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CCE Certification RequirementsCERTIFICATION REQUIREMENTSREQUIRED DOCUMENTATIONRequirement 1. Successful completion of the Examinationof Special Competence in CCEeXAM or ASCeXAM*.Requirement 1.Applicants must have taken and passed the CCEeXAM orASCeXAM*.Applicants must have taken and passed the CCEeXAM orASCeXAM*.* Applicants that pass the ASCeXAM prior to 2020 have until 2022to apply for the CCEeXAM certification; after which the only applicable examination required for certification will be the CCEeXAM.* Applicants that pass the ASCeXAM prior to 2020 have until 2022to apply for the CCEeXAM certification; after which the only examination accepted for certification will be the CCEeXAM.Requirement 2. Current License to Practice Medicine.Requirement 2.Applicants who wish to apply for certification must hold a valid,unrestricted license to practice medicine at the time of application. (Geographical restrictions may be accepted and are subject toapproval. Medical restrictions will not be accepted for purposes ofeligibility for certification.)Copy of current medical license or renewal certificate that shows anexpiration date.Requirement 3. Current Medical Board Certification.Requirement 3.Applicants must be board certified by a board that holds membership in the American Board of Medical Specialties, the AdvisoryBoard for Osteopathic Specialties, the American Association ofPhysician Specialists, Royal College of Physicians and Surgeonsof Canada, or an International equivalent board certificate.A copy of current highest board certification certificate attained,e.g., Critical Care, Anesthesiology, Cardiovascular Disease, InternalMedicine, etc. (Non-North American physicians: see page 5).Requirement 4. Specific Training/Experience inCritical Care Medicine.Requirement 4.OrCopy of equivalent documentation of permission to practice medicine in the country of principal residence. (Non-North Americanphysicians: see page 5).Supervised Training Pathway: (One of the following :)Supervised Training Pathway: A notarized letter typed on appropriate letterhead from theFellowship Director, Program Director, or Chair of Critical Careprogram. (see page 9)Applicants must have successfully completed a minimum of one year in aspecialized clinical training program dedicated to the study of Adult criticalcare before applying for certification. The training in critical care must be atfellowship level. Cardiovascular rotations during general internalmedicine, surgery, radiology, anesthesiology, or other generalresidencies cannot be counted towards this requirement. For applicantscompleting critical care training after December 31, 2022, fellowship trainingin critical care must be obtained at an ACGME accredited training programor other nationally accredited critical care training program or associatedprogram. [e.g. Adult Critical Care and/or Adult ICU fellowships (neurology,pulmonology, anesthesiology, surgery, emergency medicine)] A copy of a certificate of successful completion of specializedclinical training program dedicated to the study of adult criticalcare.ORPractice Experience Pathway:The candidate must provide documentation of their critical care practiceactivity as outlined below: Documentation of billing activity using the99291, 99292 CPT code (US physicians only), or the equivalent timededicated to the evaluation and management of critically ill patients.A notarized letter on appropriate letterhead from the Director of theIntensive Care Unit, Chief of Service of the Division or Department ofCritical Care, or the Chair of the Department that staffs the intensive careunit. (See letters documenting Training and/or Level of Service: page 5and Sample letter page 11).ORPractice Experience Pathway:Require a minimum of 750 hours of clinical experience dedicated to criticalcare medicine delivered to patients over the past three years prior toapplication. The applicant would obtain a notarized letter from the hospitaladministrator verifying these hours.NOTE: The practice experience pathway will expire for thosecompleting their core residency after 12/31/2026.(Non-North American physicians: see page 5).(continued on next page)6

