JGH Echocardiography Fellowship

Structure and Organization of the Program

Teaching Curriculum

Over the last two years, the teaching and supervisory work during the trainees’ fellowship have covered three aspects of clinical echocardiography: (1) image acquisition; (2) image interpretation; and; (3) study reporting. During the first 3 months of their fellowship, the focus has been on image acquisition, first in normal hearts and then in abnormal hearts (where the fellows were taught to adapt their image acquisition and quantification measures to the abnormalities detected or the referring physician’s question). Following this three-month period, the attending staff have taught study interpretation and reporting, and reviewed every study that trainees have interpreted.

Throughout his fellowship, the fellow has had reading assignments. At the six-month mark, the trainee was expected to have read all the chapters of the leading textbooks in the field (The Echo Manual and the Otto book), as well as seminal papers which staff have further discussed with them. Four months into their fellowship, fellows are expected to start performing specialty echo (transesophageal and stress [exercise, dobutamine] echo), which staff have demonstrated and then supervised.

Scholarly Activities

Clinical echocardiography seminars are organized weekly and attended by the fellows. JGH echo rounds occur every week and are given by residents, sonographers and fellows. These alternate with McGill echo rounds, which occur every month and are given by the McGill Cardiology echo faculty. I organize both these sets of Rounds and take this opportunity to define a learning agenda for the fellow.

In accordance with the Scholar CANMEDS section, the fellow is mentored in the preparation of a lecture he is asked to give every 6 to 8 wks to the group of echocardiographers, cardiology residents, sonographers, general cardiologists and cardiac surgeons of our institution. These lectures have enhanced the general education of our Cardiology residents. The fellow is also trained to be a teacher of echocardiography by serving as a resource person for Cardiology residents rotating in our lab, and by reviewing in-patient studies from the CCU and Cardiology Step-Down Unit with the Cardiology residents within the CTU team.

The fellow also attends general conferences organized within the Division of Cardiology, such as weekly clinical rounds (where the Fellow is expected to demonstrate the echo findings pertinent to the cases being presented), Cardiology lectures (usually given by outside Speakers), journal clubs and morbidity and mortality rounds.

Fellows are encouraged to design and conduct research projects in echocardiography during their year. Interested fellows could be paired with faculty to learn the various steps of research methodology in echocardiography and participate in ongoing research projects.

Service/Education Balance

In soliciting regular feedback from the fellows on this particular issue, fellows have generally been content with the service to teaching balance. The performance and interpretation of every case by the fellow has been followed by a one-on-one supervision and feedback from the staff signing onto the case. Weekly educational echo rounds are much appreciated by fellows.

Comments

Evaluation of the Staff, Trainee, and Rotation

At the start of the fellowship year, the chief sonographer and I provide the trainee with a general orientation.

I arrange formal quarterly face-to-face meetings with the fellow to discuss the educational objectives at their stage of their training and discuss their progress. As well, I have several – likely monthly – informal discussions with the fellow regarding their performance as I receive it from the teaching faculty. I then send an e-mail to all staff and sonographers describing the objectives and responsibilities of every fellow for the following period.

At the end of every quarter, I formally solicit the multisource feedback from sonographers and attending staff on the progress of the trainee according to their educational objectives, with an emphasis on knowledge, skill and attitude. Informal feedback occurs regularly as well.

I then meet once again with the trainee to solicit his or her feedback on staff teaching and the overall learning experience (exposure, academic environment, any arising issues). After providing them with the feedback from staff, I report the overall feedback of the trainee back to the staff on a quarterly basis.

The feedback by myself and staff on the trainee every 3 months and the GLOBAL EVALUATION form are filled on the one45.

Achieving the Necessary Case Exposure

The training requirements include a minimum of 300 trans-thoracic studies performed, 1000 trans-thoracic studies interpreted, with sufficient performance and interpretation of trans-esophageal studies (150) and stress echocardiography (exercise, dobutamine) (125).

Stress echo studies (exercise, dobutamine): 140

Impact of the Residency Program

The echo fellowship program continues to have a positive and synergistic impact on the Cardiology core residency training program.

We have trained 19 residents over the last year (2013-2014 academic year) from the McGill Cardiology and other (ER, ICU, Internal Medicine) residency programs. In fact, our echo program for Cardiology residents continues to be a popular training site for our residents and one of the most popular electives overall in the program.

Our Echo Laboratory is among the largest in the country. Our resources have grown and remain a premiere site for training for Cardiology residents and fellows.

(1)      Since the last fellowship report in 2012, we have increased our teaching faculty by 50% to include 9 full-time and 3 part-time Level III-trained echocardiographers (we had 6 full-time echocardiographiers at the time of the previous report), and 6 full-time sonographers;
(2)      We have state-of-the-art physical resources with new, fully renovated premises with designated areas for our trainees such as a fellows’ viewing room (for interpretation of studies), dedicated rooms for residents to perform patient studies, and another residents’ room for fellows to mingle and socialize during lunch time or after hours;

As a result, our lab has increased its training capacity and in addition to the fellows, has trained an average of two cardiology residents per period.

As a measure of teaching effectiveness for our Residency Program, evaluations from residents rotating in the lab on the one-45 system have been complimentary (these may be made available by the program directors). A recent verbal feedback for the Chief resident of the Core Cardiology Training Program stated that echocardiography at the Jewish is one of the best rotations of the Program. As a result, challenges, related to crowding, have arisen. We are working with the core program to ensure adequate resources for our trainees.

Summary

Strengths of the Program

Strengths of the program include:

• a strong faculty with a long tradition and commitment to teaching in echocardiography
• extensive physical and teaching resources that promote a culture of learning and synergy among various levels of training (residents and fellows)
• a high-volume laboratory that supports the minimum needed clinical exposure to achieve level III competency in this field
• a highly academic environment with weekly sub-specialty echocardiography rounds and ongoing original research by the teaching faculty in echocardiography
• Regular formal feed-back meetings have been provided on a quarterly basis

How to Apply

Please visit the McGill PGME Website for details