Level III training for echocardiography competencies has been defined by the American College of Cardiology (ACC), the American Heart Association (AHA) and the American Society of Echocardiography (ASE).

While three levels of training for echocardiography are recognized, this is the first time that Level III requirements for performing advanced echocardiographic procedures have been formally defined.

Level III training is the highest level of knowledge, experience, skill and behavior in a given field.

“Level III training in echocardiography requires additional experience beyond the basic cardiovascular fellowship; and is required of individuals who intend to perform and interpret complex studies in special populations, lead a research program, direct an academic echocardiography laboratory, or train others in advanced aspects of echocardiography. Although Level III training in echocardiography may be achieved within a standard 3-year fellowship, for many individuals, an additional period of postgraduate training will be required.”

• Level III didactic training program should provide the advanced trainee with an understanding of ultrasound physics, instrumentation, echocardiographic image formation and optimization and clinical applications of echocardiography (including contrast agents, strain imaging, 3D echo, stress echo, and TEE)
• Fully developed image acquisition skills are an essential competency for the Level III trainees as they are required to be able to train both fellows and sonographers in image acquisition and optimization.
• The Level III trainee should be fully trained in the recognition and assessment of life-threatening conditions (such as left ventricular dysfunction, cardiac tamponade, right heart failure, acute valvular regurgitation, and aortic dissection) as well as rare clinical conditions and syndromes of the cardiovascular system.
• Level III training helps develop skills necessary for cardiovascular research and education. Research should lead to presentations at conferences and publications in peer-reviewed scientific journals.
• Procedural and technical experience should include general training requirements, and specific ultrasound procedures including TTE (≥150 studies performed and ≥750 interpreted), TEE (≥150 studies performed and interpreted), 3D-echo (≥50 studies each for valve disease/image manipulation, and for ventricular volumes and function), contrast echo (≥100 studies), strain echo (≥50 studies), and stress echo (≥200 studies, including 25 for noncoronary indications).

The 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography has been published online Feb. 19, 2019 in the Journal of the American College of Cardiology. 

(Source: ACC press release, Feb. 19, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA