Pediatric Cardiology Training Research Articles

Twinning International Pediatric Cardiology Fellowship Programs: A Transformative Educational Experience for Trainees with Potential for Global Adoption.

Over the last decade, having endured the COVID-19 pandemic, education and training in pediatric cardiology have undergone a profound disruptive transformation. Trainees experience considerable stress achieving all the competencies required to become a competent pediatric cardiologist. Often the quality of the training experienced by trainees, the approach to patients, and potential institutional preference in management strategy is heavily influenced by the center in which they train. We developed an online live twin program of education between Texas Children's Hospital, Houston, Texas and Children's Health at Crumlin Dublin Ireland in 2019. We explored using grounded theory whether a regular scheduled shared teaching program improved fellow education and training between both centers. Trainees were surveyed to evaluate the benefits and disadvantages of such a twin program. The majority (93%) found the sessions helpful from an educational standpoint with many trainees reporting it to be a transformative experience. Three important learning themes emerged: practice variation between centers, managing uncertainty in clinical practice and cognitive overload. This pedagogical model could be replicated across multiple international pediatric cardiology units and facilitate "collaborative learning" among centers across the globe. Furthermore, this novel educational model could also be adopted by other medical specialties.

Fetal Cardiology Bioethics: An Innovative New Curriculum for Cardiology Trainees.

Decision-making in fetal cardiology is fraught with ethical issues yet education in bioethics for trainees is limited or nonexistent. In this innovation report, we describe the development of a fetal cardiologybioethics curriculum designed to address this gap. The curriculum was developed to supplement the core curriculum for cardiology fellows and fetal cardiology subspecialty trainees. The series combines didactic and interactive teaching modalities and contains 5 key components: (1) introduction to bioethics and its role in fetal cardiology, (2) counseling and pathways for compassionate terminal care, (3) case vignette-based ethical analysis and discussion cases, (4) fetal counseling considerations for shared decision-making and recommendations, (5) facilitated communications role play. The curriculum was refined using session evaluations from end users. This report describes the innovative curriculum as a starting point for further incorporation and study of bioethical education in pediatric cardiology and fetal training programs.

Three-dimensional printing of mitral valve models using echocardiographic data improves the knowledge of cardiology fellow physicians in training.

High fidelity three-dimensional Mitral valve models (3D MVM) printed from echocardiography are currently being used in preparation for surgical repair. We hypothesize that printed 3DMVM could have relevance to cardiologists in training by improving their understanding of normal anatomy and pathology. Sixteen fellow physicians in pediatric and adult cardiology training were recruited. 3D echocardiography (3DE) video clips of six mitral valves (one normal and five pathological) were displayed and the fellows were asked to name the prolapsing segments in each. Following that, three still images of 3D MVMs in different projections: enface, profile and tilted corresponding to the same MVs seen in the clip were presented on a screen. Participating physicians were presented with a comprehensive questionnaire aimed at assessing whether the 3D MVM has improved their understanding of valvular anatomy. Finally, a printed 3D MVM of each of the valves was handed out, and the same questionnaire was re-administered to identify any further improvement in the participants' perception of the anatomy. The correct diagnosis using the echocardiography video clip of the Mitral valve was attained by 45% of the study participants. Both pediatric and adult trainees, regardless of the year of training demonstrated improved understanding of the anatomy of MV after observing the corresponding model image. Significant improvement in their understanding was noted after participants had seen and physically examined the printed model. Printed 3D MVM has a beneficial impact on the cardiology trainees' understanding of MV anatomy and pathology compared to 3DE images.

Abstract 13876: Women Face Unique Obstacles During Pediatric Cardiology Fellowship Training

