Abstract
This position statement guides cardiovascular magnetic resonance (CMR) imaging program directors and learners on the key competencies required for Level II and III CMR practitioners, whether trainees come from a radiology or cardiology background. This document is built upon existing curricula and was created and vetted by an international panel of cardiologists and radiologists on behalf of the Society for Cardiovascular Magnetic Resonance (SCMR). Cardiovascular magnetic resonance (CMR) has seen substantial growth over the last 20 years. With an ever-increasing evidence base [1-4] coupled with improvements in scanner technology and new techniques [5-8] and evidence of cost effectiveness [9-11], international clinical practice guidelines now recommend CMR as a first-line imaging investigation for many cardiovascular conditions [12, 13] . As the indications for CMR increase, the contemporary cardiac imager needs to have the appropriate clinical knowledge and technical skills to deliver consistently high-quality CMR examinations across an increasing range of clinical scenarios. The widening indications for CMR require an expanding and available workforce of cardiac imagers that have the basic skills for independent interpretation of CMR, and a subset of practitioners with a level of expertise to supervise trainees and to lead CMR laboratories. The SCMR guidelines for training in cardiovascular magnetic resonance [14, 15] define these levels of expertise: The basic competency for CMR interpretation is referred to as Level II training -specialized training designed to provide the skills necessary to independently interpret CMR studies (also known as independent practitioner). The advanced level of expertise is referred to as Level III training -advanced training for those who aim to be responsible for the operation of a CMR laboratory and to deliver CMR training (also known as advanced practitioner). Various other guidelines and curricula have defined minimum training requirements for interpretation of CMR at local, national, and international levels [16] . These documents are designed to ensure that CMR practitioners receive appropriate training to effectively utilize, perform and report CMR. Whilst distinct, these recommendations have many consistent and common themes, with differences largely dependent on local factors, varying disease prevalence, availability of CMR and other imaging modalities, and the role of CMR in general and subspecialty practice. However, there is currently no comprehensive competency-based document that lists the skills needed for CMR interpretation at a basic and advanced level of expertise that can be globally applied, which is the primary goal of this document. Accordingly, this curriculum document aims to assist Program Leads/Directors in creating or implementing a CMR training program. It provides a framework of key basic training objectives to enable practitioners to successfully interpret CMR studies after completion of the program, and a framework of training objectives recommended to achieve advanced training in CMR. The SCMR curriculum suggests competency-based training with a final program evaluation. This guidance is intended to be comprehensive and globally relevant. Additionally, the document discusses inherent differences in previous training curricula from different specialties and suggests an approach to harmonize these. To ensure diverse representation and perspectives, the writing group for this position statement was chosen in accordance with guidance from SCMR [13] , selecting members with backgrounds in radiology and cardiology, including pediatric cardiology, and an established expertise in CMR education. Each member conducted a literature search within local national curricula and education documents, which were then shared and reviewed by the group during multiple video conferences. The document was divided into sections, with each member of the writing panel drafting a section of the document. Through consensus, the combined document and competency-based guidance were created and approved by the entire writing group. The document was then reviewed by the Scientific Documents Committee of SCMR before final approval by the society's Executive Committee.
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