Department of Medicine, Penn State College of Medicine, Hershey, PA, 17033, USA.
Department of Nuclear Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA.
Cardiovasc Ultrasound. 2022 Sep 20;20(1):24. doi: 10.1186/s12947-022-00294-1.
The American College of Cardiology Core Cardiovascular Training Statement (COCATS) defined echocardiography core competencies and set the minimum recommend number of echocardiograms to perform (150) and interpret (300) for independent practice in echocardiography (level 2 training). Fellows may lack exposure to key pathologies that are relatively infrequent, however, even when achieving an adequate number of studies performed and interpreted. We hypothesized that cardiology fellows would lack exposure to 1 or more cardiac pathologies related to core competencies in COCATS when performing and interpreting the minimum recommend number of studies for level 2 training.
We retrospectively reviewed 11,250 reports from consecutive echocardiograms interpreted (7,500) and performed (3,750) by 25 cardiology fellows at a University tertiary referral hospital who graduated between 2015 and 2019. The first 300 echocardiograms interpreted and the first 150 echocardiograms performed by each fellow were included in the analysis. Echocardiography reports were reviewed for cardiac pathologies relating to core competencies defined in COCATS.
All 25 fellows lacked exposure to 1 or more cardiac pathologies related to echocardiography core competencies despite meeting COCATS minimum recommended numbers for echocardiograms performed and interpreted. Pathologies for which 1 or more fellows encountered 0 cases despite meeting the minimum recommended numbers for both echocardiograms performed and interpreted included: pericardial constriction (16/25 fellows), aortic dissection (15/25 fellows), pericardial tamponade (4/25 fellows), valvular mass/thrombus (2/25 fellows), prosthetic valve dysfunction (1/25 fellows), and cardiac chamber mass/thrombus (1/25 fellows).
Cardiology fellows who completed the minimum recommend number of echocardiograms performed and interpreted for COCATS level 2 training frequently lacked exposure to cardiac pathologies, even in a University tertiary referral hospital setting. These data suggest that fellowship programs should monitor pathology case counts for each fellow in training, in addition to the minimum recommend number of echocardiograms defined by COCATS, to ensure competency for independent practice in echocardiography.
美国心脏病学院核心心血管培训声明（COCATS）定义了超声心动图核心能力，并为独立进行超声心动图实践（二级培训）设定了最低推荐执行（150 次）和解释（300 次）的超声心动图次数。然而，即使完成了足够数量的检查和解释，研究员可能也缺乏接触相对罕见的关键病理的机会。我们假设，当执行和解释二级培训中推荐的最低数量的研究时，心脏病学研究员可能会对与 COCATS 核心能力相关的一种或多种心脏病理学缺乏了解。
我们回顾性分析了 2015 年至 2019 年期间在一家大学三级转诊医院工作的 25 名心脏病学研究员完成的（3750 次）和解释的（7500 次）连续超声心动图报告。每位研究员的前 300 次超声心动图解释和前 150 次超声心动图执行都包含在分析中。审查超声心动图报告以查找与 COCATS 定义的核心能力相关的心脏病理学。
尽管所有 25 名研究员都达到了 COCATS 对执行和解释的超声心动图的最低推荐数量，但他们都缺乏与超声心动图核心能力相关的一种或多种心脏病理学的了解。尽管达到了执行和解释的超声心动图的最低推荐数量，但仍有 1 名或多名研究员遇到了 0 例的病理包括：缩窄性心包炎（16/25 名研究员）、主动脉夹层（15/25 名研究员）、心包填塞（4/25 名研究员）、瓣膜肿块/血栓（2/25 名研究员）、人工瓣膜功能障碍（1/25 名研究员）和心脏腔室肿块/血栓（1/25 名研究员）。
完成 COCATS 二级培训中最低推荐数量的超声心动图执行和解释的心脏病学研究员经常缺乏对心脏病理学的了解，即使在大学三级转诊医院环境中也是如此。这些数据表明，除了 COCATS 定义的最低推荐超声心动图数量外，研究员培训计划还应监测每位受训研究员的病理病例数，以确保独立进行超声心动图实践的能力。
