine training activities with feedback to

the trainee, to the educational centrally in the trainer monthly report.

6. Participate as attendant in the annual review process and in exit examination as

nominated or requested by the scientific board

JOB DESCRIPTION OF THE EDUCATIONAL SUPERVISOR

DURING THE TRAINING PROGRAM

1- Checks and evaluates the progress of the training program

2- Evaluates the trainers periodical reports and propose remedial actions for any

deficiencies

3- Ensures that all training activities are running according the curriculum

4- Checks the availability of the requirements for training.

5- Checks that each trainee is involved in an audit process

Page 13: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

03

6- Assesses the logbook activities of each trainee & provide needed remarks for both

trainer & trainees.

7- Reports to the EFOC accreditation committee and scientific board and discuss with

them the performance of trainees and their legibility to sit for the exam

8- Discuss with hospital authorities the administrative affairs of the trainees and propose

solutions.

9- Participate in the annual review process and in exit exams as nominated or required by

the cardiology scientific board.

JOB DESCRIPTION OF THE TRAINING PROGRAM

COORDINATOR DURING THE TRAINING PROGRAM 1. Advise trainees on all aspects of Echocardiography Curriculum

2. Follow implementation of the curriculum and the planned program of education

3. Supervise the organization of the training sequence

4. Ensure that each post delivers the education and training expected for that period and

to feed back to the trainers involved any unsatisfactory reports from trainees

5. In conjunction with the scientific council and the Egyptian board, may withdraw a

placement which is considered unsuitable to the needs of the trainee

6. Ensure that the cycle of academic lectures is in place

7. Monitor logbook entries by regular inspection with the specialty coordinatorthrough

the ARP

8. Arrange the ARP meeting with the head of scientific council.

9. Arrange for completion of the training post-assessment form by each trainee after the

end of each rotation. The training post assessment form is confidential and should

only be retained by the specialty coordinator with access rights to the head of the

scientific council and Program Director. The Program coordinator is to give

anonymous feedback to training units and ensure any problems highlighted are

investigated

10. Advise the scientific council on: the facilities needed for training; and the minimum

learning requirements necessary to complete training

JOB DESCRIPTION OF SPECIALTY COORDINATOR

1- Training management across hospitals and hospital networks

2- Keep records of trainees' progression in trainees’ files

3- Collection and follow up of all forms related to the training process. These forms

should be organized and summarized in a suitable spreadsheet reflecting each

activities corresponding to trainees, trainers, supervisors and training post.

4- Organization of the training sequence to meet the needs of the trainee

5- Recruitment of trainers under scientific board supervision

6- Recruitment of trainees in collaboration the Egyptian Board administration and

according to the approved scientific board requirements.

7- Follow up and facilitation of trainers and supervisors activities

8- Liaise with training hospitals’ management teams to successfully manage the training

program in each training center

Page 14: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

04

9- Coordination of annual review meetings

10- Preparation for and participation in visits for accreditation of training hospitals

11- Follow up on regular Audit of training centers performance which is based on:

a. Reports from trainers

b. Reports from educational supervisors

c. Trainee post assessment forms

d. Feedback from program director

e. Reports from the monitoring and evaluation office of the Egyptian Boards.

The specialty coordinator should identify any issues arising from previously mentioned

monitoring approaches or as a direct complain from trainees and liaise appropriately with

relevant personal to resolve it.

Overview of Rotation/Content of the Training

Program Echocardiography is currently the most widely used non invasive imaging technique to

evaluate the patient with known or suspected heart disease. It involves a wide variety of

diagnostic ultrasound techniques: M mode, 2-dimensional, harmonic, strain and strain-

rate, pulsed, continuous wave, and color Doppler imaging. In a given patient, any or all of

these modalities may be used to assess the nature and severity of a suspected cardiac

disorder. Fellowship training in Echo should include education in physical principles and

instrumentation of ultrasound, 3-dimensional cardiac anatomy, physiology, and

pathophysiology and acquisition and interpretation of transthoracic echo images. Also to

have ability to interpret transesphageal examination . Fellowship trainees will be required

to perform echo/Doppler examinations themselves and to integrate echo findings with 1)

patient history and physical examination 2)the medical and surgical management of

patients, and 3)the results of other imaging modalities (e.g. CXR, Catheterization,

Nuclear, CT, MRI).

Training Level 1:

All cardiology fellows will be required to complete a three-month core experience in

Echo

Trainees should participate in the interpretation of a minimum of 150 complete echo

examinations (M-mode, 2-dimensional, and Doppler) and personally perform 75 of these

studies. Having completed this level, trainees should be able to recognize common

cardiovascular pathologic conditions

Level 2:

Level 2 training should comprise an additional three months of full time experience

during which an additional 150 studies (300 total) will be interpreted, of which 75 (150

total) should be personally performed. A trainee having completed Level 2 should be able

to independently and accurately perform and interpret a complete adult echo examination.

Page 15: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

05

Level 3: Level 3 training consists of an additional six months and 450 additional

examinations interpreted (750 total), 150 of which should be personally performed (300

total). Trainees at this level should be increasingly independent in interpretation. This

level of training includes exposure to the administrative aspects of running an echo lab

and participation in echo related research, understanding new and evolving ultrasound

technologies and applications of echocardiography.

.

Core Competencies 1.Patient Care

2. Medical knowledge

3. Practice-Based Learning and Improvement

4. Interpersonal and Communication Skills

5.Professionalism: through clinical mentoring and self-appraisal, fellows will develop

and demonstrate a professional approach to their work responsibilities, academic pursuits,

and interactions with others.

6. System-Based Practice

7. Administrative Expectations

Page 16: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

06

Contents Theme Topic Page

THEME I General Principles Transducers ,Safety and

Physics of Cardiac Ultrasound

THEME 2 The Echocardiographic Examination and

Views and Hemodynamics Derived from Echo

Doppler

THEME 3 Cardiac function : Systolic and Diastolic

Function

THEME 4 Coronary Artery Disease

THEME 5 Valvular Heart Disease

THEME 6 Diseases of the Myocardium (nonischemic)

THEME 7 Systemic and Pulmonary Hypertensive Heart

Disease

THEME 8 Pericardial Disease

THEME 9 Congenital Heart Disease

THEME 10 Cardiac Masses

THEME 11 Diseases of the Aorta

THEME 12 Writing an Echocardiography Report

THEME 13 Medical Ethics and Consent

Page 17: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

07

THEME I.

1.1. General Principles ,Transducers ,Safety and

Physics of Cardiac Ultrasound

OBJECTIVE

All trainees must be able to appreciate the general principles of ultrasound

as well as different transducers .Safety and Physics of Cardiac Ultrasound

as well as to be applied .

KNOWLEDGE (K.1.1)

All trainees should be able to:

k.1.1.1 Describe Basic Principles of Ultrasound

K.1.1.2 Identify Transducers

K.1.1.3 Identify Imaging Principles of Ultrasound

K.1.1.4 Identify Biologic Effects of Ultrasound and Safety

K.1.1.5 Identify and manage Quality Assurance of Ultrasound

Instruments.

K.1.1.6 Describe Physical Basic Principles of Doppler

Intellectual & Clinical Skills (ICS.1.1)

All trainees should be able to:

Page 18: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

08

ICS.1.1.1 Select patients appropriately for echocardiographic

examination

ICS.1.1.2 Select patients appropriately for transducers .

ICS.1.1.3 Explain the procedure, possible biologic effects and safety .

ICS.1.1.4 Assess the Quality Assurance of Ultrasound Instruments.

Attidute & Behaviour (AB.1.1)

All trainees should be able to:

AB.1.1.1 Educate patients and explain the procedure & follow-up

AB.1.1.2 Get an informed consent

AB.1.1.3 Develop self confidence and recognition of limitations.

AB.1.1.4 Develop a team approach including a close relationship with

nursing.

AB.1.1.5 Work closely with other health care professionals as

necessary.

AB.1.1.6 Explain the anxiety that the patients suffer with

echocardiographic examination

Page 19: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

09

THEME II.

The Echocardiographic Examination and Views and

Hemodynamics Derived from Echo Doppler.

2.1. Basic Science: 2.1.1 Anatomy & Histology OBJECTIVE All trainees must be able to describe the anatomy, developmental basis

and histology of cardiac and vascular structures with special emphasis

on applied anatomy relevant to echocardiography .

KNOWLEDGE (K.2.1.1)

All trainees should be able to identify and describe:

k.2.1.1.1 Identify Embryology of heart and its venous system

K.2.1.1.2 Identify Anatomy of heart

K.2.1.1.3 Identify Anatomical landmarks

K.2.1.1.4 Identify Anatomy of coronary vessels (arteries and veins)

K.2.1.1.5 Identify Anatomy of cardiac conduction system

Intellectual & Clinical Skills (ICS.2.1.1)

All trainees should be able to:

ICS.2.1.1.1 Distinguish anatomic landmarks clinically.

ICS.2.1.1.2 Differentiate different cardiac chambers and vascular

structures in non-invasive & invasive imaging.

Page 20: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

21

2.1.2. Physiology

OBJECTIVE

All trainees must be able to discuss physiological basis of cardiac action and

mechanics and to apply this knowledge to understand the basic mechanism

of cardiac diseases .

KNOWLEDGE (K.2.1.2)

All trainees should be able to:

K.2.1.2.1 Recognize Physiologic properties of cardiac muscle and

Hemodynamics Derived from Echo Doppler

K2.1.2.2 Discuss cardiac cycle, pressure/volume loop and principles of

Volume and Flow Measurement.

K.2.1.2.3 Explain the autonomic regulation of heart rhythm.

K.2.1.2.4 Describe structural and molecular basis of the heart

K.2.1.2.5 Recognize biophysics of cardiac function

K.2.1.2.6 Describe and explain cardiac function

K.2.1.2.7 Describe and explain different mechanisms of different

cardiac diseases

Intellectual & Clinical Skills (ICS.2.1.2)

All trainees should be able to:

ICS.2.1.2.1 Interpret normal ECG and echocardiogram .

Page 21: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

20

2.1.3. Pharmacotherapy:

OBJECTIVE

All trainees must be able to demonstrate deep understanding of the

classification, pharmacokinetics and pharmacodynamics of drugs used in

the field of cardiology and its impact upon myocardial contractility .

KNOWLEDGE (K.2.1.3) All trainees should be able to:

k.2.1.3.1 Describe classification of cardiac drugs.

K.2.1.3.2 Explain mode of action, indications, contraindications,

interactions and adverse reactions of cardiac drugs.

K.2.1.3.3 Recognize the effects of age, body size, organ dysfunction

and concurrent illness on drug distribution and metabolism.

K.2.1.3.4 Recognize effect of cardiac drugs in pregnancy.

K.2.1.3.5 Describe principals of drug trials.

Intellectual & Clinical Skills (ICS.2.1.3)

All trainees should be able to:

ICS.2.1.3.1 Take a relevant history of a patient’s medication regimen

and its side effects.

ICS.2.1.3.2 Adjust the dose of the prescribed drug for each disease in

adult groups.

ICS.2.1.3.3 Monitoring different drugs effects

ICS.2.1.3.4 Recognize and manage possible drug interactions and side

effects (including treatments of concomitant diseases or

Page 22: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

22

during pregnancy).

2.2.ECHOCARDIOGRAPHIC Examination

OBJECTIVE

All trainees must be able to understand the principles underlying the

Tomographic imaging Nomenclature of standard views and Transducer

positions, views

KNOWLEDGE (K.2.2)

All trainees should be able to:

K.2.2.1 Define Basic imaging principles

1. Tomographic imaging

2. Nomenclature of standard views

3. Image orientation

4. Technical quality

5. Transducer positions, views.

K.2.2.2 Distinguish between the principle of M-Mode echo

1. Aortic valve and left atrium

2. Mitral valve

3. Left ventricle

Page 23: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

23

4. Other M-mode recordings

D. Anatomic basis of 2D-echo

1. Orientation of images (terminology and display)

2. Left ventricular wall segments

3. Coronary artery distribution

E. Principles of echo measurements

1. M-mode

2. 2D-echo

K.2.2.3 Determine causes of Conduction Disturbances

A. Production of wall motion abnormalities

B. Effect on valve motion

C. Effect on Doppler flow velocity waveforms

K.2.2.4 Determine assessment of Intracardiac Pressures.

Intellectual & Clinical Skills (ICS.2.2)

All trainees should be able to:

ICS2.2.1 History taking and appropriate examination in patients

ICS2.2.2 Obtaining an adequate resting echocardiogram

ICS2.2.3 Demonstrate a systematic approach to interpretation of resting echocardiogram

ICS2.2.4 Communicate effectively with patients

Attidute & Behaviour (AB.2.2)

Page 24: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

24

All trainees should be able to:

A.2.2.1 Take a sensible, professional attitude towards patients

A.2.2.2 Consent patients sensitively with an objective assessment of risks.

