Echocardiography – Cardiac ultrasound to answer a variety of clinical questions either as a point of care ultrasound skill or for departmental studies
Ask an expert:
My name is Craig Prescott and I am a Consultant Acute Physician working at University Hospitals Dorset on the sunny South Coast of England. If I’m not working I’ll probably be out of the country somewhere, according to my colleagues anyhow!
I studied at Barts and the London School of Medicine and Dentistry, qualifying in 2004 and completed a variety of posts before spending 2 years in Sydney. I returned to the UK in 2010 to complete Acute Medicine training in Wessex. I have been working as a Consultant since 2015 and I am also one of the Foundation Programme Directors for UHD.
What got you interested in echocardiography?
During my medical SHO rotations I worked with a Consultant Cardiologist who encouraged me to learn echocardiography. When I returned to Wessex to complete ACM training the same cardiologist further encouraged me and I took up echo as my specialist skill as part of training. I enjoyed the different pace of an echo clinic and the different focus of the interaction with patients. I had always enjoyed diagnostics and indeed had considered a career in radiology for a (very brief) time. The different pace and being able to use ultrasound to add to my clinical skills certainly appealed to me.
How did you train in echocardiography?
When I commenced echo training there were a couple of other Acute Medicine trainees completing the accreditation. Previously the accreditation for echo as a specialist skill was with the British Society of Echocardiography and I commenced this training pathway. An opportunity arose for me to expand my skillset and I went on to train in stress echocardiography within the UHD echo department.
Were there any challenges?
BSE Accreditation was challenging and it is much more appropriate that ACM trainees now do FUSIC Heart for accreditation. Availability of ultrasound machines is also a challenge due to the in intial cost and subsequent upkeep particularly in the current climate of lack of NHS funding. As FAMUS is compulsory now it will mean that ACM trainees will need access to ultrasound but beware that the machines used for FAMUS may not have an echo probe (they are different!)
How does/will this fit into your consultant working?
This training has allowed me to take on a weekly list in stress echo and also allowed for diagnostic follow up of patients presenting with chest pain to the medical take or SDEC. I use point of care ultrasound in some form in most shifts and being able to do bedside echo in the SDEC setting allows rapid safe discharge of appropriate patients. It has also allowed me to take on a role as mentor for FUSIC and I have subsequently expanded my ultrasound portfolio by training in FAMUS, for which I am also a mentor.
Do you have any tips for trainees who may be interested in echocardiography?
I think my pathway for training in echo and subsequently stress echo has been relatively unique. Training in echo will take time but bolts on nicely to the compulsory skill of FAMUS. I would engage the cardiac physiologists for their help in your training as they do more echo studies than anyone else. They will be able to help you gain the skill of obtaining good images, which is always tricky when they can be dependent on body habitus and underlying comorbidities as well as trying to get a picture of the heart whilst avoiding ribs and lungs! Did I mention that the pictures are upside down and back to front and they move with breathing?! It is a challenging skill but ultimately rewarding and I have been very lucky to have been working in a supportive region with an incredible cardiology team. If you have any queries please do get in touch.
