Levels of Training

The designation of “Levels of Training” is an effort to standardize training in a specific modality, and to express the amount of training any individual has received, in standardized form.  Many modalities within cardiology use Levels, including echocardiography, nuclear medicine, and cardiac MRI.  Levels of training are generally utilized locally, often by hospitals to decide whether or not to grant specific privileges.  Lately, many groups have been requiring specific levels of training as a prerequisite for the hiring of physicians.  There has always been the threat that third party payers might restrict payments to those practitioners with higher levels of training, but as far as we know, this has not yet occurred.

Individuals generally keep track of their own level of training, but this should really be validated by a letter from the institution or individual who has performed the training, such a fellowship or Division director.  In the case of Cardiac CT, the Society of Cardiac CT (SCCT) administers a “verification” program, through which (for a fee!) they will collect specific documents from you and certify that you have in fact received the level of training that you are claiming.

Level 1 training means that you have had exposure to the methods and applications of a modality, including accuracy in comparison to other modalities, indications, risks, pitfalls, etc.  This experience should have provided a basic background of knowledge sufficient for the practice of adult cardiology and referral for the testing, but not for the practice/independent clinical interpretation of the modality.  For Cardiac CT, level 1 requires experience in mentored interpretation of 50 cases.

Level 2 is for those trainees who wish to practice the specialty, including providing independent interpretation of studies.  For Cardiac CT, level 2 requires experience in the image acquisition of a total of 65 studies (40 must be live, 25 can be via teaching video), and mentored interpretation of at least 250 cases.  In addition, participation in 20 hours of didactic teaching is required.  These numbers refer to a TOTAL number of cases, that is, can include the cases that were used to acquire Level 1.  Therefore, higher levels subsume the lower levels.  Level 2 has recently been referred to as Independent Practitioner (IP) status.

Level 3 training represents the highest level of training and would enable the trainee to pursue a clinical or academic career in the modality and to direct a laboratory.  Focused research work with publication of one or more manuscripts, and experience teaching aspects of the technique to others is a part of Level 3 training.  For Cardiac CT, level 3 requires experience in the image acquisition of 150 studies, and mentored interpretation of at least 450 cases.  In addition, participation in 40 hours of didactic teaching is required. Level 3 has recently been referred to as Advanced Practitioner (AP) status.

Our course welcomes trainees at all levels.  We start from scratch and progress rapidly.  If you have had no prior experience in Cardiac CT or have had Level 1 training, you will finish with Level 2.  If you already have Level 2, you will find that we quickly catch up to where your training left off, and you will finish with adequate number of cases for Level 3. (However, to fully meet the Level 3 requirements you have to EITHER participate in teaching, or participate in research that results in a publication or abstract.  Most individuals accomplish this by giving Grand Rounds or a lecture at another venue at their local site, or participate in the training of other fellows).  We have had many course participants who are already Level 3 trained but feel they want more experience before they dive in with both feet!  Other Level 3 people we trained in the past have not been practicing Cardiac CT, and use the course as a refresher.  Finally, we get people who have been trained elsewhere but have been unhappy with the experience or want a more academic type of training.  They all leave Baltimore happy!  At the end of training you will have a case log, a Johns Hopkins Certificate stating the amount of training you received here, and a Johns Hopkins CME certificate (designated for 41 hours of Category 1).  If you desire, you can submit these materials to the SCCT to obtain their validation.