In April 2023, a team from King’s College Hospital, led by Dr Richard Fisher, published Serial image interpretation tasks improve accuracy and increase confidence in Level 1 echocardiography reporting: a pilot study in Echo Research and Practice. Their study demonstrated the validity of an approach proposed to the British Society of Echocardiography (BSE) Advisory Council; namely, a Level 1 Library to provide a self-learning opportunity to all of those involved in emergency echo, particularly from backgrounds in emergency and acute medicine, intensive care medicine or anaesthesia.
There has been a rapid expansion in use of echocardiography in acutely unwell patients in the last five to ten years and Point-Of-Care UltraSound (POCUS) is increasingly a component of postgraduate training curricula. Competence in emergency echocardiography can be demonstrated via a number of accreditation processes, including BSE Level 1. However, access to face-to-face training continues to be a barrier and contributes to geographical disparity in the availability of emergency echo (as shown in the 2024 NEAT-ECHO study to which the BSE contributed). The King’s College team’s study determined that serial image interpretation tasks as a distinct learning tool improved novice echocardiographers’ ability to accurately identify potentially life-threatening pathology from focused scans and paved the way for BSE’s Level 1 Library.
The Library contains 150 real-world Level 1 echocardiograms, each enabling the user to generate a report using the Level 1 reporting template and then providing feedback on performance with a suggested ‘ideal’ answer, a short commentary. The first 30 cases can be accessed free of charge. Once the first 30 cases have been completed, a further 120 cases can be accessed for a fee of £50 for BSE members and £70 for non-members. There is no time limit on completion (those wishing to use as self-reported CPD activity may have institutional requirements).
Importantly, the Library does not replace the L1 accreditation pathway as a marker of competence. The intention is to help learners work towards the expressed purpose of Level 1: [the ability to rule in] life-threatening and immediately reversible pathology in a time frame appropriate to the acute emergency patient. The average user may come from any acute specialty and will usually have done no previous echocardiography.
An additional benefit of the BSE Level 1 Library is that it provides data to inform understanding about the process of acquisition of image interpretation skills and the relationship between confidence in reporting and accuracy. These may contribute to future developments in education and accreditation processes.
Dr Jennifer Gosling, one of the developers of the Library said, “We hope that the Library will be useful to a wide range of learners interested in emergency echo and, most importantly, translate into benefit for many acutely unwell patients.”
The BSE would like to thank Dr Richard Fisher and Dr Jennifer Gosling for their tireless work on this project and King’s College Hospital NHS Foundation Trust for their collaboration.
Professor Dan Augustine, President of the BSE, said: “This initiative marks an important milestone in our efforts to reduce geographical inequality in emergency echo training. By making high-quality cases available to all, wherever they work, the Level 1 Library ensures that every clinician has the opportunity to build essential skills that can help to improve outcomes in acutely unwell patients.”
The Level 1 Library is now available at the link below.
Access the Level 1 library