BASIC NBE Echo Exam study materials

[fittipaldi1of1]

Any recommendations on what to review? Not much information available..
Plan on read through the below:
-Board Stiff TEE
-Toronto TEE
-watching some PTEMasters videos

Anything else high yield? I understand this exam is pretty basic, but much of the study material is geared towards the advanced exam...

Thanks!

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[teacher2md]

Agreed— there aren’t many helpful resources for the basic.

Check out the content outline here(page 6)

https://echoboards.org/docs/2022-BasicPTE_Exam_App.pdf

I’m reading through Perrino and making notes, but it would be great to have some example questions.

 

[Katheudontas parateroumen]

Introduction to Transesophageal Echocardiography

This page describes the Introduction to Transesophageal Echocardiography content.

e-echocardiography.com

Using this

 

[teacher2md]

Introduction to Transesophageal Echocardiography

This page describes the Introduction to Transesophageal Echocardiography content.

e-echocardiography.com

Using this

Cool- I’ll check it out. Are you doing the iTEE or the eTEE content?

 

[Katheudontas parateroumen]

Cool- I’ll check it out. Are you doing the iTEE or the eTEE content?

Just iTEE for basic.

 

[fittipaldi1of1]

Just iTEE for basic.

Have you taken it yet? Or taking it soon?

 

[shepardsun]

Would love to get a sense from people who have taken this how hard one needs to study for it. Like spanish class in high school, I didn't take my TEE time on cardiac rotations in residency seriously (hard to be excited about something after you've gotten up at the crack of dawn and spent two hours setting up the damn room) and am now regretting it. I've been doing some reading and taking the "basic exam" test on PTEMasters but don't know how relevant all of the hardcore ultrasound physics and congenital heart embryology is to the basic exam. Can somebody tell me how hard it is on a scale from 1 to 10 where 1 is the TEE views on the ABA OSCE and 10 is the advanced PTeE exam?

 

[vector2]

Would love to get a sense from people who have taken this how hard one needs to study for it. Like spanish class in high school, I didn't take my TEE time on cardiac rotations in residency seriously (hard to be excited about something after you've gotten up at the crack of dawn and spent two hours setting up the damn room) and am now regretting it. I've been doing some reading and taking the "basic exam" test on PTEMasters but don't know how relevant all of the hardcore ultrasound physics and congenital heart embryology is to the basic exam. Can somebody tell me how hard it is on a scale from 1 to 10 where 1 is the TEE views on the ABA OSCE and 10 is the advanced PTeE exam?

My understanding from people who have taken it is that it's like a 3 or 4 on that scale

 

[Radar26]

This is just from personal experience but a lot of this sounds like overkill honestly. A lot of the books mentioned require considerable background knowledge and time investment to get any benefit out of them (I.e like for fellows who have an entire dedicated year to this stuff).

I took the basic as a resident before I knew I was going into CT fellowship. Here is how I studied for it.

I really focused on the ASE’s guidelines for the basic exam. Like memorized the thing.

https://www.asecho.org/wp-content/uploads/2013/05/Basic-Perioperative-TEE-Exam.pdf

I used U of Utah’s website to practice assessing regional wall motion abnormalities.

Where's the Lesion? - Echocardiography and Perioperative Ultrasound

Echocardiography and Perioperative Ultrasound

echo.anesthesia.med.utah.edu

That’s it. Didn’t read a single book. Didn’t watch PTE masters. Studied like 2 weeks for the test during residency. Passed no problem.

The advanced is a totally different story, but the basic exam is… well… basic. Looking back, the exam is testing you to make sure you have the knowledge to be able to perform a basic exam with basic interpretations-which what “they” consider basic is written in their guidelines (listed above). If you have more time and are interested in the stuff then go hog wild, but to pass the test that was all I needed.

 

[shepardsun]

very helpful, thanks a ton!

 

[Katheudontas parateroumen]

Good luck tomorrow

 

[ToKingdomCome]

I’m in ICU fellowship and want to get basic cert. I feel like it’s going to be tough to get the required numbers. Any suggestions ?

 

[teacher2md]

What did you guys think?

Overall I thought it was a fair test. A few random topics like carotid artery velocities, but mostly stuff I was expecting.

 

[Katheudontas parateroumen]

Same very fair. I thought those carotid stuff was random too. But could have studied more. basically bought all these resources and ended up not even using them really because fellowship got too busy.

