Echo-Web.Com. Planning for Success in the Field of Echocardiography. Echo-Web Catalog and the iechoschool Curriculum

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1 Planning for Success in the Field of Echocardiography Echo-Web.Com Echo-Web Catalog and the iechoschool Curriculum Richard Keith H. Duncan, RDCS, RCS, RCIS, BBA

2 Contents The Echo-Web Course Catalog... 2 What is iechoschool?... 9 Course Summary How iechoschool Supports the Sonographer and Manager Understanding Echo-Web s Instructional Design Conclusion About The Author

3 Echo-Web and Echo-Web Sites Mission Our mission is simple: Provide a full offering of educational material to the learner in the field Provide a resource for cardiovascular professionals with the continuing medical education opportunities they need in a convenient and effective platform To provide physicians a resource for complying to their own professional requires for continuing medical education to meet the PRA Cat 1 CME requirements of the AMA To provide department managers the tools to enhance staff productivity, maintain compliance for accreditation, and a way to insure that the site is a cost-effective way for their hospital or clinics needs To become a partner in the medical professionals preparation to take the national registry examinations To partner with cardiovascular programs in providing their students another resource in their education, and their instructors with additional tools for their own instructional design projects To bring topics involving the growth of our field of cardiovascular medicine to the global world of the internet through any devices that take advantage of synchronous and asynchronous learning technologies And, to offer a Plan for Success in the Field of Echocardiography 2

4 The Echo-Web Course Catalog Echo Interactive Cardiac Anatomy This course reviews the structure and function of the heart. Areas covered are external and internal cardiac structures to include the chambers, vessels, valves, and coronary arteries. To be able to identify anatomical orientations, cardiac structures and their functions, and coronary anatomy in interactive style. Echo Clinical Evaluation of Valvular Heart Disease This course reviews the clinical skills needed to evaluate patients with acquired valvular problems. Areas covered are how conducting a medical history and physical exam helps determine how you can alter the echo examination to identify the patient's cardiac condition. To be able to identify various breathing problems, chest pain characteristics, levels of consciousness physical assessment of pulses, auscultation, and murmurs with brief descriptions of echocardiographic and cath data. Echo Basic Principles of Ultrasound This course reviews the most basic principles of ultrasound to include properties, definitions, and instrumentation needed to better understand the use of ultrasound in a medical setting for cardiac diagnosis. To be able to define principle characteristics of medical ultrasound to include the Doppler equation, types of echoes, principles, construction, artifacts, bioeffects and safety. Echo Benign Cardiac Tumors This course reviews six primary benign tumors that occur in the heart. Also covered are signs and symptoms associated with each and how to identify them using 2D echocardiography. To be able to identify nonmalignant primary cardiac tumors, signs and symptoms associated with them, and their physiologic makeup. Echo Electrophysiology and The Specialized Conduction System This course reviews the anatomy and physiology of the specialized conduction system and 3

5 accessory bypass tracts. Session includes interactive activities in identifying components, cellular depolarization processes, and bypass tract identification. To be able to identify the anatomy of the heart's conduction system, the components and their functions, the action potentials for pacemaker and non-pacemaker cells, accessory bypass tracts and currently accepted therapies for pre-excitation syndromes. Echo Digital Echocardiography This course reviews the current developments of digital echocardiography. Session includes activities in understanding digital components and instrumentation, digital processing, and the major technologies that are revolutionizing echocardiography. To be able to describe digital components and instrumentation, processing techniques, and how digital echocardiography has been developed and is used in the clinical setting. Echo The Cardiac Cycle Where It All Begins This course reviews the cardiac phases that make up the cardiac cycle. Session includes interactive activities in identifying components, waveforms, explanation of valvular function and normal hemodynamic values, and illustrations of how valvular abnormalities affect the hemodynamics of the heart. An intimate knowledge of the cardiac cycle is required to understand how color flow Doppler is used to determine valvular abnormalities. To be able to identify the phases of the heart's cyclic activity, the components and their functions, hemodynamic waveforms, normal hemodynamic values, and valvular abnormalities by examining hemodynamic waveforms. Echo 207 Fetal Echocardiography This course reviews current uses of fetal echocardiography and includes historical developments, indications, and prenatal findings, the fetal circulatory system, fetal cardiac anatomy, fetal cardiac abnormalities, and various views are covered. To be able to identify fetal circulation and cardiac anatomy, indications for fetal echo, and samples of fetal cardiac abnormalities. Echo Exercise Stress Testing & Stress Echo (2 credits) This course reviews exercise stress testing and includes blood pressure responses, methods of measurement, types, EKG changes, predictive values of EST and an introduction to Stress Echo. 4

