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Echo board studying tips

coloredcrayons

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Hi all,

Here’s some info I sent out to my fellowship for echo board studying which may be helpful for others. It's geared for initial certification not re-certificaiton

This isn't meant to be comprehensive and is just my own personal advice.

Also it’s not updated with the changing dates for the exam so just an FYI for that as well.

Studying timeline:
-Start studying by the latest in December, the months leading up to the exam can be very unpredictable, and people in prior years have had to withdraw from the test because they didn't have adequate available prep time the 2-3 months prior. This is especially true for anyone who might be a chief or might apply to EP or another subspecialty in June, the applications and the work required as a chief takes a lot of time and coincide with when you're supposed to be prepping for the exam.
-On that note, see if your chiefs can block the weekends prior to the exam so no third years have significant call and you have time to study

Study materials:

-Mayo echo videos, I'd recommend watching at least twice and taking notes (depending on how thorough you are with each pass, twice can be sufficient). This is the foundation of the exam review/prep and covers a lot of the material you should understand and memorize.

-Clinical Echocardiography Review: A self assessment tool. By Klein and Asher (second edition was the newest in 2019, not sure if a new edition came out in the last few months). I would recommend buying the book and not using a pirated PDF because once you buy the book it gives you online access to the questions in a "question bank" format so you don't have to constantly be flipping from question to answer. Also you need the online access to see the videos in the questions. Unfortunately, this book has errors which can be frustrating, but it still provides I think essential practice for the exam. I had an email chain with the people in my class so we could just FYI each other of errors we found in the book so it wouldn't trip the other people up also. Also, the book reviews some details that I thought were more than you needed to know, e.g. Table 15-1 shows cutoff values for the LV dyssynchrony assessment with Echo, memorizing those values would be unnecessary I think

-Of note, there's a handy appendix at the end of the Klein question book called "Equations and Formulas" that you should know. I felt that many of the equations could be derived based on your understanding of the physics and if you memorized some key values, but the exam can be stressful so you definitely need to have practiced using the equations via questions so you don't get locked up during the test.

-Physics handout (Edelman Basic Ultrasound Physics), aim to understand the ideas and also know the terminology they cover very well. I'd rec'd reviewing it before doing the Klein questions.

-Congenital handout (Pettersen Congenital Heart Disease Study Guide) is an excellent review. Again, I'd rec'd reading and studying this before the Klein questions.
-ASE Online Practice Exam Simulation: You should 100% review this exam and it's answers, I felt like it’s most representative of the actual exam and a significant portion of its material shows up on the test. ASCeXAM and ReASCE Exam Review Materials

-Echo guidelines, depending on how you study, some people read all the guidelines and some didn't read them all. At the bare minimum, you need to memorize the guidelines on mild-mod-severe criteria for valves and the criteria for intervening on valves (those flowcharts which are handily accessible via the ACC Guideline app)

Registration info:
The echo exam you'll be registering for is the: ASCeXAM (Home)
It looks like registration for the exam is now open, here are the relevant dates I found:

(this info has not been updated with all/any changes that have happened, I sent the email in sept 2019 so info below is old)

Early Registration Deadline: 12:00 PM (Noon) EST on January 15, 2020 Price: $995.00

Late Registration Deadline: 12:01 PM (Noon) EST on January 15, 2020 - April 1, 2020 Price: $1,195.00

Final Deadline: 12:00 PM (Noon) EST on April 1, 2020 NO EXCEPTIONS will be made beyond this deadline.

Exam Administration Date: Tuesday, July 28, 2020

-After registering, they'll send you an email with further instructions and then eventually send you an email saying you can reserve your spot at the testing center. I'd recommend registering early and reserving your testing center spot early so you have your choice of testing locations and time (morning vs afternoon).

Day of the Exam:
-I was personally rushed for time each block, the questions can be long and convoluted so keep a healthy pace when working through and mind the clock so you don't fall behind
-The exam tested more on whether you understood the concepts behind echo, than really on if you could simply read an echo. Because of this, I'd recommend gearing your studying for understanding all the concepts and equations you're presented with. Also the questions were phrased in a complicated way at times, as if they were testing if I could also understand their phrasing of the question and less if I just knew the answers. Overall it was an enjoyable exam though because they asked questions in new and thought provoking ways.