In my opinion, i think youll need more than just the NBE basic outline paper to do well/pass. Maybe the test has changed over the years.

 

[shepardsun]

Yeah, would agree with above. I think I did okay but definitely more of a focus on things like physics and doppler profiles than I was anticipating. Also could have studied more. I have Maus' book Essential Echocardiography for Non-Cardiac Anesthesiologists and I didn't make it anywhere near through the entire text but that was written to basically cover everything on the test and if you spent a few months going through it you'd probably ace it. For future reference because I didn't see the information anywhere else before the test, it's 150 questions broken into three blocks with four total hours to do it.

 

[nimbus]

Same very fair. I thought those carotid stuff was random too. But could have studied more. basically bought all these resources and ended up not even using them really because fellowship got too busy.

In my opinion, i think youll need more than just the NBE basic outline paper to do well/pass. Maybe the test has changed over the years.

I attended a POCUS course a few years ago and one of the instructors was all over measuring carotid velocities. The hope was that carotid artery VTI would be a quick and dirty surrogate for LVOT VTI. Turns out it does not correlate very well.

Efficacy of Left Ventricular Outflow Tract and Carotid Artery Velocity Time Integral as Predictors of Fluid Responsiveness in Patients with Sepsis and Septic Shock

Background: Transthoracic echocardiography is a reliable method to measure a dynamic change in left ventricular outflow tract velocity time integral (LVOTVTI) and stroke volume (SV) in response to passive leg raising (PLR) and can predict fluid responsiveness ...

www.ncbi.nlm.nih.gov

 

[pocafx]

Actually loging 150 echo is near impossible

 

[teacher2md]

In the weeks prior I thought I over-prepared but now I'm glad that I did. I think the content on e-echocardiography was good.

For future reference, the general topics that I remember were:

-Relative and absolute contraindications to TEE
-Be very familiar with all 20 views. Only knowing the ‘basic’ views would definitely not be sufficient.
-Anatomy: Obvious things (e.g ASD vs PFO) and down to granular levels, (e.g. recognize a false tendon)
-Identifying hypokinetic/akinetic/dyskinetic segments and the corresponding coronary artery
-Plenty of calculating valve gradients given the doppler signal, quantifying the severity of AS/MS.
-Recognize etiology of MS/MR and AS/AI based on image
-Recognizing tamponade physiology
-Determine fluid status
-Calculating CO given VTI tracing, etc.
-Identifying aortic pathologies (Eg dissections, aneurysm, and atheromas)
-pulmonary pathologies (E.g pleural effusion)
-Using Bernoulli and continuity equations
-A fair amount of ultrasound physics

Hopefully this is a good outline for future test-takers.

 

[ToKingdomCome]

Actually loging 150 echo is near impossible

Why do you say this

 

[shepardsun]

Why do you say this

It's challenging outside of a dedicated fellowship for those already out of residency, given that 50 of them need to be personally performed. I'm at a large academic center where the cardiac rooms are already full as it is with fellows, residents, and medical students. As a generalist it's tough to A. find the time to make the case starts and B. ask to be proctored for something that is totally elective and not within my formal wheelhouse.

 

[pocafx]

Why do you say this

I asked for cardiac cases in residency and maybe did 60. 15 days a month of echo rotation. 2 studies a day. =30. 2 months of echo =60. This gets you to 120 logged cases. I’d like to hear how people in residency got 150 echos. And I was at a place that let me do nothing but echo for 2 months. I don’t see other places let someone not be responsible for an OR for so many days

 

[teacher2md]

To get basic certification, you need to have performed 50 echoes under supervision. The remaining 100 echoes that you interpret can be done with a supervisor, or can be done through the ASA/SCA course online on your own time.

On page 5, the "Extended CME Pathway" https://echoboards.org/docs/BasicPTE_Cert_App-2021.pdf

 

[pocafx]

I missed that. I saw the footnote that practice experience pathway is not available to those graduating after 2016. I guess I could go for the extended CME pathway this year. Id have to do 25 echos this year at work.

