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engineeredout

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Look forward to any feedback you guys have (in case end up taking it next year)
 

TKase

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Look forward to any feedback you guys have (in case end up taking it next year)
I thought it was a very difficult test but pretty fair. It was a bit longer than I thought it was going to be, and most of it had a CCM bent, though a few questions we're geared more towards cardiologists (at least as it seemed to me). I have heard that NBE exams in general are tough and passing rates can be as low 70%. Fingers crossed.
 

RemyMcswain

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Dang. That was a very difficult test. Caught me off guard. I honestly did not think I was going to be there for 4 hours. There were some very tricky, nuanced clinical vignettes. I liked the fact that the questions felt real and that they expect a lot out of the examinees. However, I would not be surprised if i didnt pass. If nothing else, I learned a ton of echo over the past couple of months.
 

TKase

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Dang. That was a very difficult test. Caught me off guard. I honestly did not think I was going to be there for 4 hours. There were some very tricky, nuanced clinical vignettes. I liked the fact that the questions felt real and that they expect a lot out of the examinees. However, I would not be surprised if i didnt pass. If nothing else, I learned a ton of echo over the past couple of months.
I feel the exact same. Best of luck to you!
 

psychbender

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I think they are going to have to set the bar pretty low to even achieve a 70% pass rate. I figured it would be like the Basic PTE, but with more of a TTE and critical care focus. Instead, it was a bit of a challenge, and I thought the Advanced PTE exam wasn't that difficult (****ty loops aside).

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TKase

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What'd you use to study?
I took the SCCM board review course and reviewed the on demand videos afterwords. The eMedical Academy also had a set of 250 review questions, which were especially good for physics. ASE guidelines are also useful.
 

SuperHiro

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I thought the exam was tough! This is NOT an exam for the lay POCUS person. They had a lot of advanced images and calculations. The only reason I think I was able to answer most of the questions was because I did a cardiac anesthesia fellowship and utilize TEE almost every day. I had a very strong ultrasound (TTE, lung, abdomen) training in my critical care fellowship (at least I thought i did) and there was no way I could've answered many on those questions on just that alone.
 
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Anyone who passed mind sharing us know how was the exam and what you used to study? Also, anyone planning to bill for critical care ultrasound?
 

bigdan

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1. I read from text called Critical Care Ultrasound by Philip Lumb. It was pretty good, but long, and I didn’t have time to read through all the cardiac topics.

2. I looked at the outline the NBE put out on the examination content; it’s on the website. I was austere but very useful. I simply Googled for most of the info and filled in the outline.

3. The test was fair for the topics the aforementioned outline listed. While it obviously tested echo knowledge, a considerable amount asked for management of cardiac pathology.

4. I don’t know if I’ll start billing for FOCUS just because of this exam; would do the limited TTE code if decide to.

If you have taken the PTEeXAM or ASCeXAM, I suspect the test will be straightforward. I suspect that those routinely doing focused echo and seeing cardiac pathology will find the exam straightforward.

Good luck! The minimum passing score was just over the 19th percentile for my exam cohort, so you don’t really have to “outrun the lion” here - just be faster than your slowest friend.
 
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kemper6036

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one of my partners who has his basic TEE boards failed it.

what are everyone's thoughts on the actual utility of taking this? meaning if you already have privileges to do critical care ultrasound/POCUS, what is the purpose here?
 

psychbender

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Right now, it's just a fancy piece of paper that says you passed the test. Maybe one day they'll flesh it out into a certification. Maybe, at some point, it'll become necessary at some hospitals to become credentialed to be able to perform bedside echo for the purpose of guiding therapy. Or, maybe it'll just stay a thing that you pay a bunch of money for the privilege of being able to say that you took it.

Regardless, I have it now, so if it becomes a real thing in the future, I my piece of paper says I'm official.
 
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bigdan

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kemper -

Sorry to hear about your partner's exam results. I am not sure what the utility is; several of my peers told me it was stupid to take the exam. It literally gives me nothing of benefit, other than another line on the resume. My practice has not changed. I'm not convinced the NBE is sure what the benefit of the exam is.

A big part of why I took it is because thought the first offering of a new exam offered the best shot at a high pass rate. If they ever make it so the intensivists "need" CC Echo certification (by way of hospital or insurance company policy), I'm now covered.
 

kemper6036

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Yeah i get all that, kind of was thinking the same thing. I was thinking that for my place, there are thoughts about considering a critical care fellowship and to kind of establish myself as the echo guy for that.

it seems like the high pass rate didn't pan out. glad you all had success.
 

combatwombat

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Has anyone looked into the requirements to become board certified in critical care echocardiography (i.e. the steps you have to take after passing the CCeEXAM)?

They want us to perform 150 "complete" echo exams, including a bunch of M-mode measurements that nobody will ever use. With each exam taking about half an hour, it's a huge time investment for something that still has no tangible benefit.
 

psychbender

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Has anyone looked into the requirements to become board certified in critical care echocardiography (i.e. the steps you have to take after passing the CCeEXAM)?