CCE Certification Requirements (continued)CERTIFICATION REQUIREMENTSREQUIRED DOCUMENTATIONRequirement 5. Specific Training in Critical CareEchocardiographyRequirement 5.Supervised Training Pathway:The completion of a minimum of 150 medically necessary* criticalcare transthoracic examinations performed and interpreted arerequired for certification. Limited or “goal-directed” examinations,although frequently performed in clinical settings, do not qualify ascomplete examinations for certification(See page 5: Definition of acomplete critical care echo). Examinations performed andinterpreted during cardiovascular rotations during generalinternal medicine, surgery, radiology, anesthesiology, or othergeneral residencies cannot be counted towards thisA notarized letter typed on appropriate letterhead from the Fellow-shipDirector, Program Director, or Chair of Critical Care program and withthe signed log of cases performed and interpreted. These transthoracicechocardiogram examinations must be medically necessary*performed and interpreted under supervision by a qualified supervisor.The applicant must document all entries by being typed inchronological order within the required log format acceptable to theNBE. The date these cases were reviewed(need to submit MM/DD/YYYY), indications, findings, diagnosis, andwith the name of the supervising faculty/staff with whom the findingswere discussed.Supervised Training Pathway:requirement.ORLetter(s) Documenting Training can be found on page 9 & Samplelog on page 10**.Practice Experience Pathway:A minimum of 150 complete medically necessary* critical caretransthoracic echo examinations (See page 5: Definition of acomplete critical care echo) performed and interpreted during the 3years prior to application.ORPractice Experience Pathway:Applicant must submit a notarized letter signed by the supervisor onappropriate letterhead documenting a minimum of 150 complete medicallynecessary* critical care transthoracic echo examinations performed andinterpreted during the three (3) years prior to application. See sample letterpage 12.These examinations must have been personally performed andinterpreted by the applicant, a subset of the cases will be reviewedby the supervisor, and typed in chronological order within therequired log format acceptable to the NBE, which is signed by theapplicant. The supervisor signing off on the log must 1) have heldNBE certification status in echocardiography (ASCeXAM,CCEeXAM, or APTEeXAM), or 2) be an individual who has achievedASCeXAM/ReASC/CCEeXAM testamur status within the last tenyears and who is also a recognized expert in the field of critical careechocardiography.ANDA log of the cases performed and interpreted will be signed by the applicant, asubset of the cases will be reviewed by the supervisor, and typed inchronological order within the required format by the NBE. The log formatmust contain the following: date that these cases were performed andinterpreted (need to submit MM/DD/YYYY), indications, findings, diagnosis,and the name of the attending. See page 13 for sample log**.ANDANDCopy of certificate(s) or documentation from the institution providing CMEcredits documenting 20 hours of AMA category 1 CME devoted toechocardiography. For meetings not devoted only to echocardiography,applicants must indicate on the copy of the certificate how many hours weredevoted to echocardiography.Physicians seeking certification by this pathway must have at least 20hours of AMA category 1 continuing medical education devoted toechocardiography obtained during the three (3) years prior toapplication.(Non-North American physicians: see page 5).*Examinations performed purely for educational or researchpurposes without medical necessity are not accepted and shouldnot be listed in the log.*Examinations performed purely for educational or research purposeswithout medical necessity are not accepted and should not be listed in thelog.**Note: Do not include any patient information on the log.Logs received with patient information will be returned tothe applicant.**Note: Do not include any patient information on the log. Logsreceived with patient information will be returned to the applicant.7

Online Certification InstructionsInstructions to Upload Required Documents: Sign in to your existing NBE account on www. echoboards.org. For required documents which an applicant can supply themselves, the documents must be scanned into a PDF file format. Click on“My Documents Uploader” on the right side of the screen. Under “Program”, the individual will need to choose either the CCE – Supervised training pathway OR CCE – Practice Experiencepathway. Under “Requirement” the individual will need to upload each document as listed within the “Requirement” drop-down field. Althoughan applicant may upload a copy of the notarized letter(s), the original notarized document is required to be mailed to the National Boardof Echocardiography to complete this requirement.The National Board of Echocardiography, Inc. , 3739 National Dr., Suite 202, Raleigh, NC 27612This letter must be signed, dated, notarized, dated by the notary, and typed on official letterhead. The notarized letter will not beaccepted as only a scanned document to the uploader and must be mailed to complete this requirement. A scanned copy may beuploaded for this requirement to begin review; however, the application will not be complete until the original notarized letter isreceived by the National Board of Echocardiography. Please see page 4 when referencing your letters documenting training and/or levelof service.Theard of EchocardiooBlagranophiatattests thatyNIncorporated 1996John Doehas successfully met the requirements of this Board, and is certified as a Diplomate inCritical Care EchocardiographyArthur J. Labovitz, MDWriting Committee ChairJohn W. Allyn, MDPresident, NBE, Inc.Robert Arntfield, MDSamuel Brown, MDJose L. Diaz-Gomez, MDAntonio Hernandez, MDSteven E. Hill, MDAshish K. Khanna, MDSeth J. Koenig, MDPaul H. Mayo, MDSharon Mulvagh, MDVicki E. Noble, MDNova Panebianco, MD, MPHMuhamed Saric, MDHiroshi Sekiguchi, MDRobert Thiele, MDPassed CCEeXAM : 2019Certification Number: 2019-00000000Valid Until: 12/31/20298

