Current Status of Fetal Echocardiography Imaging and Fetal Counseling Fellow Training in 29 European Countries

Limited data exist on the implementation of current fetal cardiology training and practice guidelines, how trainees are assessed, and how trained fetal cardiologists maintain their skills among countries affiliated with the Association of European Paediatric and Congenital Cardiology (AEPC). A structured questionnaire was sent to fetal cardiologists or national delegates from 44 centers in 33 European countries. Responses were obtained from 37 centers in 29 European countries with 31 responses from fetal cardiologists. Fetal echocardiography was equally performed in maternal (18) and pediatric (16) hospitals with median 3 (range 0-6) fetal cardiologists per center and > 4 fetal cardiologists in 13 centers. Core and advanced fetal cardiology training was offered in 17 (46%) and 21 (57%) centers. Advanced training was provided in higher volume centers (19/21). Assessment methods included direct trainee observation, case-based discussions, and participation in multidisciplinary team meetings, with mostly verbal feedback provided. Criteria for independent fetal echocardiography and counseling were based on training duration (range 2-24 months), number of assessments (range 100-1500), and number of counseling abnormal cases (range 40-200) performed under expert supervision, as well as on expert evaluations of trainees based on direct observation and fetal cardiac diagnostic accuracy. Formal certification in fetal cardiology was reported in three centers. Research activity among trained experts was reported among 25 (68%) respondents overall with 19 respondents involved with collaborative research. Trainee research was encouraged but not mandatory in clinical training. Maintenance of expert skills included sufficient clinical activity volume, teaching, and different forms of national and international networking. Fetal cardiology service quality assessments included missed cases discussion in 20 (54%) centers. There is substantial variation in advanced fetal cardiology training practice in Europe suggesting a need for further clarification of training criteria and structure. Trainee assessment is mainly verbal and based on direct observation. There seems to be a need to strengthen the fetal cardiology module in core pediatric cardiology training and to improve quality assessment of the clinical service provided.