They want us to perform 150 "complete" echo exams, including a bunch of M-mode measurements that nobody will ever use. With each exam taking about half an hour, it's a huge time investment for something that still has no tangible benefit.
Exactly. Not allowing focused echoes is a crock. I think they just decreased people's interest in taking the exam in the future. According to my fellow procedure log, I had 116 TTEs in fellowship, but I didn't record how many were complete exams, versus focused exams (still all the standard views, but without tissue doppler, M-mode, or other doppler evaluation that want needed) to answer a question. Also, if exams are acquired at two institutions (say, fellowship and ones new job), are they going to pitch a fit that your current department head cannot attest to exams obtained in fellowship, necessitating multiple letters (of course, they won't tell you this until they deny the application a year after submission)?
 

vector2

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So for those of us who have already completed CC fellowship, we need to have logged 150 complete exams during fellowship and get that number signed off by our old director to get certified? LOL, I was considering taking the exam this January but Ima have to pass if there's not some easier method to grandfather people into certification
 

psychbender

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So for those of us who have already completed CC fellowship, we need to have logged 150 complete exams during fellowship and get that number signed off by our old director to get certified? LOL, I was considering taking the exam this January but Ima have to pass if there's not some easier method to grandfather people into certification
You can also get the 150 exams spread out over three years at your current job. You'll need a letter from your PD confirming that you completed fellowship, then a letter from a "supervisor" attesting to the number of exams you did. "A portion" of those exams must be over-read by the supervisor, who must be APTE or ASCE certified. With this pathway, you must also submit evidence of echo CME (20 hours?).
 

AdmiralChz

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For those pursuing any sort of certification with NBE, it almost always takes at least 12 months. I passed advanced TEE last year and only just last week was told my application was compete. To say they move at a glacial pace would be generous.

Because of this, very few institutions formally require certification in lieu of “eligibility”
 

Dam272

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So for those of us who have already completed CC fellowship, we need to have logged 150 complete exams during fellowship and get that number signed off by our old director to get certified? LOL, I was considering taking the exam this January but Ima have to pass if there's not some easier method to grandfather people into certification
Is this requirement only for IM-CCM? Or also Anesth-CCM fellowships?
 
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psychbender

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Any CCM fellowship-trained physician that wants to be certified has those minimums. Like I said, I think those requirements took some of the enthusiasm out of applying, or even taking the test.
 

Dam272

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Any CCM fellowship-trained physician that wants to be certified has those minimums. Like I said, I think those requirements took some of the enthusiasm out of applying, or even taking the test.
Does that certification mean anything in the real world? Meaning salary?
 

psychbender

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Does that certification mean anything in the real world? Meaning salary?
No, not really. In the foreseeable future, I doubt it will mean much of anything. At the moment, it's a shiny piece of paper attesting that you may know what you're talking about when you have a TTE probe on the chest of a critically ill patient. It is not tied to billing, nor do I think any hospital will require it for credentialing any time soon. It's a merit badge. However, I like echo, and when I have a suitable log, I'll submit a packet for certification and wait a year for the bloody committee to approve it, as I am presently doing for Advanced TEE.
 

crafted222

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When board certified in critical care echo, if the images are saved, and official report generated, one should be able to bill for it. One can even have echo techs acquire the images, as is commonly done by cardiologists.

Without billing tied to it, why do the exam.
 

logos

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I took it. I thought it was hard as hell but did pass. A few thoughts.

1. The SCCM review course was helpful but some of the talks were not relevant, I suspect that will get much better next year.

2. I used the book all the cards fellows use for their (reportedly even harder) test: Clinical Echocardiography Review - A self assessment tool".

3. Anything that you think is too complex and not relevant to POCUS - yes study it - it is probably on there unless it is explicitly left off (like stress echo). Think about it this way - there are a bunch of different people making the test with different interests. Cardiologists who may have an interest in making the test as difficult as possible, anesthesia people who have more TEE experience than TTE, echo people who want to focus on physics and views etc.

4. Do NOT ignore TEE. I had assumed that since TEE is not used for POCUS in any appreciable numbers (in the US anyway) that the TEE would be limited to a handful of very general type questions like "what view is this" - not so. There was way way way more TEE than I expected and it was integrated into real questions that I often would have been able to answer if the image was TTE but instead I was left trying to figure out what the heck I was looking at.

5. The physics was not hard

6. The certification requirements suck. If I had known they would be such a pain I might not have bothered taking the test to begin with.

7. Regarding the billing question - it takes a lot of infrastructure to bill directly for the exam - you need to generate a report, archive the images to a PACS system, and generate a bill. One of my sites has qpath which is tied into billing, PACS and the EMR which works great. Everywhere else I just put a description into my note and include any time I spent doing the echo into the critical care time. A limited echo does not bill for much anyway and this certification is not needed to bill for it - just the appropriate hospital privileges.