Background: There are persistent disparities in career advancement for women physicians in pediatric cardiology. We sought to explore differences by gender in fellowship experience, as these may set the foundation for long-term gender inequity. Aims: To describe and compare fellowship experiences, career aspirations and family obligations of men and women in pediatric cardiology training. Methods: We performed a national survey of pediatric cardiology fellows examining mentorship, scholarly and DEI work, clinical experiences, career intentions and family commitments. Descriptive analyses were performed. Results: A total of 176 responses were included in the analysis (men=74, women=102). Most fellows were white (69%) and aged 30-34 years old (68%). Men and women reported similar mentorship, scholarly and clinical experiences, and influential factors in their decision to pursue subspecialty training. More women plan to pursue advanced imaging training (42% vs. 24%, p=0.04), to have administrative responsibilities (27% vs. 14%, p=0.06), and to work part time during their career (28% vs. 5.6%, p=0.001). Men reported greater interest in teaching (93% vs. 83%, p=0.04). While similar proportions of men and women were married, the spouses of women were more likely to be employed (91% vs. 71%, p=0.002). Among fellows with children, more women than men planned for additional children (75% vs. 25%, p=0.0004). Among fellows without children, more men than women planned for additional children (93% vs. 74%, p=0.01). Women were more likely to report delay in childbearing due to training (71% vs. 40%, p=0.0002), that childbearing decisions were influenced by the risk of radiation exposure (22% vs. 0%, p<.0001), and the use of assistive reproductive technologies (11% vs. 1%, p=0.01). Conclusion(s): Women and men in pediatric cardiology fellowship have similar training experiences and career aspirations yet differ in their plans to raise families. Women face unique obstacles to childbearing and child raising during training. Motherhood in pediatric cardiology may be a vulnerable period during career development and advancement.

Editorial: Congenital Heart Defects in Pakistan: Addressing Challenges and Enhancing Care

Introduction:
 Congenital heart defects (CHDs) are a significant health concern worldwide, affecting millions of infants each year. In Pakistan, the prevalence of CHDs is alarmingly high, posing a considerable burden on the healthcare system and placing numerous families in distress. This editorial aims to shed light on the challenges associated with CHDs in Pakistan and highlight the need for improved strategies and resources to enhance the care and outcomes for affected individuals.
 
 High Prevalence:
 Pakistan witnesses a high incidence of CHDs, with estimates suggesting that around 50,000 children are born with these defects every year [1]. The exact causes for this high prevalence are not yet fully understood, but factors such as consanguineous marriages, maternal malnutrition, exposure to environmental toxins, and limited access to prenatal care may contribute to the increased occurrence [2].
 
 Challenges Faced:
 Several challenges impede the effective management of CHDs in Pakistan. Limited awareness among the general population, particularly in rural areas, hampers early detection and timely intervention. Late diagnosis often leads to complications and reduced chances of successful treatment. Moreover, the shortage of specialized pediatric cardiac centers and trained healthcare professionals further exacerbates the problem [3].
 
 Inadequate Infrastructure:
 Pakistan faces a scarcity of dedicated pediatric cardiac centers equipped with the necessary technology and facilities to diagnose and treat CHDs effectively. The existing infrastructure is insufficient to cater to the overwhelming demand, resulting in long waiting times and delayed interventions. Investment in establishing more centers with state-of-the-art equipment and skilled medical staff is essential to ensure timely and accessible care for affected children throughout the country.
 Financial Barriers:
 The cost of treating CHDs can be exorbitant, making it unaffordable for many families in Pakistan. Surgical interventions and long-term medical management impose a significant financial burden, further compounded by the lack of health insurance coverage for congenital conditions. Public and private collaborations, along with governmental initiatives, are needed to develop financial assistance programs and insurance schemes that provide necessary support to families affected by CHDs [4].
 
 Improving Awareness and Education:
 Raising awareness about CHDs is crucial in order to promote early diagnosis, timely intervention, and prevention strategies. Public health campaigns, educational programs in schools and colleges, and community outreach initiatives should be implemented to disseminate information about CHDs, their signs and symptoms, and the importance of seeking medical attention. Empowering healthcare professionals with specialized training and knowledge in pediatric cardiology is also essential to enhance the capacity for accurate diagnosis and appropriate management[5].
 
 Collaboration and Research:
 Strengthening collaboration between healthcare institutions, researchers, and policymakers is vital to tackle the challenges associated with CHDs effectively. Increased investment in research on the causes, prevention, and treatment of CHDs in the Pakistani context can lead to significant advancements in understanding the disease and developing targeted interventions. Furthermore, fostering international collaborations can facilitate knowledge exchange and promote best practices in CHD management.
 
 Conclusion:
 Congenital heart defects present a significant healthcare challenge in Pakistan, affecting a large number of children and placing a strain on families and the healthcare system. Addressing the challenges associated with CHDs requires a comprehensive approach that includes improved infrastructure, enhanced awareness, financial support, and collaborative research efforts. By investing in these areas, Pakistan can pave the way for better outcomes and improved quality of life for individuals with CHDs.

Pediatric Cardiology Condolence Letter Writing: Does a Fellowship Curriculum Impact Practice?