6 To be able to identify indications, relative and absolute contraindications, blood pressure responses, methods of measurement, types, EKG changes, exercises in determining sensitivity and specificity and topics in the use of echocardiography in stress testing. Echo Clinical Evaluation of Cardiomyopathies This course reviews the clinical aspects of cardiomyopathies to include hypertrophic, dilated, and restrictive forms of the disease. Topics include clinical signs and symptoms, etiologies, and diagnostics of each form and additional information on identifying the various aspects collected in each state. To be able to identify cardiomyopathies based on medical history, signs and symptoms, physical exam, electrocardiography, and radiographic findings. Etiology of each form is presented and case studies are discussed. Echo Echocardiographic Evaluation of Prosthetic Valves This course reviews the echocardiographic aspects of prosthetic heart valves to include valve types, general appearances of valves using m-mode, 2D, and color flow Doppler in identification of valvular prosthesis. To be able to identify the various valve types, colorflow patterns, pulsed and continuous wave presentation, and characteristics of several prosthetic types. Case studies are discussed. Echo Heart Sounds and Murmurs This course reviews the steps needed to evaluate heart sounds, their creation, and meaning of sounds generated by the heart. Also included are abnormal heart sounds, their origin and meaning, and heart murmurs. Heart murmurs can assist in diagnosing conditions such as valvular disease. Actual sound files are found online. To be able to identify the normal heart sounds and their origins, the changes in sounds caused by certain disease states, and the generation and meaning of heart murmurs. Echo Lead Analysis This course reviews the steps needed to evaluate the EKG and patterns that suggest various disease states. Topics include steps to measuring the components of the EKG, patterns of infarction, how to calculate the axis and causes of axis deviation, identifying chamber enlargement and bundle branch blocks. To be able to evaluate the 12 lead EKG and identify normal and abnormal values. Also to be able to identify patterns of injury, ischemia, and infarction; calculate the axis using the tri-axial 5

7 system, determine the causes of axis deviation to include chamber enlargement and bundle branch blocks. Echo Identifying Rhythms This course reviews the steps to interpreting EKGs, and the more common forms of arrhythmias. Topics include sinus, atrial, junctional, ventricular rhythms and heart blocks. Most appropriate for experienced cardiac techs, intermediate and advanced echocardiographers with some previous background. To be able to identify the more common electrocardiographic rhythms, including sinus, atrial, junctional, ventricular rhythms and heart blocks based on description, rhythm, rate, P wave configuration, PRI and QRS. Echo 222-2D Tomographic Anatomy This course reviews the standard 2 dimensional echocardiographic views, anatomy, quality control criteria, and diagnosis obtainable from each view. There are 15 to 20 views that are discussed and the measurements performed in each view. To be able to identify standard echocardiographic views, anatomy, quality control criteria, and primary diagnosis obtainable from each view to include patient positioning, transducer positioning, beam angle, quality control criteria for standardization, and obtainable diagnosis. Echo Aortic Stenosis This course reviews the pathology of aortic valve stenosis and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced Echocardiographers. To be able to identify aortic valve stenosis by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Aortic Regurgitation This course reviews the pathology of aortic regurgitation and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced echocardiographers. To be able to identify aortic valve regurgitation by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath 6

8 Echo Mitral Stenosis This course reviews the pathology of mitral stenosis and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced echocardiographers. To be able to identify mitral stenosis by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Mitral Regurgitation This course reviews the pathology of Mitral Regurgitation and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and higher level professionals. To be able to identify Mitral Regurgitation by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Mitral Valve Prolapse This course reviews the pathology of Mitral Valve Prolapse and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and higher level professionals. To be able to identify Mitral Valve Prolapse by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Pulmonic Valve Disease This course reviews the pathology of pulmonic valve disease and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced echocardiographers. 7

