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• Cardiac imaging training in the United Kingdom
  Edward D Nicol
  Published on: 23 November 2015
• Cardiac Image Training - the 2010 Curriculum
  Jim A Hall
  Published on: 23 November 2015

• Published on: 23 November 2015

  Cardiac imaging training in the United Kingdom

  • Edward D Nicol, Cardiology SpR and Trainee Representative, BSCI Executive Committee
  • Other Contributors:
    • Stephen Harden, Consultant Radiologist and BSCI Education Sub-committee Chairman , Roger Bury, Consultant Radiologist and President of the BSCI

  Sir,

  Cardiac imaging training in the United Kingdom

  It was with interest that we read the featured correspondence from Rajani et al (ref). We entirely agree with their assertion that there is a growing need for multi-modality cardiac imagers and acknowledge their concerns about the lack of structured "in-programme" training opportunities, such as cardiac imaging fellowships, to support this requireme...

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  Sir,

  Cardiac imaging training in the United Kingdom

  It was with interest that we read the featured correspondence from Rajani et al (ref). We entirely agree with their assertion that there is a growing need for multi-modality cardiac imagers and acknowledge their concerns about the lack of structured "in-programme" training opportunities, such as cardiac imaging fellowships, to support this requirement. As an initial step, The British Society of Cardiovascular Imaging (BSCI) has recently followed the lead of the British Society of Cardiovascular Magnetic Resonance (BSCMR) in producing detailed competency frameworks for cardiac CT, incorporating competency based assessment tools such as Mini CEX, DOPS and CbD to support the evolving cardiac imaging curricula produced by the respective Royal Colleges. This, in conjunction with other training frameworks, will hopefully allow a structure for more formalised imaging training in the UK. As is noted by Rajani et al some deaneries have started delivering dedicated training in cardiovascular imaging and indeed the BSCI is now running twice yearly core training days in cardiovascular CT, open to all trainees and consultants alike as part of the overall cardiac imaging training run with the Royal Society of Medicine. These conferences are delivered essentially at cost to recognise and to provide for the growing requirement for dedicated multi-modality imaging training for radiologists and cardiologists alike. As a next step, the BSCI, in conjunction with London STC in cardiology and head of radiology training in London, have set up six formal, structured, in-programme fellowships in cardiac CT that are to be launched imminently. This model has previously been developed and successfully delivered for CMR colleagues in London and it provides aspirant trainees the opportunity to gain on-site experience at established centres of excellence. This hands-on training is supported by a monthly lecture series to cover the didactic training and knowledge components of the advanced curriculum. At the core of this endeavour is to provide high quality training in cardiac imaging within the current constraints of the curriculum, to equip trainees with the skills required to be able to lead and direct cardiac imaging services in the future. It is our hope that this model may be able to be reproduced across other regions and also across the wider remit of cardiac imaging modalities. There are however significant hurdles to be overcome. Firstly cardiac imagers must seek to both work and train collaboratively. They must start engaging with each other, regardless of chosen specialty, from the outset and bring their differing skills and approaches to each other to enhance the service delivered by all. Secondly, there is a clear requirement for these individual training opportunities to be brought together as true multi-modality imaging fellowships. Thirdly, if the four main cardiac imaging societies (BNCS, BSCI, BSCMR and BSE) could sign up to a formal concordat ensuring joint advertising of training opportunities, running joint or concurrent meetings and providing a forum to develop advanced subspecialty "in programme" fellowships, open to all cardiac imagers at affordable costs, this would be a major step towards making cardiac imaging training more robust and comprehensive. Very few cardiac imagers practice in isolation from other cardiac imaging modalities and a broad understanding of complementary techniques is fundamental to high quality care. The formation of the British Cardiac Society Imaging Council has been an important initial step and would seem the obvious vehicle to facilitate these goals. Achieving the vision set by Rajani et al will require significant cooperation by cardiac imagers in the broadest sense. There will no doubt be significant challenges along the way but by achieving this goal we will be a stronger community both nationally and internationally but most importantly locally for our patients.

  Acknowledgements: Dr Ed Nicol is a London cardiology SpR and trainee representative on the BSCI Executive and Education Committees Dr Stephen Harden is a consultant cardiac radiologist in Southampton, chairs the BSCI Education Sub-committee and is a regional training lead in Radiology Dr Roger W Bury is a consultant cardiac radiologist in Blackpool and the President of the BSCI.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 23 November 2015

  Cardiac Image Training - the 2010 Curriculum

  • Jim A Hall, Chairman

  Having read the appeal for a 'new dawn in imaging training' I suspect that Rajani et al have not read the current UK cardiology training curriculum (www.jrcptb.org.uk/specialties/ST3- SpR/Documents/2010%20Cardiology%20Curriculum.pdf) and appreciated the flexibility and options open to trainees and their trainers It is factually incorrect to state that UK trainees 'only appear to be able to obtain "in-program" experience i...

