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Adult congenital heart disease training in Europe: current status, disparities and potential solutions
Colin J McMahon1,2, Inga Voges3, Petra Jenkins4
1Children's Health Ireland at Crumlin, Crumlin, Ireland cmcmahon992004@yahoo.com.
Insights
Formal training for adult congenital heart disease (ACHD) cardiologists is rare in Europe. Most doctors receive on-the-job training, with few countries offering formal programs, exit exams, or certification.
Area of Science:
- Cardiology
- Medical Education
- Public Health
Background:
- Adult congenital heart disease (ACHD) requires specialized lifelong care.
- The number of ACHD patients is increasing, necessitating trained specialists.
- Current training standards for ACHD cardiologists in Europe are not well-defined.
Purpose of the Study:
- To assess the current status of formal training for ACHD cardiologists across Europe.
- To identify variations in training programs, accreditation, and certification.
- To highlight the need for standardized ACHD training.
Main Methods:
- A questionnaire survey was distributed to ACHD cardiologists in 34 European countries.
- Data collected included recognition of ACHD as a subspecialty, training program structure, and availability of centers.
- Statistical analysis of responses from 31 countries (91%).
Main Results:
- ACHD is recognized as a subspecialty by health ministries in only 7% of responding countries.
- Formal ACHD training programs exist in only 7% of countries; 45% have limited or no programs.
- 81% of countries rely on 'on-the-job' training, with few offering exit examinations (3%) or formal certification (7%).
Conclusions:
- Formal and accredited training in ACHD cardiology is significantly lacking across Europe.
- The reliance on informal 'on-the-job' training raises concerns about consistent quality of care.
- Harmonizing training standards, exit examinations, and certification is crucial for improving ACHD patient care.
Objectives:
This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe.
Methods:
A questionnaire was sent to ACHD cardiologists from 34 European countries.
Results:
Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001).
Conclusion:
Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.
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