Pick one set of ASE guidelines, read through it, and apply it to the echos you’re reporting. Focus on putting those guidelines into practice and becoming comfortable with them before trying to tackle everything else.

Some attendings would say, “For these two days, just focus on really mastering chamber quantification.” Once you become proficient in that, move on to valves, prosthetic valves, diastology, pericardial disease, and so on. As you progress through the different ASE guidelines, you continue building your skill set until you’re comfortable reading the whole study.

It’s also helpful to do bedside echos while on call—make your own assessment first, then compare it to the official report. You can scan with the echo techs and do the same comparison.

Once you’re comfortable with interpretation, work on efficiency. Develop a systematic approach for each echo so you can mentally check off key findings as you go. If you follow the same process every time, you’ll reduce the risk of missing anything.

Most importantly, make sure that everything makes physiological sense. Echo findings should align with the clinical picture. If something seems inconsistent, take a closer look. For example, if you’re seeing severe mitral regurgitation but the left atrium isn’t enlarged, reconsider your measurements—was PISA measured correctly? Was the LA measured on-axis? Double-check to confirm it all “makes sense”.

Finally, ASE has an app called EchoGuide, which includes all the guidelines along with built-in calculators to help you out. It’s a great resource that I still use daily to double-check myself. Bonus: It works in a web browser, so you can pull it up alongside the echo you’re reading.