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  Having read the appeal for a 'new dawn in imaging training' I suspect that Rajani et al have not read the current UK cardiology training curriculum (www.jrcptb.org.uk/specialties/ST3- SpR/Documents/2010%20Cardiology%20Curriculum.pdf) and appreciated the flexibility and options open to trainees and their trainers It is factually incorrect to state that UK trainees 'only appear to be able to obtain "in-program" experience in one imaging modality' and I think this has lead to the mistaken belief that 'the structure of cardiac imaging training' is somehow disadvantaged compared to other areas of cardiology practice.

  The curriculum was written by the cardiology specialist advisory committee (SAC) with advice from trainees and the specialist imaging societies British Nuclear Cardiology Society, British Society of Echocardiography, British Society for Cardiac Magnetic Resonance and the British Society of Cardiac Imaging. The importance of 'imaging' in contemporary clinical practice is reflected in the requirements for all cardiologists in training to achieve basic competence in all areas of cardiovascular imaging nuclear, echo, CMR and CT.

  For those wanting to develop more advanced knowledge, skills and experience there is the requirement to undertake further training in their last two years to achieve further competences building on their core competences - defined in the curricular advanced modules. All advisors to the SAC curriculum writing committee were adamant that the acquisition of advanced skills and experience should be to expert level and should not be spread too thinly across clinical areas - no room for dabbling. UK trainees need to be true experts in an increasingly international arena. This will additionally help to maintain the UK as a world leader in cardiac imaging research.

  Inevitably training to expert level requires considerable time and commitment and given the constraints of the two years available for advanced modules in a five year cardiology training programme and the constraints of EWTD, trainees can not be expected to achieve this level of competence in all areas. Hence, imaging trainees and their trainers focus on two of the four modalities e.g. echo + CMR or nuclear + CT etc. Alternatively, trainees can combine imaging with other advanced skills e.g. heart failure training + CMR or device therapy + echo etc. It may be that imaging trainers wish to ensure that their trainees, whilst concentrating on one or two modalities to advanced level, are exposed to broad-based training to fully appreciate the strengths and weakness of different modalities. However, despite the sometimes unbridled enthusiasm of trainees it has to be recognized that there is not enough time to train to advanced level in everything.

  It is therefore encouraging to see that the job market reflects this. Rajani et al note that in recent job advertisements for cardiologists with an interest in imaging 90% had listed as desirable experience in cardiac CT or cardiac MRI (not both). It would therefore appear that the current training curriculum is appropriate to satisfy these demands.

  The opportunities for trainees do not end there however; those trainees who wish to add to their portfolio of skills and experience can undertake out-of-programme experience, OOPE. Although this extends training and delays their CCT date (and hence entry of others to the deanery based training programme) trainees who are supported by their trainers are rarely prevented from obtaining SAC and GMC approval for OOPE and most deaneries are happy to accommodate their wishes. These optional extra training years are undoubtedly expensive and difficult to organize so the BCS/ACC fellowships are a welcome addition to the options open to UK trainees.

  A key challenge which remains is to encourage trainees to opt for advanced training in imaging. The BJCA trainee survey in 2008 showed that only 18.5% of cardiology trainees plan a career with a major interest in cardiac imaging. This is still well short of the BCS projected workforce need of around 40% of the consultant workforce (www.bcs.com/documents/guidelines/BCS%20Cardiac%20Workforce%202005%20final%20draft%20June%202005.pdf). The recent pronouncements from NICE may produce a shift in career preferences but this has not been evident in the past e.g. following the publication of the NICE MPS guidelines in 2003. The BCS and the Cardiology SAC are continuing to work with the specialist societies to provide not only regional and national training days but also guides to educational resources available for trainers and trainees which will make it easier for trainees to see how they can best acquire the necessary knowledge, skills and attitudes for their chosen career path.

  I believe the current curriculum provides the necessary flexibility for trainees to achieve advanced competences in cardiac imaging and that it will produce the leaders and role models of tomorrow who will advance the practice of this particular area of cardiology and inspire future generations of cardiologists. Rajani et al can be reassured that the specialist imaging societies will continue to have a major influence in the design and implementation of cardiology training. The scope of cardiology training will not be a static arena and the curriculum will have to continue to evolve to meet the demands of trainees, trainers and more importantly the general public and our patients.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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