Other helpful material:
-Very good paper which explains tissue harmonic imaging and also pulse inversion (a concept not completely explained in the above material):
A Primer on the Physical Principles of Tissue Harmonic Imaging
https://pubs.rsna.org/doi/pdf/10.1148/rg.2015140338

-Good review on strain/strain rate imaging:
Strain and Strain Rate Imaging by Echocardiography – Basic Concepts and Clinical Applicability
Strain and Strain Rate Imaging by Echocardiography – Basic Concepts and Clinical Applicability



Examples of errors in Klein I had found to give you an idea:

-Chapter 8 question 39 figure 8-25A has the mitral inflow E velocity increasing with inspiration and decreasing with expiration, noting that this is typical in constriction. Pretty sure it's the opposite relationship.
referance: Respiratory maneuvers in echocardiography: a review of clinical applications (Respiratory maneuvers in echocardiography: a review of clinical applications)

On chapter 15, Q1, they talk about assessing LV dyssynchrony by M mode: the "septal to posterior wall motion delay" (viewed in the parasternal short axis view). They define it as the time delay between the systolic inward motion of the septum and LV posterior wall. The way they write it, it sounds like it's the time delay between the onset of systolic inward motion of the septum and posterior wall. But the figure shows the time delay between the peak contraction of the interventricular septum and posterior wall.
-Looking it up, it's supposed to be the peak contraction of the septum and LV posterior wall.
Reference:
Echocardiographic evaluation of cardiac dyssynchrony
Echocardiographic evaluation of cardiac dyssynchrony


Test results:
It seems like they tend to come out in mid to late September, results came back 9/16/19 this year, they send you an email with a link to check your results and your login info. They break down your performance by category and tell you what percentile you were in etc.
 
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6abeeb2020

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Just took my echo boards today.
I thought my prep was decent but the exam is extremely tough.
You had to know the specific papers they're asking about.
I could answer only 40-50% of the exam comfortably.

Anyone with similar experience?
 

SpyGuy

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Just took my echo boards today.
I thought my prep was decent but the exam is extremely tough.
You had to know the specific papers they're asking about.
I could answer only 40-50% of the exam comfortably.

Anyone with similar experience?

I just took the exam yesterday. BRUTAL.
I don't even know if more studying would have helped.
Some of the questions, I had no idea what they were trying to ask.
I'm just hoping I passed.
Truly depressing. :(
 

Sapien3

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Other helpful material:
-Very good paper which explains tissue harmonic imaging and also pulse inversion (a concept not completely explained in the above material):
A Primer on the Physical Principles of Tissue Harmonic Imaging
https://pubs.rsna.org/doi/pdf/10.1148/rg.2015140338

-Good review on strain/strain rate imaging:
Strain and Strain Rate Imaging by Echocardiography – Basic Concepts and Clinical Applicability
Strain and Strain Rate Imaging by Echocardiography – Basic Concepts and Clinical Applicability
Thank you! just downloaded these and will review.
 

drk

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Passed as well. Agree with Mayo videos and Klein. The Sorrell book was not worthwhile and actually more confusing.

Edelman Physics and Feigenbaum M-Mode article as well.

Would add that reviewing some of the guideline documents were pretty helpful as well.
 
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disorder

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Passed above median. 1 month dedicated. 1 month with full time work.
Mayo x1 with notes.
Klein x1.
Board vitals x2.
Congenital hand out
MMODE feigenbaum
Edelman physics
 
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Rocher

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I found the NBE practice exams to be the most helpful, followed by Board Vitals and the Mayo videos. I thought Klein had too many overly detailed questions that weren't that relevant on the actual exam, though ultimately it was helpful enough that I'd recommend it. The Edelman physics handout was plenty for the boards. I took notes on any concept I didn't understand well and snipped important figures into a Word document which I studied exclusively the week before the exam. I passed by a wide margin.
 

bostoncardio

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I am glad to have passed with a reasonable score. I was a bit scared after seeing how much everybody studied. The one guy who watched the Mayo videos 7 times really got me nervous.

Anyway, this is what I did:
  • Mayo videos x 1 - I did these at a slow pace, pausing frequently to give me time to think. This took me about 2 weeks.
  • EchoSAP x 1 - Not amazing, but acceptable. Many questions on the test were similar. I only did practice questions, not the modules.
  • Klein x 0.25 - I did the physics in Klein, and a smattering of other stuff, but not much of it.
I usually perform moderately well on exams, so my study schedule might not be sufficient for everyone. I think I did considerably less than most of my colleagues recommended, but that was mostly because I started working a full-time job and basically did not have time. In hindsight I would have completed Klein, reviewed the congenital handout, and maybe watched the Mayo videos more than once.

I hope people are pleased with their results and good luck to future test takers!
 
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mayn

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Passed with a surprisingly high score (90+ percentile) so I'll pass on my thoughts.

Nothing out of the ordinary in terms of preparation. Tried to not reinvent the wheel and stuck to Mayo videos, Klien, Edelman, and that ASE congenital packet. Cant go wrong with this material, just have to give yourself enough time to prepare.

I did watch some of the Mayo videos a couple times along with some ASE videos (prosthetic valves for example, though fantastic on Mayo videos was good to supplement using ASE).

Helps to be in a high echo/TEE volume program, but regardless of baseline echo exposure, the usual preparatory material definitely works.
 
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6abeeb2020

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Passed, 98th percentile.
I did Mayo and ASE videos and took notes,
Klein book and the ASE questions. I agree with the comments that some concepts in Klein can be an overkill but it is worth the time and the effort.
Skimmed through the guidelines while watching the videos.
The M-mode review by Feigenbaum is a must. For congenital the videos were more than enough, for physics Klein and Edelman notes are absolutely enough. I scored 90+% on both.
If you work/train in a lab that uses contrast/perfusion, the stress echo questions are going to be challenging. I feel some of the echo videos they used are from 15 years ago (no LVO/ no perfusion).
I just want to say I felt absolutely terrible after taking the exam, I am sure they took out a lot of the questions since I supposedly answered 88% correct.

