The development of smaller, mobile, sophisticated ultrasound machines has been central to echocardiography becoming an everyday tool in the intensive care setting. However, the parallel process of ensuring quality studies are obtained from these machines places a focus on training standards for the doctors operating them. In response, credentialing and certification programmes in advanced critical care echocardiography have come into existence around the world, and although they are not identical, the programmes share many of the same features whether it is run in France, Scotland, Australia, the United States, or elsewhere. The challenge of determining the optimum training programme is an ongoing process and will no doubt evolve further over time. Yet the development of the programmes to date demonstrate how far critical care physicians have come over the past two decades in achieving quality care in the use of echocardiography.