Condolence letter (CL) writing after the death of a child is an important opportunity for humanism. Pediatric cardiology fellowship training now recognizes the importance of palliative care, but rarely includes CL education, despite its fragile patient population. To address this professionalism gap, a formal CL writing curriculum was created and implemented in a pediatric cardiology fellowship. This study investigated the impact of the curriculum on pediatric cardiology CL writing, and broader CL practices and beliefs. Pediatric cardiology fellows at a high volume urban academic program from 2000 to 2022 were divided into two cohorts (exposure to CL curriculum [2014-2022] vs. no exposure [2000-2013]) and responded by anonymous electronic multiple choice and open ended survey to assess the CL curriculum and describe current CL practices and beliefs. Impact of curriculum elements was determined by ordinal ranking. A 5-point Likert scale was used to report physician behaviors. Chi-square tests of independence were utilized for group comparisons. The overall survey response rate was 59% (63/107). Cardiologists who participated in the curriculum (64%, 35/55) were more likely to report writing CLs (80% vs. 40%; P < 0.01). Impactful curriculum elements included the opportunity for all fellows to contribute to a CL (78%) and identifying a primary fellow to write the CL (66%). A majority (>75%) of curriculum participants agreed that formal teaching increased their frequency, ability, and comfort in writing CLs. Development of condolence expression educational programs in pediatric cardiology training should be expanded.

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Representation of Women and Minority Faculty and Fellows in Academic Pediatric Cardiology Training Programs

BackgroundStudies have shown that diverse care teams optimize patient outcomes. Describing the current representation of women and minorities has been a critical step in improving diversity across several fields. ObjectivesTo address the lack of data specific to pediatric cardiology, the authors conducted a national survey. MethodsU.S. academic pediatric cardiology programs with fellowship training programs were surveyed. Division directors were invited (July 2021 to September 2021) to complete an e-survey of program composition. Underrepresented minorities in medicine (URMM) were characterized using standard definitions. Descriptive analyses at the hospital, faculty, and fellow level were performed. ResultsAltogether, 52 of 61 programs (85%) completed the survey, representing 1,570 total faculty and 438 fellows, with a wide range in program size (7-109 faculty, 1-32 fellows). Although women comprise approximately 60% of faculty in pediatrics overall, they made up 55% of fellows and 45% of faculty in pediatric cardiology. Representation of women in leadership roles was notably less, including 39% of clinical subspecialty directors, 25% of endowed chairs, and 16% of division directors. URMM comprise approximately 35% of the U.S. population; however, they made up only 14% of pediatric cardiology fellows and 10% of faculty, with very few in leadership roles. ConclusionsThese national data suggest a “leaky pipeline” for women in pediatric cardiology and very limited presence of URRM overall. Our findings can inform efforts to elucidate underlying mechanisms for persistent disparity and reduce barriers to improving diversity in the field.

Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association.

This summary from the American Heart Association provides guidance for the provision of primary and subspecialty palliative care in pediatric congenital and acquired heart disease. A comprehensive literature search was conducted from January 2010 to December 2021. Seminal articles published before January 2010 were also included in the review. Human subject studies and systematic reviews published in English in PubMed, ClinicalTrials.gov, and the Cochrane Collaboration were included. Structure: Although survival for pediatric congenital and acquired heart disease has tremendously improved in recent decades, morbidity and mortality risks remain for a subset of young people with heart disease, necessitating a role for palliative care. This scientific statement provides an evidence-based approach to the provision of primary and specialty palliative care for children with heart disease. Primary and specialty palliative care specific to pediatric heart disease is defined, and triggers for palliative care are outlined. Palliative care training in pediatric cardiology; diversity, equity, and inclusion considerations; and future research directions are discussed.

Entrustable Professional Activities and Their Relevance to Pediatric Cardiology Training.

Entrustable professional activities (EPAs) have become a popular framework for medical trainee assessment and a supplemental component for milestone and competency assessment. EPAs were developed to facilitate assessment of competencies and furthermore to facilitate translation into clinical practice. In this review, we explore the rationale for the introduction of EPAs, examine whether they fulfill the promise expected of them, and contemplate further developments in their application with specific reference to training in pediatric cardiology.

Pediatric and Congenital Interventional Cardiology Training

Pediatric and Congenital Interventional Cardiology Training

3D-printed heart models for hands-on training in pediatric cardiology – the future of modern learning and teaching?