9 To be able to identify pulmonic stenosis by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Tricuspid Valve Disease This course reviews the pathology of tricuspid valve disease and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced echocardiographers. To be able to identify tricuspid stenosis by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Hypertrophic Cardiomyopathies This course reviews the pathology of hypertrophic cardiomyopathies and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced echocardiographers. To be able to identify hypertrophic cardiomyopathies by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Dilated Cardiomyopathies This course reviews the pathology of dilated cardiomyopathies and the results of diagnostic testing indicating the condition. Topics include causes and medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced echocardiographers. To be able to identify dilated cardiomyopathies by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, echo and cath Echo Diseases of the Aorta This course reviews the pathology of aortic diseases and the results of diagnostic testing indicating multiple conditions. Topics include causes and medical history, signs and symptoms, 8

10 EKGs, palpation, auscultation, echo and cath Most appropriate for intermediate and advanced echocardiographers and vascular sonographers. To be able to identify diseases of the aorta by reviewing the results of diagnostic procedures to include medical history, signs and symptoms, EKGs, palpation, auscultation, and echo And more courses and activities to be developed thanks to the feedback from our subscribers. What is iechoschool? The program consists of all of the courses currently on the site available for awarding CME and new courses as they are approved are included in the curriculum. The program also uses exclusive materials to enhance the student s understanding and application of the content covered. The program is scheduled to be completed in 14 weeks, however, the pace is left up to the student. Weekly assignments are made to give the student a structural approach to learning, a sense of achievement, and a period to review the materials at their own convenience. The courses remain open for the student to use for up to 3 years in preparing for the national registries. The online meetings/webinars are encouraged but are not required. These meetings allow a review of progress, an opportunity to ask questions, offer suggestions on content like you are really in a classroom! The program includes documents helpful in preparing for the national exams and also standards guidelines developed by the registries and by the American Society of Echocardiography. Competency forms, patient log sheets, and guidelines are provided to record progress and completion of the stated objectives in the clinical setting. Worksheets are also included to provide the students the real-world performance of measurements and calculations in evaluation of cardiac disease. The program also includes The Echocardiographer s Pocket Reference, 4 th Edition and Cardiovascular Principles both by Terry Reynolds, RDCS. 9

11 Each week, it is encouraged for the students to use Echo-Web s diverse activities, like UDiagnoseIT, PopQuiz, and video presentations present on The EchoWeb s YouTube channel. Exclusive materials are available to the iechoschool Student not available to regular subscribers. A 200 question mock registry exam is assigned once the course materials have been completed. The exam currently includes an answer sheet for the student to identify areas needing review for the student to feel confident and ready to take the national registry examinations. The Mock Registry is being developed into a self-grading, self-identifying module that indicates the correct response on the exam and a link to the material the student should review. The Mock Registry can be taken at any time and as many times as needed as the student progresses to the national registries event marking them as meeting the qualifications of our national board examinations and recognized by their peers. A certificate of achievement is presented upon successful completion of the instructor-guided program and an Echo-Web T Shirt. Our Motto is We are with you from Day 1 to Registry. Course Summary Each course includes a 10 question exam based on the materials covered in each course. Echo 208 Exercise Stress Testing and Stress Echo is a 2 credit course and a 20 question exam. Each course post-test requires a passing grade of 70% in order to quality for successful completion and the certificate issued recognizing that the student has met the minimum requirements. Each post-test is self-grading and scoring results are available immediately after completion. If the student s score is below the 70 percentile, that student is notified after submission. The post tests may be taken as many times as the student desires. The courses may be attempted at any time and repeated as often as desired for the learner to feel comfortable with the material and appreciate the achievement in passing. Echo-Web courses have been developed with the national standards in mind. Both CCI and ARDMS areas of knowledge have been incorporated in the material and testing techniques. Echo-Web courses have been developed as a full multi-media and interactive experience to take advantage of the adult learners system of understanding and information integration. Courses include text, audio, video, interactive modules useful in modern instructional technologies. Statistics are collected on each course to evaluate their effectiveness in communicating the proper knowledge and skills for future modification of testing procedures and content. This is the method of content evaluation requested from any CME provider and follows the national standards of the Association of Colleges and Schools. The Echo-Web learning experience also includes videos posted on YouTube and onsite for the student to practice the skill of diagnosing cardiovascular pathology with real case studies. 10