Sample LetterCritical Care Echocardiography Certification for Physicianswho completed one year of clinical fellowship dedicatedto Critical Care Echocardiography (Requirements 4 and 5)ABC Hospital123 Main Street New York, NY 54321 (212) 123-5432Date letter was written (MM/DD/YYYY)National Board of Echocardiography, Inc. 3739 National DriveSuite 202Raleigh, NC 27612RE: Physician’s Full NamePhysician’s Date of BirthACGME Program NumberTo Whom It May Concern:REQUIREMENT 4This letter confirms that Dr.(Name)successfully completed a minimum of one year of specialized clinical trainingdedicated to the study of Adult Critical Care at our institution between (MM/DD/YYYY) and (MM/DD/YYYY) . Thisletter further confirms that this program is an accredited ACGME training program or other nationally accredited critical careechocardiography training program.REQUIREMENT 5Our records indicate that Dr.(Name)had specific training in Critical Care Echocardiography and personallyperformed and interpreted (# of cases) complete critical care transthoracic echocardiograms under appropriatesupervision.I certify that the number of studies provided above are exact numbers and are not rounded and/or estimates.Sincerely,John DoeNameTitle (Fellowship Director, Program Director, or Chair of Critical Care program.)Notary SealSworn and subscribed to before me on (date):Signature of Notary Public:NOTE: The EXACT number of studies performed and interpreted MUST be provided. Committee decisions will bedetermined using the numbers provided in this letter. If using a fiscal year, exact dates are required. For example,MM/DD/YY - MM/DD/ YY. Letters MUST be typed on appropriate letterhead and MUST be notarized.9

Sample Case LogRequirement 5: Supervised Training PathwayTransthoracic Examinations(Examinations Performed and Interpreted)Physician’s Full Name:Physician’s Date of Birth:ATTESTATION:I attest that this is an accurate recording of the cases performed and interpreted by myself and are complete critical care transthoracicechocardiograms.Applicant's Signature:Date:Fellowship Director's Signature:Date:*Note: Under the Supervised Training pathway the attending should be listed as the physician with whom the findingswere discussed.NumberDate D/YYAttendingFindingsHypotensionHyperdynamic LV, NormalValve Function, LVOT VTIof 23cm2.1cm pericardial effusion,Suspected pericardialMitral valve inflow variation ofeffusion with lactic acidosis30%Respiratory FailureDilated right ventricle, severe TR,RVSP of 40mmHg, TAPSE of14mm1234567(continue numbering)10Septic ShockDr. SmithPericardial tamponadeDr. PhillipsRight ventricular FailureDr. Smith

Sample LetterCritical Care Echocardiography CertificationPractice Experience Pathway(Requirement 4)ABC Hospital123 Main Street New York, NY 54321 (212) 123-5432Date letter was written (MM/DD/YYYY)National Board of Echocardiography, Inc. 3739 National DriveSuite 202Raleigh, NC 27612RE: Physician’s Full NamePhysician’s Date of BirthTo Whom It May Concern:REQUIREMENT 4This letter serves to confirm that Dr.(Name)is a physician practicing in our hospital. Our records indicate that(he/she) has (*#) hours of clinical experience dedicated to critical care medicine delivered to patients between(MM/DD/YYYY) and (MM/DD/YYYY) . The above clinical experience hours were collected using CPT code of99291, 99292, or the equivalent time dedicated to the evaluation and management of critically ill patients. In caseswhere CPT codes are not available, I have used a rigorous quantitative method to confirm these hours.Sincerely,Jane SmithNameTitle (Director of the Intensive Care Unit, Chief of Service of the Division or Departmentof Critical Care, or the Chair of the Department that staffs the intensive care unit, etc.)Notary SealSworn and subscribed to before me on (date):Signature of Notary Public:NOTE: *The number of hours MUST be provided. Letters documenting training MUST be on appropriate letterhead andMUST be notarized. The numbers provided must be in parallel, concurrent years but need not be calendar years. Theend of the most recent year for which credit is requested must fall within the 12 months prior to receipt of the completeapplication. When documenting in a calendar or fiscal year, number of hours are required. For example, MM/DD/YY - MM/DD/YY. Committee decisions will be determined using the numbers provided in this letter.11

