Skip to main content Accessibility help

Learning strategies among adult CHD fellows

  • Jouke P. Bokma (a1) (a2), Joshua A. Daily (a3), Adrienne H. Kovacs (a4), Erwin N. Oechslin (a5), Helmut Baumgartner (a6), Paul Khairy (a7), Barbara J.M. Mulder (a1) (a2) and Gruschen R. Veldtman (a8)...



Subspecialisation is increasingly a fundamental part of the contemporary practice of medicine. However, little is known about how medical trainees learn in the modern era, and particularly in growing and relatively new subspecialties, such as adult CHD. The purpose of this study was to assess institutional-led and self-directed learning strategies of adult CHD fellows.


This international, cross-sectional online survey was conducted by the International Society for Adult Congenital Heart Disease and consisted primarily of categorical questions and Likert rating scales. All current or recent (i.e., those within 2 years of training) fellows who reported training in adult CHD (within adult/paediatric cardiology training or within subspecialty fellowships) were eligible.


A total of 75 fellows participated in the survey: mean age: 34 ± 5; 35 (47%) female. Most adult CHD subspecialty fellows considered case-based teaching (58%) as “very helpful”, while topic-based teaching was considered “helpful” (67%); p = 0.003 (favouring case-based). When facing a non-urgent clinical dilemma, fellows reported that they were more likely to search for information online (58%) than consult a faculty member (29%) or textbook (3%). Many (69%) fellows use their smartphones at least once daily to search for information during regular clinical work.


Fellows receiving adult CHD training reported a preference for case-based learning and frequent use of online material and smartphones. These findings may be incorporated into the design and enhancement of fellowships and development of online training resources.


Corresponding author

Author for correspondence: J.P. Bokma, MD, PhD, Department of Cardiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 5668679; Fax: +31 20 5666809; E-mail:


Hide All
1. Cassel, CK, Reuben, DB. Specialization, subspecialization, and subsubspecialization in internal medicine. N Engl J Med 2011; 364: 11691173. doi:10.1056/NEJMsb1012647.
2. Lewis, SJ, Mehta, LS, Douglas, PS, et al. American College of Cardiology Women in Cardiology Leadership Council, changes in the professional lives of cardiologists over 2 decades. J Am Coll Cardiol 2017; 69: 452462. doi:10.1016/j.jacc.2016.11.027.
3. Warnes, CA, Bhatt, AB, Daniels, CJ, Gillam, LD, Stout, KK. COCATS 4 task force 14: training in the care of adult patients with congenital heart disease. J Am Coll Cardiol 2015; 65: 18871898. doi:10.1016/j.jacc.2015.03.030.
4. Webb, G, Mulder, BJ, Aboulhosn, J, et al. The care of adults with congenital heart disease across the globe: current assessment and future perspective: a position statement from the International Society for Adult Congenital Heart Disease (ISACHD). Int J Cardiol 2015; 195: 326333. doi:10.1016/j.ijcard.2015.04.230.
5. Stout, K, Valente, AM, Bartz, PJ, et al. Task force 6: pediatric cardiology fellowship training in adult congenital heart disease. Circulation 2015; 132: e91e98. doi:10.1161/CIR.0000000000000197.
6. Sawatsky, AP, Zickmund, SL, Berlacher, K, Lesky, D, Granieri, R. Understanding resident learning preferences within an internal medicine noon conference lecture series: a qualitative study. J Grad Med Educ 2014; 6: 3238. doi:10.4300/JGME-06-01-37.1.
7. van der Bom, T, Zomer, AC, Zwinderman, AH, Meijboom, FJ, Bouma, BJ, Mulder, BJM. The changing epidemiology of congenital heart disease. Nat Rev Cardiol 2011; 8: 5060. doi:10.1038/nrcardio.2010.166.
8. Chamberlain, LJ, Fernandes, SM, Saynina, O, et al. Variation in use of pediatric cardiology subspecialty care: a total population study in California, 1983 to 2011. J Am Coll Cardiol 2015; 66: 3744. doi:10.1016/j.jacc.2015.04.053.
9. Marelli, AJ, Ionescu-Ittu, R, Mackie, AS, Guo, L, Dendukuri, N, Kaouache, M. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 2014; 130: 749756. doi:10.1161/CIRCULATIONAHA.113.008396.
10. Baumgartner, H, Budts, W, Chessa, M, et al. For the Working Group on Grown-up Congenital Heart Disease of the European Society of Cardiology, recommendations for organization of care for adults with congenital heart disease and for training in the subspecialty of “Grown-up Congenital Heart Disease” in Europe: a position paper of the Working Group on Grown-up Congenital Heart Disease of the European Society of Cardiology. Eur Heart J 2014; 35: 686690. doi:10.1093/eurheartj/eht572.
11. Turner, AM, Prihoda, TJ, English, DK, Chismark, A, Jacks, ME. Millennial dental hygiene students’ learning preferences compared to non-millennial faculty members’ teaching methods: a national study. J Dent Educ 2016; 80: 10821090.
12. Srinivasan, M, Wilkes, M, Stevenson, F, Nguyen, T, Slavin, S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Acad Med 2007; 82: 7482. doi:10.1097/01.ACM.0000249963.93776.aa.
13. Stuart, J, Rutherford, RJ. Medical student concentration during lectures. Lancet 1978; 2: 514516.
14. Mokadam, NA, Dardas, TF, Hermsen, JL, et al. Flipping the classroom: case-based learning, accountability, assessment, and feedback leads to a favorable change in culture. J Thorac Cardiovasc Surg 2017; 153: 987996.e1. doi:10.1016/j.jtcvs.2016.10.101.
15. Rodriguez Muñoz, D, Alonso Salinas, G, Franco Diez, E, et al. Training in management of arrhythmias for medical residents: a case-based learning strategy. Int J Med Educ 2016; 7: 322323. doi:10.5116/ijme.57c2.a738.
16. Franko, OI, Tirrell, TF. Smartphone app use among medical providers in ACGME training programs. J Med Syst 2012; 36: 31353139. doi:10.1007/s10916-011-9798-7.
17. Wiechmann, W, Kwan, D, Bokarius, A, Toohey, SL. There’s an app for that? Highlighting the difficulty in finding clinically relevant smartphone applications. West J Emerg Med 2016; 17: 191194. doi:10.5811/westjem.2015.12.28781.
18. Raaum, SE, Arbelaez, C, Vallejo, CE, Patino, AM, Colbert-Getz, JM, Milne, CK. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States. J Educ Eval Health Prof 2015; 12: 48. doi:10.3352/jeehp.2015.12.48.


Type Description Title
Supplementary materials

Bokma et al. supplementary material
Bokma et al. supplementary material

 Unknown (1.7 MB)
1.7 MB

Learning strategies among adult CHD fellows

  • Jouke P. Bokma (a1) (a2), Joshua A. Daily (a3), Adrienne H. Kovacs (a4), Erwin N. Oechslin (a5), Helmut Baumgartner (a6), Paul Khairy (a7), Barbara J.M. Mulder (a1) (a2) and Gruschen R. Veldtman (a8)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed