Abstract 13399: Variable Exposure to Echocardiography Pathology and Core Competencies Among Cardiology Fellows-in-training

Abstract

Introduction: Current guidelines recommend interpretation of at least 300 echocardiograms to achieve competency in echocardiography for independent practice (level II COCATS). Recommended core competencies in echocardiography include proficiency in evaluating native and prosthetic valve diseases, pulmonary hypertension and right heart dysfunction, and suspected cardiac masses or endocarditis, among others. Whether the recommended number of cases allows for adequate exposure to the various core competencies, however, is unclear. Hypothesis: We investigated whether certain core competencies are less commonly encountered when using the recommended case numbers by current guidelines. Methods: We reviewed echocardiograms interpreted by 10 of our cardiology fellows (2 per year) who began training from July 2015 through July 2019. We recorded core competency measures encountered in the first 300 echocardiograms interpreted by each fellow, including measures of left and right ventricular dysfunction, valvular diseases, cardiac masses, aortic disease, and pericardial disease. Paired T-test was used to compare the mean occurrence between different core competencies. Results: Among the 3000 echocardiograms reviewed, abnormal wall motion was the most common pathology encountered, whereas each other core competency was relatively less common (p<0.05 for all comparisons, see plots below). Deficiencies in core competencies included: 9/10 fellows had no cases of aortic dissection, 3/10 had no cases of valvular mass, 2/10 had no cases of cardiac chamber mass, 2/10 had no cases of cardiac tamponade, and 1/10 had no cases of prosthetic valve dysfunction. Conclusions: The recommend number of echocardiograms in current guidelines does not ensure adequate exposure to all areas of echocardiography core competency. Educators should consider strategies to supplement learning in these areas to ensure experience in all areas of echocardiography core competency.