Remote Echocardiography Training According to International Standards: Opportunities of the Virtual Format and Practice Requirements
Limits of the Remote Format in Echocardiography Training
According to the ASE position (Altman C.A. et al., 2021), virtual training provided significant support during the COVID-19 pandemic; however, training in pediatric and congenital heart diseases, as well as fetal echocardiography, cannot be completed in a virtual environment. Both pediatric cardiology residents and ultrasound specialists need practical clinical experience to develop technical skills and knowledge. As institutions adapted to safely conducting studies, they successfully returned trainees to the clinical learning environment.
The Role of Simulation and Feedback-Based Learning
In the updated ASE guidelines (2024) for targeted neonatal echocardiography and cardiac POCUS in NICUs, data is provided on the effectiveness of simulation training for mastering echocardiography skills, as well as the impact of expert and augmented feedback and quantitative feedback on the development of complex medical skills within competency-based medical education. For transesophageal assessment, the use of computer echocardiographic simulation improves the learning curve (ASE, 2023, Little S.H., Rigolin V.H. et al.).
Certification and Confirmation of Study Volume
The increased use of cardiac ultrasound by clinicians outside the cardiology community is associated with the emergence of portable ultrasound devices. The National Board of Echocardiography has developed a formal certification process for critical care echocardiography, requiring confirmation of 150 completed and interpreted studies (ASE, 2020).
| Direction | Remote Format Possibility | Source |
|---|---|---|
| Pediatric / Congenital / Fetal Echocardiography | Cannot be completed virtually; clinical practice required | ASE, 2021 |
| Critical Care Echocardiography (NBE Certification) | Requires confirmation of 150 scans | ASE, 2020 |
| TEE / Structural Interventions | Simulation improves the learning curve | ASE, 2023 |
Remote Assessment and Telemedicine in Echocardiography
The possibilities of remote work are reflected in the ASE-REWARD study (Remote Echocardiography with Web-Based Assessments for Referrals at a Distance), dedicated to remote echocardiography with web-based assessment for distant referrals (Singh S. et al., J Am Soc Echocardiogr 2013). Portable echocardiography was studied in the context of diagnostic value and the learning curve in out-of-hospital cardiovascular disease screening (Weiner R.B. et al., 2012).
Training Programs
The "Expert Echocardiography" course is available, considering the method at a qualitatively new level, including assessment in obesity, pregnant women, and valvular disease. Training is available for specialists from Russia and CIS countries through a division in the Republic of Kazakhstan. Exact enrollment conditions, timelines, and forms of final certification for each program — [to be specified].
Frequently asked questions
Can fetal and congenital echocardiography be fully mastered remotely?
No. According to ASE (2021), training in pediatric, congenital heart diseases, and fetal echocardiography cannot be completed in a virtual environment — practical clinical experience is required.
How many studies are required for certification in critical care echocardiography?
The National Board of Echocardiography (NBE) requires confirmation of 150 completed and interpreted studies (ASE, 2020).
Does simulation training help in mastering echocardiography?
Yes. Data is provided on the effectiveness of simulation training and feedback, and computer simulation improves the learning curve in transesophageal assessment (ASE, 2023, 2024).
Is training available for specialists from CIS countries?
Yes. The "Expert Echocardiography" course is available for specialists from Russia and CIS countries through a division in the Republic of Kazakhstan.
Is remote assessment of echocardiographic studies possible?
Yes, such an approach was studied in the ASE-REWARD study — remote echocardiography with web-based assessment for distant referrals (J Am Soc Echocardiogr 2013).