The following are 10 points to remember about the updated training guidelines for pediatric cardiology fellowship programs:

1. The new guidelines reflect a major shift in medical education over the last decade to competency based-training. There has subsequently been a de-emphasis on minimum time spent on subspecialty services and minimum procedure numbers.
2. The American Board of Pediatrics has directed that Entrustable Professional Activities (EPAs) be used to evaluate a trainee’s ability to practice independently. An example of an EPA is that ability of trainees to “diagnose and manage congenital or acquired cardiac problems.” For each EPA, there are five “levels of entrustment,” ranging from Level 1 (“The fellow has baseline knowledge and skills but is not allowed to perform the EPA independently”) to Level 5 (“The graduate may act as a supervisor and instructor”).
3. All trainees must acquire level 4 expertise (“The fellow may act independently upon graduation”) by the conclusion of the fellowship training program.
4. Fellows are required to be proficient in the six core competency domains of Medical Knowledge, Patient Care and Procedural Skills, Systems-Based Practice, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills.
5. For the Systems-Based Practice domain, fellows are expected to coordinate care among health care providers, including the transfer and transition of care. This includes both “hand-offs” as well as the transition and transfer of adolescents to adult congenital cardiology services. Fellows are also required to lead a quality improvement project.
6. For the Practice-Based Learning and Improvement domain, fellows are to participate in activities that promote evidence-based learning such as journal clubs and literature reviews. Programs are to utilize individual learning plans (ILPs) to review previous goals and objectives and plans for the next 3-6 months.
7. Fellows are expected to demonstrate professionalism by practicing within the scope of expertise and technical skills as well as with a high rate of attendance at fellow conferences. Completion of procedure logs, duty hour logs, and faculty evaluations is expected in a timely manner.
8. For the Interpersonal and Communication Skills domain, fellows are expected to function as an effective communicator within a multidisciplinary team, engage in shared decision making with patients and their families, and participate in end-of-life patient care plans.
9. Training in research and scholarly activity remains a critical part of fellowship training in pediatric cardiology. Examples of components of this training include the interpretation and critical review of scientific literature, knowledge and skill in study design and statistics, and development of the skills necessary for grant writing, abstract submission and presentation, and manuscript preparation and submission.
10. Although there is a de-emphasis on procedural numbers and duration of rotations, recommendations for minimal numbers of procedures remain as a basis for the determination of competency. For core training in advanced imaging, trainees should perform and interpret a minimum of 150 echocardiograms and review and interpret an additional 100 echocardiograms. For cardiac catheterization, the laboratory should perform at least 150 diagnostic and/or interventional catheterizations, and the trainee should participate in a minimum of 50 cardiac catheterizations.

Keywords: Pediatrics, Heart Defects, Congenital, Accreditation, Curriculum, Education, Medical, Patient Care, Fellowships and Scholarships, Cardiac Catheterization, Health Personnel, Quality Improvement, Decision Making, Research, Rotation

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