8. RE: does it mean anything? Maybe in 10 years. We will see. If it starts meaning something the first thing you will see is people using it for leadership positions - ultrasound directors etc. In general Emergency Medicine people have been the leaders in developing and advancing point of care ultrasound and have the only formal fellowships in it. The fact that very few EM people are embracing this route of substantiating POCUS experience is a very bad sign for this certification. I spoke with a handful of ED based ultrasound directors before taking this test and none were excited about it, none were taking it, and all of them sort of talked about the idea in general terms. No one totally discouraged taking it but they seemed to think of it on the level of POCUS certificate courses like the ones SCCM and ATS offer, which I think is significantly below what this pathway represents or should anyway.
 
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vector2

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Any CCM fellowship-trained physician that wants to be certified has those minimums. Like I said, I think those requirements took some of the enthusiasm out of applying, or even taking the test.
I call bs that most fellows met the certification req which includes completing 150 exams, all with ~14-16 comprehensive TTE views plus CFD and spectral doppler and the required measurements.....unless they were specifically doing so in order to get certified. I finished CC fellowship before I knew this exam existed and literally everyone used limited TTE in a POCUS fashion to answer a particular question, even in the CTICU. I saved my comprehensive exams for the 100+ TEEs I did in the OR...
 

logos

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Yep. That's the rub. 150 complete echos - all the views, doppler, diastology, measurements - the whole shebang. 150 POCUS echo would be no sweat - even if I had to start archiving images now. But a complete echo takes forever and is beyond the scope of what all but a very few people do in the ICU.
 

psychbender

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I call bs that most fellows met the certification req which includes completing 150 exams, all with ~14-16 comprehensive TTE views plus CFD and spectral doppler and the required measurements.....unless they were specifically doing so in order to get certified. I finished CC fellowship before I knew this exam existed and literally everyone used limited TTE in a POCUS fashion to answer a particular question, even in the CTICU. I saved my comprehensive exams for the 100+ TEEs I did in the OR...
That's what they drilled into the fellows in my class, so that's what we did. My PD had a good idea of what was coming, and he made it clear that he expected all of his fellows to pass the test, and obtain certification. I did a ton of POCUS exams as well, but did close to the required number of complete exams for practice (guessed they'd only require 100, logged 116). Unfortunately, I inadvertently deleted my detailed log (just have the 'complete TTE exam' box checked in my fellow log to keep track of numbers), so I doubt I'll get to count any from that year. My present job, likewise, doesn't really have a good way for me to store my bedside exams, and the device we have on the unit can't do a full exam with doppler, color, TDI in an efficient manner, so I'll likely not apply for certification. Bummer.
 
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Hi Guys, I just paid for the exam, I don't know where I should study, any advice will be highly appreciated
 

sylvanthus

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Well, I was thinking of going the certification route, but the 150 complete echos signed off by a supervisor who is certified is an impossibility. My supervisor is not certified, so guess I am hosed. Unfortunate requirement.
 

SuperHiro

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Literally just submitted everything for the next round of CCEeXAM certification. Getting those 150 echos was rough. i had to give up a bunch of my nonclinical days to echo. The CMes were easy enough. An ASE membership gives you access to 28.5 free echo based CMEs. Next meeting is early February, hope I get it!
 

logos

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Congrats on getting the 150!

If you don't mind:

1. What did you consider a "complete" transthoracic echo. Did you do color flow, doppler, diastology, all the measurements on each like a formal cardiology echo? or more like a bedside echo should be just all the images and maybe some CFD or doppler directed at answering a specific question?

2. Can you come back and let us know if you get it? I'm interested in knowing what they want in terms of "complete".

The definition of "complete" is just non-existent. I even emailed them to ask and the NBE staff basically said they don't know either.
 

Modanq

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Tough exam today. Not sure what neurology critical care, surgery critical care and pulm critical care folks thought about that exam. Much more geared towards cardiology and CV anesthesia CTICU folks. Very very heavy cardiac based.

Lots of mitral inflow, doppler, etc.
 
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Tough exam today. Not sure what neurology critical care, surgery critical care and pulm critical care folks thought about that exam. Much more geared towards cardiology and CV anesthesia CTICU folks. Very very heavy cardiac based.

Lots of mitral inflow, doppler, etc.
Agree but I think there was some focus on effects of ventilator on heart


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Took the Jan 2020 offering of the critical care echo boards. I thought the exam was very difficult but fair. It reminded me of the usmle step 1 exams in time management. There were many questions on heart lung interactions, echo images which mirrored the quality of ICU images, cardiology type questions requiring intimate knowledge of cardiac dimensions and “spot” diagnoses with limited history and a fair amount of hemodynamics equations. There was a large amount of echo physics and a smattering of congenital diseases. A tough exam, and as others have noted, one whose role in the critical care environment is still evolving. However the results pan out, i ended up learning a lot about echo in the past 6 weeks and plan to continue developing my skills
 
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