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Faculty of Health Sciences

Department of Medicine

Cardiology – Echo AFC Fellowship

ADVANCED ECHOCARDIOGRAPHY

Fellowship Program at McMaster

Welcome to the Advanced Echocardiography Fellowship at McMaster University. We are an accredited program with the Royal College of Physicians Surgeons of Canada (Area of Focused Competence) and successful applicants are eligible to receive a Diplomate certificate from RCPSC. During our comprehensive 12-month training, the successful applicant will achieve Level III competence in Echocardiography.

Welcome

This is a structured 12-month fellowship program designed to provide all aspects of echocardiography training. The combination of a high volume of cases, diverse pathology, dedicated staff, and structured teaching provide unparalleled learning environment.

Certification Outcome

The successful completion of the fellowship will grant a Fellowship McMaster Certification. The successful candidate is also eligible to receive Diplomate certificate from RCPSC (separate application process and fees apply).

Entry Requirements

Current entry requirements are as follows:

    1. Completion of Cardiology Training Program (or its equivalent after review of training certificates)
    2. The applicant must have achieved level II competence in echocardiography prior to applying
    3. Foreign candidates must fulfill all of the requirements put forth by the McMaster University Post Graduate Medical Education (PGME).

Application Deadline

Deadline for receipt of all material is 15 months prior to the anticipated start date.

Goals of Training

After completion, the trainee will achieve level III competence in echocardiography.

Length of Training

This is a 12-month (consecutive) training program.

Funding

There are two streams for applicants:

  • There are 2 internally funded spots which are funded through a fund created and contributed to by all echocardiography faculty.
  • There are 2 externally funded spots available. These include applicants that are sponsored by their Government or local Hospital.

Curriculum Highlights

A high volume of cases is seen daily across three of our academic sites. Trainees will spend ~6 months at the Hamilton General Hospital site, 5 months at the Juravinski Hospital and Cancer Centre site, and 1 month at the McMaster University Medical Centre site. Each of these echo labs will have a different patient population and hence exposure is enhanced across the training. There will also be a 1-month rotation in the cardiac operating rooms and the cath lab (structural heart disease) at the Hamilton General Hospital. The trainee will get a hands-on approach to intraoperative and intraprocedural evaluations and will work with cardiac anesthesiologists as well as experts in imaging within the structural heart disease program. During the 12 months, the trainee will surpass the requirements for level III certification in all areas (TTE interpretation, TEE performance, Stress echocardiography, and contrast echocardiography).

Expandable List

  1. Physics of ultrasound
  2. Principles of M-mode, 2D Echocardiography, and Doppler
  3. Pericardial effusion and Echo-guided pericardiocentesis
  4. Chamber Quantification
  5. Assessment of LV systolic function
  6. Assessment of LV diastolic function
  7. Aortic stenosis
  8. Aortic regurgitation
  9. Diseases of the aorta
  10. Mitral stenosis
  11. Mitral regurgitation
  12. Assessment of RV and pulmonary hypertension
  13. Introduction to TEE
  14. Infective Endocarditis and its complications
  15. Myocardial infarction and its complications
  16. Echocardiographic evaluation of cardiomyopathies
  17. Echocardiographic evaluation of prosthetic valves
  18. Echocardiographic assessment of pericardial constriction and restrictive cardiomyopathy
  19. Acyanotic congenital heart disease
  20. Cyanotic congenital heart disease
  21. Stress echocardiography
  22. Cardiac tumours, masses, and sources of emboli

Teaching format

  • Formal presentations to address fundamental topics in cardiac ultrasound
  • Presented by faculty and trainees (both cardiology residents and advanced echocardiography fellows) with faculty supervision

Weekly Thursdays

  • 13:15 – 14:30 (at HGH sites, video conferenced to all other sites)
  • All trainees will be expected to attend (either in person or via video-conferencing which is available to all sites). Fellows are protected from all clinical duties during this time.