Sample LetterCritical Care Echocardiography CertificationPractice Experience Pathway(Requirement 5)Supervisor’s Name123 Main Street New York, NY 54321 (212) 123-5432 Email addressDate letter was written (MM/DD/YYYY)National Board of Echocardiography, Inc. 3739 National DriveSuite 202Raleigh, NC 27612RE: Physician’s Full NamePhysician’s Date of BirthTo Whom It May Concern:REQUIREMENT 5The records presented to me by Dr.(Name)reflect that (he/she) has personally performed and interpretedcomplete critical care transthoracic echocardiograms, between (MM/DD/YYYY) and (MM/DD/YYYY) .I have discussed with Dr.(Name)her cases recorded within his/her log.(# of cases)his/her experiences regarding these cases and I have directly reviewed a subset of his/I am familiar with the criteria proposed by the NBE as outlined in the definition of a critical care transthoracic echocardiogram*.In my opinion Dr.(Name)has the clinical competence and professional qualities necessary to perform as a critical careechocardiographer.The applicant has certified the number of studies provided above are exact numbers and are not rounded and/or estimates.Sincerely,Jack JonesType Name(Diplomate of the ASCeXAM, CCEeXAM, APTEeXAMORTestamur of the ASCeXAM within the last ten years & who is also a recognizedexpert in the field of critical care echocardiography.)Notary SealSworn and subscribed to before me on (date):Signature of Notary Public:NOTE: *The EXACT number of studies performed & interpreted MUST be provided. Letters documenting training MUSTbe on appropriate letterhead and MUST be notarized. The numbers provided must be in parallel, concurrent years butneed not be calendar years. If documenting fiscal years, exact dates are required. For example, MM/DD/YY - MM/DD/YY.Committee decisions will be determined using the numbers provided in this letter. *See page 5 for definition of a completecritical care transthoracic echocardiogram.12

Sample Case LogRequirement 5: Practice Experience PathwayTransthoracic Examinations(Examinations Performed and Interpreted)Physician’s Full Name:Physician’s Date of Birth:ATTESTATION:I attest that this is an accurate recording of the cases performed and interpreted by myself and are complete critical care transthoracicechocardiograms.Applicant's Signature:Date:FindingsNumberDate PerformedExampleMM/DD/YYHypotensionHyperdynamic LV, Normal ValveFunction, LVOT VTI of 23cmSeptic ShockExampleMM/DD/YYSuspected pericardialeffusion with lactic acidosis2.1cm pericardial effusion, Mitralvalve inflow variation of 30%Pericardial tamponadeExampleMM/DD/YYRespiratory FailureDilated right ventricle, severe TR,RVSP of 40mmHg, TAPSE of 14mm234567(continue numbering)13Right ventricular Failure

CCE COVID-19 Temporary RequirementsIn view of the disruption of global healthcare due to the corona virus pandemic and its adverse effect on manypostgraduate training programs, the National Board of Echocardiography is offering additional pathways to complete thetraining requirements to achieve board certification in Critical Care Echocardiography. These options are available tocandidates who are fellows at any time during the year 2020 and who successfully complete a fellowship.CERTIFICAT

Applicants must be board certified by a board that holds member-ship in the American Board of Medical Specialties, the Advisory Board for Osteopathic Specialties, the American Association of Physician Specialists, Royal College of Physicians and Surgeons of Canada, or an International equivalent board certificate. Requirement 4.