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Learning strategies among adult CHD fellows

Published online by Cambridge University Press:  10 September 2019

Jouke P. Bokma*
Department of Cardiology, Academic Medical Center Amsterdam, the Netherlands Netherlands Heart Institute, Utrecht, the Netherlands
Joshua A. Daily
Department of Cardiology, Arkansas Children’s Hospital, Little Rock, Arkansas, USA
Adrienne H. Kovacs
Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
Erwin N. Oechslin
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Helmut Baumgartner
Department of Cardiovascular Medicine, University Hospital Muenster, Germany
Paul Khairy
Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
Barbara J.M. Mulder
Department of Cardiology, Academic Medical Center Amsterdam, the Netherlands Netherlands Heart Institute, Utrecht, the Netherlands
Gruschen R. Veldtman
Department of Cardiology, Heart Institute Cincinnati Children’s Hospital Medical Center, OH, USA
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:



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.

Original Article
© Cambridge University Press 2019 

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