 

[Katheudontas parateroumen]

When do these results come out?? Been about 10 weeks now

 

[fittipaldi1of1]

Yah I’m wondering the same. Today is 10 weeks for me

 

[Katheudontas parateroumen]

Results are up! Passed! The road to basic certification is quite confusing. I just graduated ICU fellowship, I have 50+ personally done TEEs between my residency and fellowship time and I did the ASA/SCA course for 100+ cases. I believe that's what's needed for that extended CME pathway. I'm not sure if I need a letter from both my residency and ICU fellowship program directors because those 50 TEEs performed were between residency/fellowship? Also doesn't appear that extended CME pathway needs to submit a case log, only the PD letter?

 

[teacher2md]

You may need a letter from both. One thing that’s weird is that the requirements say no fewer than 25 exams performed in any of the years for which you are counting exams. So if I’m reading this correctly, if you did 20 in CA3 year and 30 in fellowship, those 20 may not count..

 

[vector2]

Results are up! Passed! The road to basic certification is quite confusing. I just graduated ICU fellowship, I have 50+ personally done TEEs between my residency and fellowship time and I did the ASA/SCA course for 100+ cases. I believe that's what's needed for that extended CME pathway. I'm not sure if I need a letter from both my residency and ICU fellowship program directors because those 50 TEEs performed were between residency/fellowship? Also doesn't appear that extended CME pathway needs to submit a case log, only the PD letter?

Do you know the rules and/or bylaws at the hospital(s) you work at vis a vis privileging for inserting the TEE probe, performing and billing for studies, etc?

 

[shepardsun]

Passed. Based on the scaled score breakdowns and minimum passing score it looks like there was an overall pass rate of 92%.

 

[teacher2md]

Man, people did really well on this test. I got 85% correct raw score, and was only in the ~70th percentile.

 

[Katheudontas parateroumen]

Do you know the rules and/or bylaws at the hospital(s) you work at vis a vis privileging for inserting the TEE probe, performing and billing for studies, etc?

Credentialed to use/ perform intraop TEE. Not sure about billing. This would only be for rescue purposes most likely and on the rare occasion monitoring. No cardiac, transplants, or aortic cases at my place.

 

[nimbus]

Credentialed to use/ perform intraop TEE. Not sure about billing. This would only be for rescue purposes most likely and on the rare occasion monitoring. No cardiac, transplants, or aortic cases at my place.

AFAIK anybody can dictate a report and bill. Nobody is checking echo board status. Just like non-board certified anesthesiologists can make a living, so can non board certified echocardiographers. In fact, the cardiologist who is director the echo lab at our hospital is not NBE certified. Im sure he collects for his thousands of reads. I’m an advanced testamur but not certified and have had no problems collecting. The NBE certification process takes time. People aren’t reading echos for free before they become certified.

Hospital privileging is determined by the chief of anesthesia who is often your buddy.

 

[vector2]

Credentialed to use/ perform intraop TEE. Not sure about billing. This would only be for rescue purposes most likely and on the rare occasion monitoring. No cardiac, transplants, or aortic cases at my place.

The reason I'm asking is because the hoop jumping to get the NBE cert may not be worth it if being certified vs testamur makes absolutely no difference to your hospital privileges. This is especially true if we're talking about basic for rescue/monitoring vs advanced for cardiac surgery.

 

[fittipaldi1of1]

The reason I'm asking is because the hoop jumping to get the NBE cert may not be worth it if being certified vs testamur makes absolutely no difference to your hospital privileges. This is especially true if we're talking about basic for rescue/monitoring vs advanced for cardiac surgery.

I have no intentions of becoming certified in basic echo.. the piece of paper showing I passed is already next to useless, but at least I have it now

 

[psychbender]

The reason I'm asking is because the hoop jumping to get the NBE cert may not be worth it if being certified vs testamur makes absolutely no difference to your hospital privileges. This is especially true if we're talking about basic for rescue/monitoring vs advanced for cardiac surgery.

Indeed, NBE is incredibly painful to deal with. I became Basic certified right out of residency, then an Advanced testamur just a couple of years later. My certification will expire in another year, and they're insisting I take both exams to maintain basic cert/advanced testamur status. This is after they said they would count my CCM fellowship to allow for Advanced certification, then changed their minds when I actually submitted my packet, with letters attesting to everything they stated they'd require. My hospital does not require anything for credentialing, so I'm going to drop the certification and just maintain Advanced testamur status, and likely drop my worthless NBE Critical Care Echo testamur status as well.