A.2.2.3 To educate patients as to the treatment options open to

them, to empower them to take their own decisions as to

their preferred treatment strategy.

Page 25: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

25

THEME III. Cardiac function : Systolic and Diastolic Function: 3.1. Systolic and Diastolic Function:

OBJECTIVE

All trainees must be able to competently apply the knowledge of Principles

of echocardiography in detection of cardiac dysfunction.

KNOWLEDGE (K.3.1)

All trainees should be able to:

k.3.1.1 Describe Determinants of LV Performance.

K.3.1.2 Explain Global LV Systolic Function and Regional systolic

function, Interdependence of LV and RV and Global RV

systolic function

K.3.1.3 Identify Cardiac Diastolic Function

Basic Principles. , Echo-Doppler Approach to LV Diastolic

Function, Right Ventricular Diastolic Function.

K.3.1.4 Describe new advances in assessment of cardiac function

Intellectual & Clinical Skills (ICS.3.1)

All trainees should be able to:

ICS.3.1.1 Perform a complete functional echocardiographic study.

Attitude & Behaviour (AB.3.1)

All trainees should be able to:

Page 26: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

26

AB.3.1.1 Correctly attitude to the procedure approach-appreciating

usage.

THEME IV. Coronary Artery Disease

4.1. Coronary Artery Disease OBJECTIVE All trainees must be able to appreciate the role of echocardiography in the

management of patients with coronary artery disease and also to recognize

and deal with complications of coronary artery disease.

KNOWLEDGE (K.4.1)

All trainees should be able to identify:

K.4.1.1 Identify the role of Coronary Artery Anatomy and Function

K.4.1.2 Identify Coronary Artery Abnormalities.

K.4.1.3 Describe Basic principles , Relationship of wall motion and

wall thickening to coronary artery perfusion and Myocardial

Ischemia and detection of ischemic muscle

K.4.1.4 Detect and locate coronary artery disease

1. Regional wall motion abnormality

2. Relationship between transmurality and regional function

3. Non-CAD causes for chest pain.

K.4.1.5 Identify Quantitation of MI

Page 27: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

27

(prognostic value: guide therapy)

C. Limitations and alternate approaches

D. Complications and associated findings.

K.4.1.6 Implantation of Follow-up transthoracic echo

Intellectual & Clinical Skills (ICS.4.1)

All trainees should be able to:

ICS.4.1.1 Select appropriate patients for echocardiographic

examination with coronary artery disease.

ICS.4.1.2 Consent a patient in a balanced and informed way about the

role of echocardiography in a safe and logical fashion.

ICS.4.1.3 Decide when an alternative technique or approach may be

required

Attitude & Behaviour (AB.4.1)

All trainees should be able to:

AB.4.1.1 Take a sensible, professional attitude to the procedure; learn

under supervision with appropriate requests for advice

AB.4.1.2 Be aware of importance of members of a multi-disciplinary

team in patient management and in maximizing benefit of

echocardiography .

AB.4.1.3 Appreciate the psychological impact of the patient's illness on the

patient and their family, and manage it selectively

Page 28: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

28

THEME V. Valvular Heart Disease

5. Valvular Heart Disease: OBJECTIVE All trainees must be able to select appropriate cases for Valvular Heart

Disease and understand the cardiac and thoracic anatomy and to apply this

knowledge to understand the and safely extract data using all available

technology.

KNOWLEDGE (K.4.2)

All trainees should be able to identify:

K.5.1.1 Basic Principles of Valve Stenosis : Aortic Stenosis , MitraL

Stenosis Tricuspid stenosis and pulmonary valvular stenosis

K.5.1.2 Basic Principles of Valve Regurgitation.

K.5.1.3 Mitral Valve Prolapse

K.5.1.4 Prosthetic Valve : Types of prosthetic valves, Echo-Doppler

clues to prosthetic valve dysfunction Routine” follow-up of

prosthetic valve function

K. 5.1.5 Endocarditis

A. Role of echo in diagnosis

K.5.1.6 Valvular Heart Disease Associated with Systemic Conditions

Intellectual & Clinical Skills (ICS.4.2)

All trainees should be able to:

ICS.5.1.1 Select appropriate echocardiographic approach patients for

Page 29: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

29

with Valvular Heart Disease

ICS.5.1.2 Consent a patient in a balanced and informed way about the

risk of Valvular Heart Disease in a safe and logical fashion.