Teaching format

  • Formal review and presentation of a peer-reviewed article
  • The trainee will be expected to critically appraise the paper regarding its methodology and comment if results appropriately support the purported findings
  • As a rule, articles will be chosen by the program director/faculty mentor in order to cover a range of important issues in cardiac ultrasound. However, trainees will be couraged to identify potential articles which may be chosen if deemed relevant after reviewing with faculty mentor.
  • The sessions will be meant to be very interactive. Discussion between the various staff and trainees will highlight recurrent methodological issues in how data is presented and analyzed as well as the applicability of findings.

Schedule

  • Once monthly Mondays 8-9 AM at HGH site
  • All trainees will be expected to attend (protected from clinical duties)

Teaching format

  • Trainees will review their research projects and feedback is provided
  • In the early phase of training, the emphasis will be on methodological aspects and project feasibility.
  • Later on during training, the emphasis will be on the review of initial data and its interpretation

Schedule

  • Once every 3 months, Mondays 8-9 AM at HGH site
  • All trainees will be expected to attend (protected from all clinical duties)

Teaching format

  • Trainees/faculty will identify and present cases that are felt to warrant further discussion
  • Cases will be chosen on the merit that they highlight specific technical nuances, address challenges in interpretation, or illustrate rare pathology.
  • Interactive discussion will be expected in a “question and answer” format

Schedule

  • Once to twice per month Mondays 8-9 AM at HGH site.
  • All trainees will be expected to attend in person and are protected from all clinical duties.
  1. Echo in Congenital Heart Disease I. Segmental Analysis.
  2. Echo in Congenital Heart Disease II. Simplex Defects.
  3. Echo in Congenital Heart Disease III. Complex Lesions.
  4. TEE in Structural Heart Disease Intervention.
  5. Intraoperative Echocardiography
  6. Echocardiographic assessment of Dyssynchrony
  7. Strain Echocardiography
  8. Setting up and managing an Echo lab
  9. Contrast Echocardiography
  10. 3D Echocardiography
  11. Advanced Hemodynamics. Part I.
  12. Advanced Hemodynamics. Part II.
  13. Advanced Stress Echocardiography.

Teaching format

  • Formal presentations to address advanced topics in cardiac ultrasound
  • Presented by faculty in a didactic format.
  • Copy of slides (PDF format) provided to fellows as part of the curriculum

Schedule

  • Once per month Mondays 8 – 9 a.m. at HGH site.
  • All trainees will be expected to attend in person and are protected from all clinical duties.

Teaching format

Challenging cases in both valvular and nonvalvular heart disease will be presented and discussed formally with cardiovascular surgeons, interventional cardiologists, non-invasive cardiologists, and Echocardiography faculty

Schedule

Fridays 8 – 9 a.m.

Teaching format

  • Formal QA/QI rounds for the HHS echocardiography labs
  • Chair of the QA/QI committee presents data from the preceding quarter and 3-4 cases will be discussed in detail to highlight important issues
  • During one of these sessions, the fellows will present the findings of their QA/QI project

Schedule

  • Quarterly on Wednesdays 8 – 9 a.m.
  • Host site rotates amongst all 3 sites however all rounds are video conferenced across the 3 sites.
  • All trainees will be expected to attend in person and are protected from all clinical duties.

Teaching format

  • At the beginning of the Fellowship, the trainee will be provided with an electronic folder containing PDFs of core articles in the field of echocardiography including all appropriate Guidelines. Specific articles that require mandatory reading will be identified.
  • The folder also contains lecture series and textbooks on cardiac imaging.
  • The list will be updated on a regular basis (annually or more frequently as key literature becomes available).

Schedule

  • Throughout the year as per the trainee’s own schedule

Supervision & Feedback

Trainees will have formal assessments on a quarterly basis. This includes ITERs as well as formal review and approval of procedure logs by the program director. There will also be a formal review meeting with the program director on a quarterly basis. There will also be 2 examinations during the year. These do not count towards a final “grade” however they do provide the trainee with areas of weakness that require additional attention.