Glad to be done,
Thank you guys for recommending these wonderful resources.
 
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thecalccobra

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Passed, 98th percentile.
I did Mayo and ASE videos and took notes,
Klein book and the ASE questions. I agree with the comments that some concepts in Klein can be an overkill but it is worth the time and the effort.
Skimmed through the guidelines while watching the videos.
The M-mode review by Feigenbaum is a must. For congenital the videos were more than enough, for physics Klein and Edelman notes are absolutely enough. I scored 90+% on both.
If you work/train in a lab that uses contrast/perfusion, the stress echo questions are going to be challenging. I feel some of the echo videos they used are from 15 years ago (no LVO/ no perfusion).
I just want to say I felt absolutely terrible after taking the exam, I am sure they took out a lot of the questions since I supposedly answered 88% correct.

Glad to be done,
Thank you guys for recommending these wonderful resources.

Thanks for sharing. Do you recommend a textbook, particularly to skim through 1st and 2nd year, or are videos + Klein enough?
 

House of Cards

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Thank you all for these useful information
Im preparing to start this week
but have 2 basic questions,
Is TOE & ICE included ?
& if included where to read them
I didnt get any ICE images and I dont think it is tested.

I did get more than few TEE questions. You dont really need to go too deep into it. Just know the basic views ( I read them from Toronto virtual TEE online) and do klein questions you should be good.
 

BMW M5

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Passed, 98th percentile.
I did Mayo and ASE videos and took notes,
Klein book and the ASE questions. I agree with the comments that some concepts in Klein can be an overkill but it is worth the time and the effort.
Skimmed through the guidelines while watching the videos.
The M-mode review by Feigenbaum is a must. For congenital the videos were more than enough, for physics Klein and Edelman notes are absolutely enough. I scored 90+% on both.
If you work/train in a lab that uses contrast/perfusion, the stress echo questions are going to be challenging. I feel some of the echo videos they used are from 15 years ago (no LVO/ no perfusion).
I just want to say I felt absolutely terrible after taking the exam, I am sure they took out a lot of the questions since I supposedly answered 88% correct.

Glad to be done,
Thank you guys for recommending these wonderful resources.
Can I ask how much you got on the ASE practice exam? And how far out from the exam?
 

Sapien3

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Everyone feels like **** after the exam.
sad i'm fine GIF by PlayStation

You Can Do It Love GIF by Sarah The Palmer
 
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aafisahar

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Any advice? 🙏🏼🙏🏼
Same as others, klein, mayo or ase, that congenital packet, feigenbaum M mode paper.

The reality is that it's a poorly designed test far removed from clinical practice. Echo boards reminds me of M1 and M2 exams where topics of little clinical importance was tested on solely because it was the pet project of some researcher who hasn't seen a patient in decades.
 
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Did you pass your boards? how long did you study for? And what materials helped the most?

Same as others, klein, mayo or ase, that congenital packet, feigenbaum M mode paper.

The reality is that it's a poorly designed test far removed from clinical practice. Echo boards reminds me of M1 and M2 exams where topics of little clinical importance was tested on solely because it was the pet project of some researcher who hasn't seen a patient in decades.
 

alternatego

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I failed the exam, passing score was 496, my score was 466 and % correct 59%.
I studied the Klein questions (except for Congenital which I regret not doing), the ASE qbank partially, and the ASE guidelines.

I memorized those formulas down cold, knew the valvular guidelines. I did watch ANY videos which was probably a big mistake.

All in all, I see this failure is an opportunity to improve given that my echo knowledge is not adequate and my program sucks at formal echo teaching in spite of being a big name NYC academic program. I'm passing this POS exam with high marks next year. Will be reading Feigenbaum and Otto in the meantime.
 

aafisahar

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Did you pass your boards? how long did you study for? And what materials helped the most?
passed, 80+% percentile. Honestly, the biggest help was doing as many questions as possible, including Klein and ASE. The mayo vids were high yield; I watched them about 1.5 times. Definitely got some free points from watching these vids alone. The ASE videos are okay, they seem to be more catered to recerts than new test takers. I only watched ~30-50% of them, mostly on topics I wasn't comfortable in.
 

KeepontheBeat

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Passed: 85 percentile 80% correct. Started watching Mayo videos and Klein casually about 2-3 months out. Used Klein as a learning tool and not as a self assessment, really studied all the concepts in this book. ASE practice exams (most comparable to exam) 1 month and 2 weeks out. Studied all the ASE exam concepts hardcore. Did a 2nd go at Klein and ASE exams non stop after that. Mixed in Mayo videos on concepts I needed improvement on. Felt like absolute garbage after the exam, pleasantly surprised after I found out my score.
 
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