New training statement defines Level III echocardiography competencies for first time

February 19, 2019

WASHINGTON (Feb. 19, 2019) -- A new advanced training statement from the American College of Cardiology, the American Heart Association and the American Society of Echocardiography defines the training requirements for performing advanced echocardiographic procedures, or "Level III" training, for the first time.

Cardiovascular echocardiography, or ultrasound, is an important diagnostic imaging technique used to assess cardiac anatomy and function and to help guide many therapies for heart conditions. Proper training is important to ensure positive clinical outcomes and patient safety.

While three levels of training for echocardiography have long been recognized, this is the first time that Level III training for echocardiography has been formally defined. Level III training represents the highest level of knowledge, experience, skill and behavior in a given field.

"All cardiologists should have a basic understanding of echocardiographic techniques--their strengths, limitations and appropriate use," said Susan E. Wiegers, MD, professor of medicine at the Lewis Katz School of Medicine at Temple University, Senior Associate Dean of Faculty and chair of the writing committee. "Although it is expected that most, if not all, fellows will achieve Level II competency in echocardiography during their three years of general cardiology training, this document describes the more focused, in-depth experience required for Level III competency."

This document complements the ACC's 2015 Core Cardiovascular Training Statement (COCATS 4), which defines the training requirements for all clinical cardiologists. Training in echocardiography for nine cumulative months is generally required to gain the level of experience necessary for Level III competency. However, the determination of whether a fellow has achieved Level III knowledge and skill will ultimately be assessed based on the competencies defined in this training statement.

The document outlines the length of training, the types of disorders that should be reviewed, the number of various procedures typically required for competence and the knowledge base and skill required to be an advanced echocardiographer. It acknowledges that the number of procedures needed to achieve competency may vary from one individual to another, and the education and training of advanced echocardiographers should occur in a structured clinical learning environment, usually within a formal cardiology fellowship program. This training statement outlines the resources that are typically required in these training programs and includes requirements for echocardiographic lab accreditation and teaching faculty guidelines.

The writing committee recognizes that the indications, technology and capabilities of cardiac ultrasound are continually advancing. The competencies defined in this document equip the advanced echocardiographer with the knowledge needed to acquire new skills as they emerge.

"The use of cardiovascular ultrasound is a key component in the care of many patients in the hospital and outpatient office as well as guiding interventional cardiac procedures in the catheterization lab and the operating room," Wiegers said. "It is important to define what is required to become a Level III echocardiographer."
The 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography will publish today in the Journal of the American College of Cardiology and will appear in upcoming print issues of Circulation: Cardiovascular Imaging and the Journal of the American Society of Echocardiography.

The document was developed in collaboration With the American Thoracic Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists and Society of Critical Care Medicine.

About the American College of Cardiology

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on, Facebook, Twitter or by calling 1-800-AHA-USA1.

About the American Society of Echocardiography

As the largest global organization for cardiovascular ultrasound imaging, the American Society of Echocardiography (ASE) is the leader and advocate, setting practice standards and guidelines. Comprised of over 17,000 physicians, sonographers, nurses, and scientists, ASE is a strong voice providing guidance, expertise, and education to its members. The Society has a commitment to improving the quality of the practice of ultrasound and imaging of the heart and cardiovascular system for better patient outcomes. For more information about ASE, visit

American College of Cardiology

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