Background: This project aims to develop a new concept in training pediatric cardiologists to meet the requirements of interventional cardiac catheterizations today in terms of complexity and importance. This newly developed hands-on training program is supposed to enable the acquisition of certain skills which are necessary when investigating and treating patients in a catheter laboratory.Methods: Based on anonymous CT-scans of pediatric patients’ digital 3D heart models with or without cardiac defects were developed and printed three-dimensionally in a flexible material visible under X-ray. Hands-on training courses were offered using models of a healthy heart and the most common congenital heart defects (CHD). An evaluation was performed by quantifying fluoroscopy times (FL-time) and a questionnaire.Results: The acceptance of theoretical and practical contents within the hands-on training was very positive. It was demonstrated that it is possible to master various steps of a diagnostic procedure and an intervention as well as to practice and repeat them independently which significantly reduced FL-time. The participants stated that the hands-on training led to more confidence in interventions on real patients.Conclusion: With the development of a training module using 3D-printed heart models, basic and advanced training in the field of diagnostic cardiac examinations as well as interventional therapies of CHD is possible. The learning effect for both, practical skills and theoretical understanding, was significant which underlines the importance of integrating such hands-on trainings on 3D heart models in education and practical training.

Pediatric Cardiology Fellowship Training in Exercise Medicine: A General Needs Assessment.

The aim of this study was to improve understanding of exercise medicine training needs for pediatric cardiology fellows. A survey was sent via email to all (N = 63) pediatric cardiology training program directors in the United States to evaluate the perceived exercise training needs of pediatric cardiology fellows. The survey consisted of multiple-choice responses as well as a few open-ended responses. A 60% response rate was achieved. 74% of programs did not have a pre-existing exercise core program. This type of training was felt to be important or very important in 84%. A wide variability of time allotted for exercise training exists amongst programs from < 1week to > 4weeks, with 2weeks being most common. There was no consensus on a target number of total exercise tests nor types of tests in which fellows should participate. Preferred methods in training consisted of lectures and online media. Less preferred methods of teaching methods included dedicated reading of a handbook, a dedicated rotation, or live webinars. There was general support to develop exercise training competencies as well as the associated online learning materials with a focus on competency rather than target numbers. There is a need for educational recommendations for exercise training in pediatric cardiology fellowships as well as a unified method of achieving competencies.

Pediatric cardiology national education series: A remote education response to COVID-19

ObjectiveMedical education experienced widespread disruption during the first peak of the COVID-19 pandemic. In response, members of the Society of Pediatric Cardiology Training Program Directors (SPCTPD) created a series of live, Zoom-based lectures for pediatric cardiology fellows. The goals were to support fellow didactic education and connect fellows and faculty during the pandemic. We sought to determine the impact of the lecture series on pediatric cardiology fellows around the country. MethodsPediatric cardiology experts from across the country volunteered to give lectures in the Pediatric Cardiology National Education Series (PC-NES). Lectures were held online once or twice weekly for 3 months during Spring 2020, while many fellows had modified clinical responsibilities. Fellows voluntarily completed an online survey before and after the lecture series. ResultsOn the initial survey, a majority of fellows responded they would benefit from more didactic education while their training was impacted by COVID-19. After the series concluded, almost all (95%) fellows responded that PC-NES lectures were valuable supplements to their training during COVID-19. They included quality of lectures, board-relevance, and a way to connect to the pediatric cardiology community as key reasons for participating in PC-NES, and 100% responded they felt PC-NES should continue in some capacity. ConclusionThe PC-NES was a low-cost, simple way to deliver high-quality supplemental education to pediatric cardiology fellows, help trainees build a network of peers and learn from experts outside their home institution. Similar models could connect other pediatric trainees at local, regional, or national levels, and provide valuable supplemental education opportunities.

Pediatric Cardiology Training in the United States

Pediatric Cardiology Training in the United States

Usefulness of SCT in detecting clinical reasoning deficits among pediatric professionals

Nowadays, in some Spanish autonomous communities, between 30% to 50% of the Primary CarePediatric positions are carried out by professionals without specific training in the specialty.In addition, when Spanish general practitioners with pediatric practice complete their Resident Medical Intern program are not evaluated on their Pediatric Cardiology clinical reasoning. Actual unawareness about this knowledge precludes professional retraining directed to solve deficiencies in this collective.Script Concordance Test is a new clinical reasoning assessment tool which places examinees in real clinical situations in which they have to interpret data and assess hypothesis to make decisions. This tool allows getting consistent data through variables analysis but it still hasn't been used in Spain for health professional's evaluation so far.Our goal is the development, validation, and application of a Script Concordance Test for clinical reasoning analysis in Pediatric Cardiology to ensure if practitioners attending children have enough Pediatric Cardiology knowledge for safe practice and to learn if qualification, Pediatric Cardiology formation, years of pediatric practice, and training course completion influence the score obtained.Our method describes a Script Concordance Test which was approved by a Pediatric Cardiology experts committee, met reliability criteria, allowed distinguishing evaluated subject different formative grade (188 pediatricians and 38 general practitioners), and was accessible for investigators. A statistical study including demographic and employment variables and achieved scores was performed to study a possible relationship between them.4 pediatricians (2.1%) and 1 GP (2.6%) didn't pass the questionnaire. Pediatric Cardiology qualification and training programs influenced more in Pediatric Cardiology clinical reasoning than the accumulation of years of pediatric practice and the frequency of this practice. We observed that the older the professional was, the lowest the score in the questionnaire.