ICS.5.1.3 Assess severity of Valvular Heart Disease using different

tools.

Attitude & Behaviour (AB.4.2)

All trainees should be able to:

AB.5.1.1 Foster a team approach to assessment of Valvular Heart

Disease including a close relationship with cardiac surgeons

AB.5.1.2 Educate patients about the treatment options available to

them and to explain treatment strategies including surgical

AB.5.1.3 Work closely with other health care providers

THEME VI. Valvular Heart Disease

6. Diseases of the Myocardium (nonischemic)

OBJECTIVE

All trainees must be able to select appropriate cases of non ischemic

myocardial diseases.

KNOWLEDGE (K.6.2)

All trainees should be able to identify:

K.6.1.1 Identify Cardiomyopathies

K.6.1.2 Identify Dilated cardiomyopathy

Page 30: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

31

1. Echo features

2. Associated findings.

K.6.1.3 Identify Hypertrophic cardiomyopathy

1. Epidemiology

a. Prevalence, incidence

b. Associated risk factors for sudden death

c. Presentation

d. Genetics

2. Anatomic features

a. Varied patterns of myocardial hypertrophy (pleomorphic)

Spectrum of dynamic obstruction

K 6.1.4 Identify Restrictive cardiomyopathy (RCM)

1. Etiologies

a. Primary

1) Idiopathic

2) Loeffler’s eosinophilic endomyocardial disease

3) Endomyocardial fibrosis

b. Secondary

1) Amyloid heart disease

2) Hemochromatosis

3) Heart muscle disease occasionally presenting

Page 31: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

30

with restrictive features

a) Post irradiation heart disease

b) Carcinoid heart disease

c) Doxorubicin/daunorubicin toxicity

d) Progressive systemic sclerosis

2. Typical 2D-echo findings

K.6.1.5 Endocarditis

A. Role of echo in diagnosis

K.6.1.6 Va Differentiating RCM vs constrictive pericarditis

Intellectual & Clinical Skills (ICS.6.2)

All trainees should be able to:

ICS.6.1.1 Consent a patient in a balanced and informed way in a safe

and logical fashion

Attitude & Behaviour (AB.6.2)

All trainees should be able to:

AB.6.2.1 Foster a team approach including a close relationship with

cardiac surgeons

AB.6.2.2 Educate patients about the treatment options available to

them and to explain treatment strategies including surgical

AB.4.2.3 Work closely with other health care providers as necessary:

Page 32: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

32

THEME V. MEDICAL ETHICS AND CONSENT

All trainees should know, understand and apply appropriately the

principles, guidance and laws regarding medical ethics and

confidentiality and be able to obtain valid consent from the patient and

respond to the patient's level of understanding and mental state.

KNOWLEDGE (K.5)

All trainees should be able to recognize

K.5.1 The principles of medical ethics

K.5.2 The factors influencing ethical decision making: religion,

moral beliefs, cultural practices.

K.5.3 Different types and structure of consents

K.5.4 Persons from whom consent should be taken

K.5.5 Situations where patient consent, while desirable, may not

required for disclosure e.g. communicable diseases

Intellectual and Clinical Skills (ICS.5)

All trainees should be able to:

ICS.5.1

Explain to the patient and family his or her disease, natural

history, prognosis, management plans, all care options and

possible complications.

ICS.5.2 Obtain a valid consent

ICS.5.3 Practice and promote accurate documentation within

clinical practice

Page 33: Curriculum of Adult Echocardiography Subspecialty Zamala curriculum.pdf · Curriculum of Adult Echocardiography Subspecialty ... Ain Shams University and head of the Cardiovascular

33

Attitude and Behavior (AB.5)

All trainees should:

AB.5.1 Respond to the patient's level of understanding and mental

state and how this may impair their capacity for informed

consent.

AB.5.2 Demonstrate balanced attitude to deliver the information in

the consent without ease or frightening to the patient and

his/her family.

AB.5.3 Respect patient’s requests for information not to be shared,

unless this puts the patient, or others, at risk of harm

AB.5.4 Demonstrate honesty and openness in any financial

arrangements with patients

AB.5.5 Conforms to codes of practice.