12 How iechoschool Supports the Sonographer and Manager What is Provided: All courses on Echo-Web (including interpretive video sessions) Your personalized assignment page complete with assignments, course completion certificates, field specific documents, links to learning enhancement activities, and more as the site progresses as a global resource for echocardiographers Exclusive worksheets, documents, learning modules, and reference materials Weekly Instructor driven interactive chat sessions in webinar format for additional info and Q & A Your personal copy of Terry Reynolds' "Echocardiographers Pocket Reference, 4th Edition" which includes vascular topics and his "Cardiovascular Principles" A Mock Registry exam and personal analysis of areas you need to review as in preparation for taking the registries 25+ CME certificates and a Certificate of Completion A two year subscription until you are ready to apply for the registry An invitation to attend special webinars geared at learners by some of the clinical application specialists that are held high in esteem by their contribution to the field and willingness to teach various topics as optimization of the image, tips and tricks, and even rising new technologies And, your clinical preceptor receives an Echo-Web Subscription FREE! Overall Goals To be able to perform a full echocardiographic procedure To develop the knowledge and skills a professional sonographer must possess To support the department, staff, and sonographer in an effective learning experience for the student and the Preceptor To be prepared to take the registry examination (CCI/ARDMS) We are with you from Day 1 to Registry 11

13 Understanding Echo-Web s Instructional Design Teaching adults is vastly different from teaching children. Pedagogy is the method for teaching children using techniques that foster and communicate unique, first learned experiences. These concepts involve introducing the learner using clear and concise definitions for which future understanding will be built upon. Andragogy is the method of teaching more mature individuals who have a framework of understanding and building upon previous experiences to allow new knowledge to be gained by integrating those experiences with new information. Andragogic instruction is more about facilitating the material/concept model and basing it on previous knowledge. Instructional design for the more advanced learner is similar to the curriculum found in college programs. Breaking down the overall instructional goal into a series of progressive topics are models used for binding previous experience to new knowledge. Echo-Web was developed from the start with this concept in mind. Each Series describes the proper audience and learning objectives for that level. Note the examples that follow: The 100 series of courses are basic topics like general anatomy, cardiac anatomy, and other subjects based in identification of various structures and systems. SERIES 100 The 100 Level Series courses address basic knowledge and skills of cardiac medicine needed to advance to beginning skill level building in echocardiography. Courses include basic anatomy and physiology of the body, basic cardiac anatomy, basic electrocardiography, basic pharmacology, and basic cardiac life support. Presentation utilizes standard, animation, interactive and simulation methods to reinforce learning. Evaluation utilizes knowledge-recall and application-interpretation constructs to meet course objectives. The 200 series of courses are more advanced topics like clinical assessments of cardiac disease symptoms, ultrasound physics, and cardiac physiology, forms of cardiology procedures, to include stress testing, heart sounds, electrocardiography, and introductory courses on ultrasound imaging. These are areas that all cardiac professionals must use in performance of a thorough cardiovascular assessment. Series 200 The 200 Level Series address knowledge and skills of cardiac medicine needed to advance to entry level echocardiography. Courses include principles of ultrasound, echocardiographic tomography, standard cardiovascular diagnostic techniques, and clinical skills development. Presentation utilizes standard, animation, interactive and simulation methods to reinforce learning. Evaluation utilizes knowledge-recall and application-interpretation constructs to meet course objectives. 12

14 The 300 series of courses are disease specific topics to include valvular diseases, diseases of the cardiac muscle, and of the major vessels in a complete echocardiographic examination. These are areas that all cardiac professionals must use in performance of a thorough cardiovascular assessment. Series 300 The 300 Level Series address knowledge and skills of cardiac medicine needed to advance to clinical echocardiography. Courses include cardiac pathophysiology, diagnostic and interpretive skill building, clinical skills development, and advanced cardiac life support. Presentation utilizes standard, animation, interactive and simulation methods to reinforce learning. Evaluation utilizes knowledge-recall, application-interpretation, and simulation constructs to meet course objectives. The 350 and 400 series of courses are focused on congenital heart diseases and the Diagnostic Series that utilize all previous topics in building a complete understanding and interpretation of cardiovascular pathology. These are currently in development. Conclusion Echo-Web is continually making advances in course development, instructional design, implementation of new web technologies, and efforts to create a truly confident, professional echocardiographer. Echocardiography or Cardiac Sonography is an art. The highly skilled echocardiographer knows that each patient is different, each disease may be present singularly yet most are in combination, current signs and symptoms are important, how to use tips and tricks to properly obtain each view and follow medically required protocols, and it is up to the echocardiographer to investigate, evaluate, and document the progression of cardiovascular disease each time a patient presents themselves. A skilled echocardiographer employs all of their knowledge and skills to provide the best in patient medical care and to provide the cardiologist with the information to treat, intervene, and possibly cure the most important person, the patient. A real echocardiographer continues to grow in knowledge and skills and never, ever stops learning. 13