Association for European Paediatric and Congenital Cardiology recommendations for basic training in paediatric and congenital cardiology 2020.

The recommendations of the Association for European Paediatric and Congenital Cardiology for basic training in paediatric and congenital cardiology required to be recognised as a paediatric cardiologist by the Association for European Paediatric and Congenital Cardiology are described below. Those wishing to achieve more advanced training in particular areas of paediatric cardiology should consult the training recommendations of the different Association for European Paediatric and Congenital Cardiology Working Groups available on the Association for European Paediatric and Congenital Cardiology website (www.aepc.org) and the respective publications 1-6. The development of training requirements is the responsibility of the Educational Committee and the Association for European Paediatric and Congenital Cardiology Council in collaboration with the Working Groups of the Association for European Paediatric and Congenital Cardiology. Trainees should be exposed to all aspects of general paediatric and congenital cardiology from fetal life to adolescence and adulthood. Centres performing generalised and specialised work in paediatric and congenital cardiology should be committed to deliver postgraduate training. At each training institute, trainers should be appointed to supervise and act as mentors to the trainees. Association for European Paediatric and Congenital Cardiology will provide basic teaching courses to supplement the training process.

National Survey on Training in Pediatric Cardiology by the "Junges Forum" of the DGPK.

This is the first national survey of residents and fellows in pediatric cardiology in Germany evaluating training, research activity, and the general working environment. An online questionnaire including 62 questions (SurveyMonkey) was developed by the "Junges Forum" of the German Society of Pediatric Cardiology. Fellows and residents during training and up to 3 years after completing their pediatric cardiology fellowship were invited to participate. A total of 102 pediatric cardiology fellows and residents completed the questionnaire. Many participants complained about their training as being unstructured (47%) and non-transparent (37%). The numbers of technical and catheter interventions required by the national medical board in Germany cannot be achieved, especially regarding invasive procedures. Sixty per cent work more than contractually agreed, usually in Germany it is 40 hours daytime work plus on calls, while 90% of all participants prefer less than 50 weekly working hours; 50% of the participants are engaged in research that is usually done during their spare time. More than 90% are satisfied with their professional relationships with colleagues and coworkers. Seventy-eight per cent describe their career perspectives as promising, and 84% would start a fellowship in pediatric cardiology again. The majority of pediatric cardiology fellows and residents are satisfied with their working environment and with their choice of a career in pediatric cardiology. Besides the heavy work load, we identified the urgent desire for better structured transparent clinical training concept including the teaching of manual skills, i.e., invasive procedures and catheterization.

Peter J B Hubner

Peter Hubner was born in London in 1942, the third son of a Czech antiques dealer who emigrated to England after the first world war. Peter developed an interest in...

Noninherited Risk Factors of Congenital Heart Defects in Offspring: A Revi

Prognosis of children with congenital heart defects (CHDs) continues to improve with advancement in technology and training in pediatric cardiology and cardiac surgery; however, lack of information about risk factors for malformations in cardiovascular development impeded the prevention of CHDs. Etiology of CHDs are complex and possibly lies within the interaction of environmental exposures and inherited factors. Studies found multiple maternal environmental exposures, including living in newly renovated rooms, residential proximity to main traffic, smoking and maternal occupation as manual worker significantly associated with CHDs. Advanced maternal age, low socioeconomic status, maternal perinatal diseases including maternal fever, diabetes, influenza, maternal certain medication use and alcohol intake were also significantly associated with CHDs. Isolated CHDs and multiple defects have different profiles of risk factors, while subtype of CHDs share common risk factors. Because of differences in methods, these studies are only suggestive. Relatively less information has been reported on noninherited factors that may have an adverse effect on the cardiovascular development, which has made it difficult to create population-based strategies to reduce the burden of illness from CHDs and for couples to choose lifestyles to reduce the risk of delivering a child with CHDs.Bangladesh J Child Health 2017; VOL 41 (1) :40-52