About time: Echocardiography update in UK intensive care curriculum

There is growing, albeit still limited, evidence supporting the use of focused echocardiography in intensive care to improve patient outcomes.^1,2 The infrastructure for echocardiography in intensive care units (ICUs) has also significantly advanced, with many units now equipped with multiple echo-capable machines and trained mentors. ³ However, access remains inconsistent with a lack of 24/7 availability and many residents struggle to obtain training. With many having to seek training outside of scheduled work hours not everyone is able to participate, which raises significant concerns around equal opportunity. Notably, access to focused echocardiography was identified as the most requested curriculum change in the most recent Faculty of Intensive Care Medicine (FICM) Intensivists in Training Survey. ⁴

The integration of modern technologies into UK medical curricula has been slow and inconsistent. ⁵ There is a chicken and egg circular discussion about not mandating skills in the curriculum that cannot be delivered, which then are not delivered as they are not mandated in the curriculum. In contrast, emergency and acute medicine have explicitly included echocardiography in their training programmes. While initial implementation challenges arose, education delivery has steadily improved over time. The European “Competency-Based Training in Intensive Care Medicine in Europe” (CoBaTrICE), which the UK intensive care curriculum is based on, was updated in 2022 to include ultrasound of the heart, lung, abdomen, and vascular system as core competencies. ⁶

The UK intensive care curriculum does not mandate proficiency in any specific procedural skill. For example, there is no requirement to be competent in central or arterial line placement by the end of training. By the same provision any skill can be learnt within the curriculum, such as echocardiography. However, that has not led to the consistent delivery of ultrasound training to those who want it.

After a concerted effort over the past years by the FICM intensivist in training committee, a compromise was achieved and update to the UK curriculum has been requested to the General Medical Council. ⁴ The revised High Level Learning Outcome (HiLLO) 6 key descriptor will emphasise the performance and interpretation of “point-of-care ultrasound.” This change represents a crucial step towards making echocardiography and ultrasound training accessible to all intensivists in training who wish to acquire the skill.

Importantly, the acquisition of echocardiography skills can follow the same pathways as other ICU procedures, such as central line placement, and be assessed through standardised evaluations like directly observed procedural assessments (DOPs). There are many excellent courses delivered to focus the learning into a structured system however these are not mandatory and form one of many ways of achieving the same capability.

The evolution of ultrasound integration into intensive care training offers valuable lessons. As medicine continues to advance at a rapid pace, education must keep pace with innovation. While balancing evidence-based practice and financial considerations remains essential, our goal should be to ensure that intensive care medicine education in the UK remains at the forefront of innovation and excellence.

Waqas Akhtar Guy’s & St Thomas’ NHS Foundation Trust, London, UK