Advanced Critical Care Echocardiography Certification: An Update

Abstract

Certification in advanced critical care echocardiography (ACCE) is now offered by the National Board of Echocardiography (NBE). In a previous editorial written before the NBE had fully developed the process of certification, we summarized the development of the certification.1Mayo P.H. Narasimhan M. Koenig S. Advanced critical care echocardiography: the intensivist as the ACCE of Hearts.Chest. 2017; 152: 4-5Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar This editorial will summarize some new information concerning the certification that will be of interest to the pulmonary/critical care community, now that the process is mature. The NBE board examination has been given two times. In January 2019, 512 physicians took the examination with a pass rate of 81%, whereas in January 2020, 416 physicians took the examination with the pass rate not yet established. The examination assesses knowledge of the cognitive base skill at image interpretation required for mastery of ACCE. Details of subject matter covered in the NBE board examination are listed on the NBE website (www.echoboards.org). Physicians who took the 2019 examination came from a wide variety of backgrounds; critical specialists (pulmonary, critical care medicine, anesthesiology, emergency medicine, and surgical) and hospitalists who provide critical care services were all well represented. There was strong showing from fellows in training from a variety of training backgrounds. For guidance on how to study for the examination, interested readers may access the independent website www.advancedcriticalcareecho.org. Although many components of the cognitive base of ACCE are shared with cardiology echocardiography, others are unique to critical care practice. The site includes a comprehensive reading list of articles that are specific to ACCE as well as a wealth of information about the certification process. A major difference between ACCE and standard consultative cardiology echocardiography is that ACCE requires the intensivist to be fully capable at image acquisition, image interpretation, and immediate application of the results of the study at point of care. The cardiology echocardiographer is expert level at image interpretation. For this reason, the NBE requires a high level of skill at image acquisition by the intensivist who seeks certification in ACCE. In addition to passing the examination, which is referred to Testamur status, to achieve certification the candidate is required to perform a minimum of 150 full image set ACCE echocardiography examinations with supervision by a qualified mentor. The NBE has not precisely defined what constitutes a full ACCE image set. An example of an acceptable image set has been prepared for the ACCE community and is available with free access at the website www.advancedcriticalcareecho.org. The full image set of ACCE is available in written form in Table 1 of the International Statement of Training in ACCE.2International consensus statement on training standards for advanced critical care echocardiographyExpert Round Table on Echocardiography in ICU.Intensive Care Med. 2014; 40: 654-666Crossref PubMed Scopus (137) Google Scholar The NBE website provides information on logbook requirements, qualifications required for serving as a mentor, and guidance on requirements for documentation of successful completion of the image set. The NBE will allow clinicians who are actively involved with provision of critical care services to achieve certification in ACCE. It has become apparent that many hospitalists provide high-level critical care in the ICUs that are not staffed by critical care specialists. Because there is both interest and need for this group of hospitalists to become competent in ACCE, the NBE will allow them to fulfil the requirements for certification until December 31, 2026. Emergency medicine specialists who provide critical care services are also welcomed to achieve certification in ACCE. To summarize, the certification process requires two steps: pass the cognitive examination and become Testamur status, and completion of a large portfolio of ACCE level echocardiograms that are reviewed and approved by a mentor. A rate-limiting step has been identification of qualified mentors as well as the major time commitment required to perform 150 full studies of critically ill patients. The ultrasonography working group at CHEST offers an annual review course for the examination that has been both well attended and well-reviewed. The next one is scheduled for December 2020. In addition, the College offers a 3-day course each June that focuses on image acquisition and interpretation. This course is designed for the critical care clinician who has passed the NBE examination and seeks to “jump start” their image portfolio. This course has also been well-attended and well-reviewed. CHEST is also considering the development of a system to help candidates for certification in ACCE in pairing with qualified mentors. CHEST has been in the forefront of the developing the certification and remains fully committed to helping interested intensivists to achieve this goal.