15 About The Author Richard Keith Howell Duncan has been in the field of cardiology since His experience as an orderly in a small county hospital witnessing a patient die in the ICU affected him. His interest in medicine would come later as he just started college and was not sure of his life s direction. He accompanied a friend to a US Army recruiter but had no plans to join the armed services. His interests included theater production, professional photography, computer programming, music, architectural design, marine biology, chemistry, and medicine. Joining the Armed Services did not seem to be foremost in his mind. The recruiter identified a Military Occupational Specialty (MOS) in cardiac technology offered by the US Army. He recounted that it took all of two minutes to make a commitment to take advantage of the opportunity and to serve the country in any capacity. After Basic Training, the next step was to attend the cardiac technician program at Fort Sam Houston in San Antonio, TX. His assignment would turn out to be at the military base nest to his hometown. Fort Rucker, AL is the US Army Center for Helicopter Flight Training and Rotary Wing Aviator. His next assignment was to attend the Cardiopulmonary Technology Program at the Naval School of Health Sciences. Upon completion, he was assigned to the Dwight D. Eisenhower Army Medical Center at Fort Gordon, Augusta, Georgia. Upon completing his service, he joined University Hospital in Augusta, GA, as the Lead Tech of the Cardiac Cath Lab. He brought his education to the staff and assisted training the small staff in the new therapies of anti-thrombolytic therapy, coronary angioplasty, and electrophysiology studies. As the staff and number of labs increased, he and some co-workers discussed the need to educate the growing number of hospital employees wishing to join the growing number of teams needed to operate a larger facility. This became a project to offer an organized educational system to offer the essentials for a cardiovascular technologist to provide the best possible care for the cardiac patient. He, with others, developed the Georgia Heart Institute School of Cardiovascular Technology in association with Augusta Technical College. His training there as an adjunct instructor provided him with the understanding of instructional design, teaching methodologies, and the recognition that the new technology known as the World Wide Web would be the most important development in facilitating a fully immersive and global experience. Echo-Web was born. Since that time, he has been involved in organizations like his election to the echo chair for Alliance of Cardiovascular Professionals, participation in local and national societies, proctor and member of the exam writing committee for Cardiovascular Credentialing International and holding many Registry Review Seminars across the nation. His web development skills were provided to the American Society of Echocardiography, Cardiovascular Credentialing international, the Society of Vascular Ultrasound, Pacific Vascular Institute and the collaboration on development of Vascular-Web. 14

16 He has obtained the Registered Cardiac Sonographer, Registered Diagnostic Cardiac Sonographer, Registered Invasive Specialist credentials and his bachelor s degree in Business Administration with a computer programming minor. He feels a medical professional should never stop learning and that meeting a challenge can be very rewarding. And, as an instructor, one must provide motivation, new techniques in learning, and make education an enjoyable experience. Rick is currently working on expanding the company s educational mission to include invasive, non-invasive, and electrocardiography websites as he says, These things are close to my heart. Pun intended. iechoschool is an extension of the mission of Echo-Web to provide an instructor-guided online program to help others in the medical field to cross-train and to prepare for the national registry examinations. He reminds everyone interested in joining iechoschool that all of us have been in the student s position before, a seemingly overwhelming amount of material and performance, but that it is developed in a college format where more advanced courses are based on the previous material. And, when any participant in his courses, lectures, registry reviews, or online education expresses doubt in their ability to absorb everything, he explains that it all quite simple, It s just plumbing and electricity and from that understanding we just go on learning how unique the cardiovascular system is and how fascinating the emerging technologies are. Final Words Rick wants to acknowledge everyone that has participated over the years in contributing their time and skills to make all of this happen, especially to close friends and colleagues. You guys are the BEST! 15