The TEE accreditation process is comprised of two parts; a theoretical part (written exam), and a practical part (log book).

1. Written Exam
   
   Paper I will consist of 100 multiple choice questions (MCQ) covering the theoretical scope of TEE. Paper II will consist of 50 video clips or still images upon which candidates will be required to answer an MCQ question. Each paper will take one hour to complete.

There is no negative marking (that is, candidates receive credit for correct answers but are NOT penalized for incorrect answers), and the pass mark for this exam will be about 60%.

2. Practical Log Book
    

   1. For the completion of the accreditation process, candidates will be asked to provide a log book, with data of 125 TEE studies, written in an appropriate TEE report format. The log book should be completed and submitted within 2 years from the completion of the written TEE exam.

   2. Candidates should work with a local supervisor who should be a senior echocardiographer at their institution.

   3. For anesthetists, either a cardiologist or an anesthetist experienced in TEE would be suitable. Since the supervisor has to certify that the candidate is a competent echocardiographer, it is essential that the supervisor is experienced themselves at TEE and not simply head of anesthetic department. For credibility, supervisors should ideally (but not necessarily) be holding a certification or accreditation in echocardiography from the American or European Boards of Echocardiography, or any other renowned institution.

   4. Once the candidate has completed all 125 echo cases, he should provide his echo reports to the ECTAS secretariat, together with a cover letter from the supervisor, showing his credentials, and certifying that these studies have been done under his supervision.

   5. Once the log book has been submitted, the ECTAS TEE committee will then review the TEE reports, examining the format and presentation. The committee will then choose 10 cases at random, for which the full report will be studied in detail. It is important that the TEE report provided is a full echo report, and not simply an add-on to the trans-thoracic echo (TTE) report.

   6. A 5-point scale is used for the assessment of echo reports, where ‘5’ is perfect and ‘1’ is dreadful. The pass mark is 30/50 (i.e. an average of 3 out of 5).

   7. No candidate should pass the logbook if they score a ‘1’ in any single report.