News From CHEST® Physician

National Board of Echocardiography offering board exam


Due to significant interest in the pulmonary/critical care community, the National Board of Echocardiography (NBE) has opened registration for a board examination as a requirement for national level certification in advanced critical care echocardiography (ACCE). The examination has been developed by the National Board of Medical Examiners; CHEST and the other professional societies are well represented on the writing committee. The first examination is scheduled to be given on January 15, 2019.

The board of the NBE will be the final arbiter for other requirements for certification. We anticipate that these will be available in 2019.

A few essential questions about the certification:

1. Who will be eligible for certification in ACCE?

The policy of the NBE is that any licensed physician may take the examination. Passing the examination confers testamur status, which is only one of several requirements for certification. The board of the NBE will make the final decision as to how to define the clinical background of the candidate that will be required for certification.

2. What will be the requirements for demonstration of competence at image acquisition for ACCE?

Competence at ACCE requires that the intensivist be expert at image acquisition of a comprehensive image set. The board of the NBE will make the final decision as to what constitutes a full ACCE image set, how many studies must be performed by the candidate, and how the studies will be documented. Regarding the latter question, it is likely that there will be a need for identification of qualified mentors to guide the candidate through the process of demonstrating competence in image acquisition.

3. What resources exist to learn more about the examination?

For some suggestions regarding mastery of the cognitive base, Dr. Yonatan Greenstein has set up an independent website that has recommendations about study material and an example of the full ACCE image set ( The NBE website has a list of subjects that will be covered in the examination. In addition to passing the examination, there will be other elements required for ACCE certification. The NBE has not yet made final decision on the additional requirements. As soon as they are available, they will be posted on the NBE website (

There is keen interest amongst fellows and junior attendings in the NBE certification who are already competent in whole body ultrasonography. They see ACCE as a natural and necessary extension of their scope of practice, as a means of better helping their critically ill patients, and as a means of acquiring a unique skill that defines them as having a special skill compared with other intensivists. A smaller group of senior attending intensivists are primarily motivated by a well-defined practice-related need of skill at ACCE and/or a strong perception that knowledge of ACCE may directly improve their ability to care for the critically ill patient. Interest in certification extends across the various specialties that provide critical care services. The NBE has indicated that there has been a strong showing of registrations for the examination thus far.

We recommend that candidates for certification consider that passing the examination should be the priority. Collection of the image set may occur in parallel, as the two will complement each other. Preparation for the examination requires intensive study of the cognitive base of ACCE and mastery of image interpretation.

To aid in preparation for the ACCE examination, CHEST is offering a comprehensive review course, Advanced Critical Care Echocardiography Board Review Exam Course, being held at the CHEST Innovation, Simulation, and Training Center, December 7-8, 2018, in Glenview, Illinois.

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