Focused intensive care echocardiography: 1000 participating, 300 accredited and counting

We welcome correspondence and constructive feedback with ideas on how the focused intensive care echocardiography (FICE) process could be improved. At the time of writing, there were 302 fully accredited FICE practitioners and 383 registered FICE Mentors in the UK. While attainment of basic echo competency is currently not a mandatory requirement for intensive care medicine trainees, we do view this as a worthy goal in the medium to long term. We agree that there certainly is a lot of participation, as our own data show. Since FICE was launched in August 2012, 1044 people have enrolled for training and uptake has increased rapidly. There were 358 registrations in 2015 alone, a 47% increase on 2014. Nationally, of those who registered for the process in 2013, 25% completed (median time 13 months), and of those who registered in 2014, 34% completed (median time eight months). Due to lead time, 2015 data cannot be meaningfully interpreted yet, but we are optimistic that these trends will continue. Finding time for training is always a challenge, on both sides. FICE accreditation clearly requires a considerable amount of personal dedication, motivated by belief that time spent doing so is worth it, and the fact that so many have accomplished this, completely voluntarily, is testament to how valued and achievable the process is. FICE has demonstrated that it is possible to set up a national training programme, but like any, it takes time to get trainers established in every hospital. We are currently in the process of reviewing our national Mentor coverage to determine where cold spots exist and direct resources towards them. FICE training is open to doctors and allied health professionals both inside and outside intensive care, and that so many are attracted to the process is a strength, not a weakness. Access to logbook and training opportunities can usually be arranged with advanced planning, regardless of base specialty, and we recognise the importance of preparing delegates for this challenge on FICE courses. The entire FICE programme could already take up to 24 months to complete. Within this time, the first and last logbook scan should be no more than 12 months apart. While we acknowledge that the process may not be perfect, it was the result of extensive collaboration between the Intensive Care Society and the British Society of Echocardiography. There was considerable discussion, before definitions of timeframe and supervision were agreed, to strike the right balance between governance and pragmatism. We believe that collecting one case per week should be achievable for all, and aspiring to obtain this body of experience over a longer time frame would compromise the acquisition of skills needed to perform and interpret focused echo. However, exceptions are always considered, as we appreciate that learning must happen within the ‘real world’. Decision making by unaccredited individuals based on unverified scans, and unsupervised practice outside of the FICE skill set, both pose potential risks to patients, breach Good Medical Practice, and are unacceptable. We make it clear that individuals must not practice in this way, and intensive care echo leads should establish local governance measures to preclude it. We hope to expand on these data in a dedicated article soon. Until then, we thank Drs Jacques and Pettipher for starting this discussion and would like to encourage any units finding it difficult to deliver FICE training to get in touch with us at fice@ics.ac. uk.