I appreciate the response by Jacob et al to my editorial published recently in Revista Española de Cardiología1 on echocardiographic training for noncardiologists. Their letter is a clear demonstration of the need to regulate the practice of echocardiography by nonspecalists, as well as the training these noncardiologists should receive and the scope of their echocardiographic studies. This needs to be done as soon as possible to ensure that the training for each particular need does not descend into chaos and that the physician acquires the necessary knowledge to attain competence in an orderly fashion.
As emergency physicians, the authors have identified a problem (the need for echocardiographic training) and have attempted to solve it as best they could with an empirical approach. In the absence of current guidelines, they decided, in agreement with cardiologist colleagues, on the number of hours of training, the scope of training, and the specific skills needed to record an echocardiogram in their specific area. And they did this because there were no regulations or established levels of competence required for their daily practice.
Without doubt, things should be different, and they should not need to take the initiative themselves. Rather, our Society, through its Imaging Working Group and based on experience, should provide training guidance according to the different needs, as I proposed in my editorial. I recommend the autors carefully read an attractive, and in my opinion, fantastic proposal from the influential Italian Society of Echocardiography,2 which reclassifies the definition of echocardiography according to different levels of training, competency, and use. The society defines 4 types of use of echocardiography, which require completely different training, competencies, and application. The first is the basic level (ultrasound for initial diagnosis, determining the extent of disease, and examination). The second is general echocardiography (transthoracic echocardiography, transesophageal echocardiography, stress tests, and 3-dimensional echocardiography). The third type is application of echocardiography in specific situations (intraoperative, catheterization laboratory, coronary artery disease unit, critical care unit). Finally, there is the application in the emergency room, with echocardiography performed on admission of the patient to the emergency room or out-of-hospital in an emergency situation. Obviously, each level is regulated with homogeneous training to obtain appropriate competency in each case.
To ensure a rational use of echocardiography and so to provide the best care we can for our patients, I suggest that the Spanish Society of Cardiology take up the challenge and establish training criteria according to the needs of each specific area of use, with particular attention to uses outside the cardiology department.