Exam Preparation

You are probably at this site wondering how to go about preparing for Certification in ACCE. 

The following are recommendations based on my experience preparing for the examination and based on discussions with other experts in the field that have already acheived Testamur status with the NBE Examination of Special Competence in Adult Echocardiography prior to the availability of this examination.

Please note that I have no financial relationships to any of the entities recommended in this section. I do teach critical care ultrasonography with CHEST. Some of the links will take you directly to Amazon.com to purchase - I do receive a small incentive fee if you purchase. If you plan on purchasing a resource mentioned here I would appreciate it if you did through the provided links as this income can help offset the cost of maintaining this website.

1. Exhaustive study of the relevant chapters from a standard textbook of cardiology echocardiography. These would be defined by the topic list released by the NBE. The depth of knowledge related to these topics should be similar that of the graduating cardiology fellow, i.e. completely comprehensive.

 

There are many very well written textbooks on cardiology echocardiography. Some of the encyclopedic texts are quite costly. A cost efficient approach is to purchase a high quality but shorter review of the field and supplement it with a text that has a collection of questions. A good starting point would be the Textbook of Clinical Echocardiography by Catherine M. Otto. I had been using this book prior to preparing for the examination, but it served as the primary textbook for my board preparation. For  those who like having a definitive reference text as well, The Echo Manual by Jae K. Oh and Feigenbaum's Echocardiography by Armstrong and Ryan fit that bill.

For those planning on taking this examination that are not coming from a strong background in general critical care ultrasonography (i.e. lung ultrasonography, pleural ultrasonography, lower extremity DVT study, abdominal ultrasonography - i.e. FAST exam, identifying hydronephrosis, AAA, etc) review of a general critical care ultrasonography textbook is recommended. There are many resources available. I am personally familiar with and endorse the following texts in no particular order. Note that one text is enough for the uninitiated and if you already know this stuff then just focus on the advanced echocardiography material and make sure to hit some of the general journal articles in the reading list.

- Critical Care Ultrasonography, 2nd Edition by Levitov, Mayo, Slonim.

- Oxford Textbook of Advanced Critical Care Echocardiography, 1st Edition by McLean, Huang, Hilton. 

- Point of Care Ultrasound, 2nd Edition by Soni, Arntfield, Kory

- Whole Body Ultrasonography in the Critically Ill by Daniel A. Lichtenstein.

2. Review of definitive set(s) of practice questions that include image interpretation and clinical applications of ACCE. Unfortunately, no ACCE specific question set exists to date.

 

- A popular cardiology review that should be considered is Clinical Echocardiography Review: A Self-Assessment Tool by Allan L. Klein and Craig R. Asher. I found this resource to be excellent although at times overly comprehensive for the purposes of this examination. The book also comes with a digital access which was the main way that I interacted with the contact. The content is broken down into logical content areas making it easy to skip sections that obviously are not relevant to this examination.

- Another cardiology question-based review book to consider is Echocardiography Board Review by Ramdas G. Pai and Padmini Varadarajan

- Physics is an important component of this examination and an understanding beyond that of a single chapter in an echocardiography textbook is recommended. An excellent and succinct review and question book that focuses on ultrasonography physics is "Ultrasound Physics" by Sidney K. Edelman, Ph.D. This is a 44 page book with questions at the end of each chapter. I have reached out to Dr. Edelman to find out how this resource can be purchased as currently his website seems to only sell much more comprehensive resources that are likely over complicated for the purposes of this examination. Those interested could purchase Dr. Edelman's comprehensive textbook Understanding Ultrasound Physics, 4th Edition. I can't imagine that the bulk of this 567 page book is worth your time in reading, but I include it for those that like to have everything at their fingertips.

 

3. Regular practice at image interpretation. The best way to gain experience in image interpretation  of a large number of studies is by regular attendance in the echo reading room staffed by expert cardiology readers. There are currently limited resources on the internet of ACCE cases. For fellows, regular case review sessions of ICU image sets are useful to supplement work in the cardiology reading room. 

The Canadian Society of Echocardiography has a nice series of cases available for review online.

The Journal CHEST has an excellent section created by Seth Koenig, MD, FCCP, called "Ultrasound Corner." Each monthly issues online typically presents 1-2 cases whereby the authors present a clinical scenario followed by critical care ultrasonography images. A question is posed to the reader and subsequently Dr. Koenig walks the readers through the case and ultrasound images and explains everything  that is pertinent. There are a lot of cases available and spending time going through them is definitely worth your while for exam preparation.

4. Exhaustive study of literature related to ACCE that is not covered in the standard cardiology echocardiography textbooks. Unfortunately, there seems to be no English language textbook that provides a definitive review of ACCE. Oxford Press is bringing out a summary of the field, but it is not likely to be available before the first examination.

 

This requires the candidate to access literature on the subject of ACCE. The European Society of Intensive Care Medicine (ESICM) has released a recommended reading list to the European Diploma in Advanced Critical Care Echocardiography (EDEC) candidates (this is the European ACCE Certification). The reading list on my website is based upon the EDEC reading list, however, I have  taken the liberty to provide you all with short annotations about relevance for ACCE examination preparation.

I emphasize the need to read beyond the cardiology requirements; as, while there is much crossover in content, there are applications of ACCE that are specific to critical care that are not covered in cardiology textbooks.

This website's reading list will be updated periodically with recommended readings.

Review Courses

Those planning on taking the examination may consider attendance at a review course for the ACCE examination.

 

I am aware of two review courses that are designed for critical care clinicians who are preparing for the examination:

CHEST

Advanced Critical Care Echocardiography Board Review Exam Course

Date: December 6-15

Glenview, IL, USA

Member Price: $1,259.00

List Price: $1,559.00

 

SCCM

Critical Care Echocardiography Review Course
Date: TBD
Rosemont, IL, USA

Member Price: $1,700

List Price: $1,775

Various member options - price ranges $945.00 - $1,700.00 by clinician type and registration date

Hands-on Courses

The review courses focus on the cognitive foundation required for the examination. For those that also need to learn the image acquisition aspect of advanced critical care echocardiography, the following hands-on, live-learning courses are available:

CHEST

Advanced Critical Care Echocardiography

May 12 - 13, 2022

Glenview, IL, USA

Member Price: $2,599.00

List Price: $2,899.00

SCCM

Live Advanced Critical Care Ultrasound

Chicago Il, IL, USA

Next course not yet scheduled

NYU School of Medicine

Advanced Critical Care Echocardiography

February 27 - February 28, 2020

Full price: $1,500

Reduced: $800 (physician's-in-training, advanced practice providers, other non-physician healthcare professionals)

contact: Marla.hymes@nyumc.org

Other:

Leon Boudourakis, a trauma surgeon at Kings County Hospital in NYC and Diplomate of the ACCE exam has started a Facebook group dedicated to ACCE. Follow this link to check it his Facebook group called the "Critical Care Echocardiography Group."