Trainees perceived lack of time and limited access to supervision as major barriers to course completion. Nevertheless, successful portfolio completion was related to factors other than protected time in the echocardiography laboratory or unconditional direct supervision in ICU.

65 learners were enrolled and 18 were interviewed.

4 (9%) learners completed the portfolio.

Learners reported lack of time and supervision, and skill complexity as the main barriers to practicing independently.

Conditional supervision was associated with a higher rate of submitting unsupervised echocardiograms than unconditional supervision.

After rotation in the echocardiography laboratory, submission of unsupervised echocardiograms decreased.

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